life in the balance

THE QUARTERLY MAGAZINE OF THE PENNSYLVANIA MEDICAL SOCIETY SPRING 2016 • VOLUME 3, NUMBER 2

LIFE IN THE BALANCE

EXPERTS AND DOCTORS OFFER ADVICE ON ACHIEVING WORK/LIFE INTEGRATION AND MITIGATING STRESS

10 LEGISLATIVE SUMMARY Bills advance in spite of budget impasse

26 THE FUTURE IS NOW Innovations that are already easing health care delivery

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pennsylvania physicianSPRING 2016 1

contentsVOL. 3, NO. 2

FEATURES

COVER STORY1426

THE FUTURE IS NOW Recent innovations in health care technology are helping Pennsylvania physicians slash costs while guaranteeing quality care in a variety of environments.

LIFE IN THE BALANCE Experts and doctors in the trenches offer advice on recognizing signs of stress and burnout, and ways to mitigate their effects.

COLUMNS

10 Legislative & Regulatory Update

12 Op-Ed

34 Practice Made Perfect

36 Physicians & Philanthropy

38 Consulting Physician

42 Life After Medicine

48 Strong Medicine

DEPARTMENTS

02 President’s Prescription A Balancing Act

04 From the EVP’s Desk Individuals with Many Dimensions

06 Physician Newsmakers Member Blogger Spearheads First-Ever Pennsylvania Teen Health Week

08 The Section Scoop How Do You Achieve Work/Life Balance?

43 On Call Calendar of Events

44 Medicine Bag Pennsylvania Physicians: The Unsung Heroes of PAMED CME

46 PAMED Pulse A Conversation with Mary Stock Keister, MD, on Work/Life Balance

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pennsylvania physicianSPRING 20162

PRESIDENT’S PRESCRIPTION

SPRING 2016 • VOLUME 3, NUMBER 2

EDITORIALExecutive Vice President: Michael Fraser, PhD, CAE, FCPPEditor-in-Chief: Kerry RoyerDeputy Editor: Rachel Damrauer, MPAEditorial Director: Annette GraySenior Managing Editor: Lori B. RaceySenior Editor: Ian P. MurphyEditorial Coordinator: Jordan Kell

CREATIVEDesign: Stacy BoldenGraphic Designer: Zon Buckley

SALESVice President: Susan WelterSales Director: Stephanie Harkins, (717) 430-2237Sales Representative: Laura Gaenzle, (717) 430-2351

Published in partnership with: The YGS Group 3650 West Market Street York, PA 17404 Phone: (717) 505-9701

BOARD OF TRUSTEES

OFFICERS 2015-2016Scott E. Shapiro, MD, FACC, FCPP PresidentCharles Cutler, MD, MACP President-ElectTheodore Christopher, MD, FACEP

Vice PresidentKaren A. Rizzo, MD, FACSImmediate Past President David A. Talenti, MDBoard ChairJohn Gallagher, MD Board Vice ChairErick J. Bergquist, MD, PhDSecretaryMartin D. Trichtinger, MDSpeaker, House of DelegatesJohn J. Pagan, MD, FACSVice Speaker, House of Delegates

PENNSYLVANIA PHYSICIAN IS PUBLISHED QUARTERLY (FALL, WINTER, SPRING, SUMMER) BY THE PENNSYLVANIA MEDICAL SOCIETY (PAMED), 777 EAST PARK DRIVE, P.O. BOX 8820, HARRISBURG, PA 17105-8820. ©2016 PENNSYLVANIA MEDICAL SOCIETY. ALL RIGHTS RESERVED.

Mission: To serve as a pathway for sharing, innovation, collaboration, and discussion among all Pennsylvania physicians, legislators, policymakers, and other health care stakeholders to improve and protect health care in Pennsylvania.

Subscriptions: For subscription information, call (800) 228-7823, Ext. 2653, or email [email protected].

Postmaster: Send address changes to Pennsylvania Physician, PAMED, 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820.

The opinions and ideas reflected in Pennsylvania Physician are not necessarily representative of the policies and opinions of the Pennsylvania Medical Society (PAMED). Appearance of an advertisement does not imply endorsement or guarantee of the advertiser’s claims. PAMED reserves the right to reject advertising and/or editorial content, and edit for style and fit. Email permission and reprint requests to [email protected].

THE QUARTERLY MAGAZINE OF THE PENNSYLVANIA MEDICAL SOCIETY

SCOTT E. SHAPIRO, MD, FACC, FCPPPresident, PAMED

A BALANCING ACT

When asked about the topic of work/life balance, I first thought that I didn’t have much wisdom to share. But then — after talking about my personal experiences with someone on staff at the Pennsylvania Medical Society (PAMED) — I realized that there are many things I do as a husband and the father of three young children to maintain work/life balance. I also realized that there is no one, overarching strategy you can use to achieve work/life balance; rather, it’s about the day-to-day choices you make.

Like many of you, I wear many hats. So one thing I do to encourage work/life integration is look at my calendar every day. It’s a balancing act, to be sure. But if, for example, I start to see too many work meetings in a given week, I try not to schedule any more for that week. If there are work-related tasks that can be done after my children go to bed, I save those things for later. I also employ technology to help me

balance priorities between work and home.That’s what this issue of Pennsylvania Physician is about. Read what your colleagues

are doing to achieve work/life balance, manage stress, and prevent burnout. How can PAMED help, you ask? We not only offer education on important topics such as these, but we also can save you time and energy by advocating on your behalf and providing you with time-saving, relevant tools that will help you make more time for the most important things — your family, friends, patients, and hobbies. I hope you enjoy this issue, and am confident that it will help you find tools that assist in maintaining your own work/life balance.

If you’re a member, thank you for your support. If not, I invite you to be a part of this exciting time of change by becoming a member at JoinNow.pamedsoc.org. ◆

Work/life balance is about the day-to-day choices you make.

David Talenti, MD, swears in Scott Shapiro, MD, as PAMED president, accompanied by his family.


FROM THE EVP’S DESK

MICHAEL FRASER, PHD, CAE, FCPP Executive Vice President, PAMED

INDIVIDUALS WITH MANY DIMENSIONS

Recently, I stepped away from my desk and onto a flight to visit a dear friend halfway around the world at a momentous occasion in her life. It meant everything to both of us for me to be there, and travel never fails to invoke introspection or broaden my perspective.

As I boarded the flight home, I thought about how multidimensional we are as individuals. We deserve to pay attention to the facets of the human experience that feed our souls, whether they may be sports, family, art, music, food, friends, exercise, worship, travel, or reading the Sunday paper. But achieving work/life integration and balance can be elusive — particularly for physicians who have dedicated their professional lives to a field that directly and deeply impacts others.

There is no one secret to achieving harmony. But inside this issue, you will find ways to prioritize tasks, apply innovation and technology to your advantage, and communicate with people in your life to set realistic expectations. There is a way to manage work/life balance, and my guess is that many physicians have unlocked the riddle by focusing their energies on something meaningful — doing what they love, improving humanity, and enhancing lives.

PAMED is here to help you with the larger topics shaping the medical landscape. We advocate on issues that can serve to advance the profession. We also have tools that can help you identify strategies to maintain work/life balance and prevent physician burnout. Go to page 17 or www.pamedsoc.org/lifeofmedicine to learn more.

If you are a member, you already know the benefits that PAMED’s chorus of voices brings to supporting the profession. You know the people who strive for better public health and safety. Thank you for your membership.

If you are not yet a member, I invite you to join us. Head to [email protected], and let us do the work necessary to make it easier for you to reach your goals. We will help you strike that balance. ◆

My guess is that many physicians have unlocked the riddle by focusing their energies on something meaningful.

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Federal and State Regulatory Compliance • Fraud and Abuse Laws HIPAA • Risk Management • Practice Formation and Compliance

Credentialing • Licensure • Affiliation Agreements

Care is Your Business, Change is OursHouston 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.

Fraser enjoys time away from the office.

Combating Opioid Abuse in Pennsylvania

Visit PAMED’s opioids resource center for the latest news, education, and tools.

www.pamedsoc.org/opioidresources

Pennsylvania Medical Society’s (PAMED) Opioid Education and Resources“Addressing Pennsylvania’s Opioid Crisis: What Health Care Teams Need to Know”—Multimedia education with video interviews, statistics, prescribing guidelines, scenario-based learning, and more• CME credits available• Free for PAMED members

Long-acting and extended-release opioids online courses—Learn about prescribing, monitoring, assessment, and documentation

• CME credits available• Free for all prescribers in Pennsylvania

Opioid Prescription Checklist—Use this checklist to start the conversation about pain management with your patients. Includes a list of things to consider when taking pain medication and is printed in the form of a prescription notepad.


PHYSICIAN NEWSMAKERS

MEMBER BLOGGER SPEARHEADS FIRST-EVER PENNSYLVANIA TEEN HEALTH WEEK

BY CHUCK MORAN

For Laura Offutt, MD, of Radnor, Pa., teen health is a passion. Using the power of social media, Dr. Offutt reaches out to this age group by providing credible, relevant online health information through a blog at www.realtalkwithdroffutt.com.

In late January, she extended her efforts to spearhead the first-ever Pennsylvania Teen Health Week with the support of PAMED and the help of the College of Physicians of Philadelphia and the Pennsylvania Department of Health.

The week kicked off Jan. 24 with a proclamation from Gov. Tom Wolf. Throughout the week, educators and news stories covered issues such as violence, mental health, sexual development, substance abuse, and diet and exercise.

So who is Dr. Offutt, and what makes her tick? Pennsylvania Physician recently interviewed her to find out.

Pennsylvania Physician: What is your background?Dr. Offutt: I grew up in the Washington, D.C., area, and although I always was sort of a health nut, I wasn’t set on becoming a doctor when I was a child. There are no doctors in my family — my father is an engineer, and my mother is a retired high school math teacher. I went to Columbia University in New York City for college, and after taking a year off, I went to Northwestern University Medical School in Chicago, where I got my Doctor of Medicine.

I was one of those medical students who loved every rotation I did (mostly), and I had a hard time deciding where to focus. Eventually, I picked Internal Medicine as my specialty, and came

to Philadelphia to do my residency at Thomas Jefferson University.

After completing my residency, I joined the academic Internal Medicine practice at Jefferson, where I spent half of my time caring for inpatients and outpatients, and the other half teaching the medical residents and students.

After practicing medicine at Jefferson, I left to go into the pharmaceutical industry. What initially was going to be a few-year plan while my husband finished his surgical residency turned into more than 10 years in industry. I worked at a few companies, across medical functions and in positions of increasing responsibility in pharmacovigilance (drug safety), clinical research, and medical affairs. In these roles, I became

interested in global aspects of medicine and regulatory agencies, as well as in population health.

I left the industry and started a medical consulting business that kept me busy most of the time, but between assignments, I came up with the idea of starting a teen health blog. That blog has grown from a simple Blogspot page to a Web-based teen health resource with a mission of engaging teens with accurate and unbiased health information where they are — online — and encouraged them to ask questions to learn how to advocate for their own health.

PP: Why are you so passionate about teen health?Dr. Offutt: As an internal medicine physician, I often saw patients suffering

Laura Offutt, MD


from diseases that developed from behaviors started in their teen years. Whether it was cirrhosis or alcoholism in a patient who started drinking heavily as a teen, pulmonary disease in a 50-year-old, 50-pack-a-year smoker, or insulin-resistant diabetes in a patient who is struggling with the effects of poor diet and inactivity from a young age.

As a mother of two teens, I found myself lecturing them — like we all lecture our kids — about what I would often lightly call “sex, drugs, and rock ’n’ roll.” In hearing what and how they learn health information at school, [I found that] many teens — like adults — go online and find health misinformation. Tiring of the sensationalization of medical stories by some media outlets, I realized there was a need for clear, approachable, unbiased information written for teens — where nothing is off-limits, where the expert can be identified, and where anonymity is welcomed.

The more I interact with teens to help me shape my work, the more my passion is reinforced. Teens are smart and have innovative ideas. And they care about their health. I love the energy of teens, and how they have all these ideas that are unedited and unfiltered. I don’t understand why so

many [people] talk disparagingly about teens. We were all teens once!

So I love the age group, I love the energy and curiosity, and I see where there are gaps in how they receive their health information. Pulling all of this together makes me hope I can make a difference in both the short and long term, in at least a few of these young people’s lives.

PP: What obstacles did you overcome in creating Teen Health Week?Dr. Offutt: The biggest obstacles in creating this week were that I had never done anything like this before — so it was all of the unknowns! I didn’t know how to request a state proclamation. But one of my teen advisors knew more, and got me pointed in the right direction. I realized that the College of Physicians, which shares a deep interest in adolescent health and wellness, might be able to advise me. They have been tremendous collaborators.

I didn’t know anyone in the Department of Health, but when I reached out to Pennsylvania Physician General Dr. Rachel Levine with the idea, she enthusiastically and quickly responded, and connected me with colleagues in her department who helped tirelessly. When we learned

that we would get the proclamation, I knew we should make a toolkit to help schools and organizations be able to join in with minimal development work on their part, given the newness of Teen Health Week and the already overflowing plates they had serving students. I researched toolkits to get ideas to incorporate into ours.

I didn’t know how to get the word out about the week to the state, so I reached out to my network. Many jumped right in, made suggestions, and shared the information with their networks, and helped me identify the next steps. The Delaware County Medical Society and PAMED have been a tremendous help, knowing what was needed even when I couldn’t articulate it.

The obstacles that didn’t exist were resistance or disapproval. So many organizations and professionals have worked for so long to improve public health and the health of teens. The enthusiasm they added to this week has been incredible. Honestly, Teen Health Week was originally envisioned as a little social media campaign to see what would happen if we just tried to pick a week to celebrate. Now, with the state proclamation and broad support, it has grown to be a much bigger and defined observance, thanks to everyone who has jumped in to support it. ◆

Chuck Moran, MS, has more than 25 years of experience in media relations settings including higher education, finance, and health care. He currently serves as PAMED’s director of media relations and public affairs. In addition, he supports his profession as a member of the Pennsylvania Public Relations Society. Email him at [email protected].

“Teen Health Week was originally envisioned as a little social media campaign. With the state proclamation and broad support, it has grown to be a much bigger and defined observance.” —Laura Offutt, MD


THE SECTION SCOOP

HOW DO YOU ACHIEVE WORK/LIFE BALANCE?

WE ASKED MEMBERS OF PAMED’S SECTIONS ABOUT THEIR STRATEGIES FOR ACHIEVING AND MAINTAINING BALANCE BETWEEN WORK AND LIFE, AND HERE’S WHAT THEY TOLD US.

MEDICAL STUDENT PERSPECTIVELudwig Koeneke-Hernandez is a member of the Sidney Kimmel Medical College Class of 2018 at Thomas Jefferson University in

Philadelphia, and a member of PAMED’s Medical Students Section (MSS).

My strategy for work/life balance centers around the philosophy that the work ethic we create now, while in medical school, sticks with us for the rest of our careers. That said, I am a firm believer that relaxation is necessary in order for a student to study effectively and perform well on exams and in the clinic. I strive to achieve work/life balance by scheduling work time to allow for spontaneity and pursuing creative outlets.

Scheduling and staying organized are key to minimizing stress and pressure. Planning ahead on the topics I will cover and study the next day helps keep me motivated and provides me with a sense of accomplishment. When I am not scheduled to work, I like to set aside ample time to pursue spontaneous activities that arise or that I create myself. I think it is very important to allow yourself to live a bit untidily, although within a structured timeframe. For instance, I like to leave a day of the weekend open just in case something springs up.

One of the biggest ways I decompress from all the long hours of studying is by pursuing different creative outlets. Undergraduate medical education tends to be pretty

cut-and-dry, lacking much room for creativity and imagination. So it is important to pursue a creative hobby in whatever field you may be interested. Strive to achieve work/life balance, and you will have a much better time and perform better in school.

RESIDENT PERSPECTIVEMadushini Craner, DO, is a Family Medicine resident at Good Samaritan Hospital in Lebanon, Pa., and a member of PAMED’s Residents

and Fellows Section (RFS).

As a wife and mother to a toddler and a newborn, my strategy for achieving work/life balance is to work smarter, not harder. An efficient combination of time management, organization, determining priorities, and setting boundaries has gone a long way in helping me strike a healthy work/life balance.

I start by analyzing my present situation, and then keep a log of everything I do in a certain time period, including work-related and personal activities. This data aids me in recognizing just how efficiently I am using (or abusing) my time.

Organization is paramount in my life. I use an electronic date planner to turn my goals into realities. I set aside a few minutes at the beginning of each day to capture my tasks for the week ahead. I also sync my calendar with an electronic to-do list, and write everything down from grocery lists, upcoming events, and celebrations to pending work presentations.

In order to determine priorities, I reflect on what’s important to me and make a list of top priorities at work and at home. I audit these priorities by using an A to D grading system — A being critical and D being a lesser “would be nice if possible.”

I believe I set fair and realistic limits on what I will and will not do at work and at home, and clearly communicate these boundaries to my attending [physician], coworkers, partner, and family. Additionally, I set aside a time at home during which I am fully present, and will not check or respond to work-related messages.

YOUNG PHYSICIAN PERSPECTIVE Natasha Alligood-Percoco, MD, is chief resident in the Obstetrics & Gynecology department of Penn State Hershey

Medical Center in Hershey, Pa., and a PAMED member.

As a young physician and mother, finding work/life balance has been my strategy for survival. I currently serve as the administrative chief resident for the OB/GYN department at a university hospital. In addition to my clinical duties, I also manage resident staffing and remain active with research and medical student education. At home, I stay busy with my two daughters, ages seven and four.

This double life would not be possible without the support of my husband and family, as well as some serious time management and organization.


I protect my “mom time” by avoiding charting and studying while home with my daughters. I stay organized by syncing calendars, lists, and reminders across my electronic devices.

Residency has been tough, so as a family, we love to make the most of our time together. Living in Pennsylvania has provided us with many opportunities for outdoor recreation. Our daughters enjoy camping and hiking throughout the beautiful state park system. Later this year, we will be relocating to Williamsport, Pa., as I transition to practice with Susquehanna Health. We look forward to joining a new community, exploring a new area of Pennsylvania, and beginning the next stage of my career.

INTERNATIONAL MEDICAL GRADUATE PERSPECTIVE

Rajinder Pabla-Sahi, MD, FACP, is a program director of Internal Medicine Residency at Pinnacle Health in Harrisburg, Pa. She is a PAMED member.

I can come up with a million and one answers for this question based on quotes and tips from “experts.” Meditation works for a lot of people, but not for me. What works for me is laughter. There is humor in everything.

In our line of work, there is so much grief, anxiety, and uncertainty. I learned a long time ago — back when I was in the Philippines — that if you internalize everything, you bring your work home with you because you are affected by the

situation. So I try hard not to internalize things. Am I successful? The majority of the time, I am.

Don’t look at the glass as being half-empty, but half-full. There’s always someone doing worse than you. Not that I wish that on anyone, but it’s the truth. Always look up and not down, but never forget where you came from.

What truly brings me joy is my three-year-old daughter. I forget everything when I am with her. Who

cares when you are down on the f loor making silly faces or giving your kid a piggyback ride? I don’t. I also find that if you worry about appearances, you will never be happy.

Sometimes when we worry about materialistic things, we never move forward, because we are afraid to try out new things. When I’m with my daughter, I forget the world, I am silly and laugh, and I have fun. You have to have humor in life, otherwise it becomes boring. Live, laugh, love! ◆

WHAT ARE PAMED’S SECTIONS? Rapid, radical change faces the medical profession, but the younger generation — young physicians, medical students, and residents — have the opportunity to shape their own futures. Similarly, the International Medical Graduates (IMG) section brings together physicians with diverse backgrounds to share their concerns and experiences.

PAMED’s sections for these diverse groups serve as their voices across the state. Members of the sections are engaged and involved in PAMED initiatives and policymaking. To get involved in one of the sections, contact:

Medical Students Section (MSS) and Residents and Fellows Section (RFS): Eric Walsh at [email protected] or (717) 558-7828

International Medical Graduates Section (IMG) and Young Physicians Section (YPS): Stacia Pearce at [email protected] or (717) 909-2657


LEGISLATIVE & REGULATORY UPDATE

LEGISLATIVE SUMMARY

BY DAVID THOMPSON

It should come as no surprise that last year’s legislative activity didn’t come to a conclusion when we celebrated New Year’s 2016 — or at least not activity on the state budget for the 2015-2016 fiscal year. Understanding what happened and why isn’t easy to do without considering the implications of the November 2014 general election.

Gov. Tom Wolf ’s election in 2014 broke a nearly 50-year cycle in which all incumbent Pennsylvania governors had won re-election to a second four-year term. Were Pennsylvania voters sending a message to lawmakers in Harrisburg? Perhaps. But if they were, the message was mixed. While the electorate reset the clock on eight-year gubernatorial tenures, it also put historic Republican majorities in place in the state Senate (31-19) and House (119-84).

Following a general election, it is customary for both chambers of the General Assembly to re-elect legislative leaders and fill any leadership vacancies. With Gov. Wolf still celebrating his Nov. 4 win, Senate Republicans broke with tradition and ousted Senate Majority Leader Dominic Pileggi (R-9th) in favor of then-Appropriations Chair Jake Corman (R-34th). On the other side of the rotunda, House Republicans also elected new leaders and basked in the glory of election victories not seen since before World War II.

Gov. Wolf ’s first year in office got into full swing with a February budget address that called for — among other things — taxing natural gas producers mining the Marcellus Formation and expanding state funding for education. The message was not well-received by legislators, many of whom had campaigned on pledges of no new taxes and smaller government during the

previous year. Gov. Wolf had zeroed in on issues such as these during his own campaign, however, making him believe that he had the public’s support. But as discussed before, voters had sent a mixed message.

In spite of the seemingly endless wrangling over the budget — the nine-month impasse ended in late March after Gov. Wolf neither signed nor vetoed the 2015-2016 state budget, allowing it to become law — it was a fairly busy year for medicine.

PAMED worked to ensure that $4.67 million in funding for the Primary Care Practitioner Program — the umbrella program that funds loan repayment for physicians and residency slots —

was included in the partial budget Gov. Wolf approved in late December. At the same time, funding was also approved for Pennsylvania’s new ABC-MAP prescription monitoring program, which is expected to be operational by August 2016. PAMED was pleased that the Pennsylvania Health Care Cost Containment Council, or PHC4, received a $2.71-million appropriation for the current fiscal year.

Of nearly 350 bills that PAMED monitors, several have made their way onto state legislators’ shortlists and are worthy of mention. Legislation to legalize cannabis for medical purposes (SB 3) topped the list for 2015, winning approval in the Senate in May 2015, but


the legislation’s advancement slowed considerably in the House as supporters and opponents weighed their options. The House amended and approved the bill in March 2016. However, as of press time, it is unclear whether the Senate will concur with the House’s amendments or make additional changes. While PAMED opposes the legislation, we have repeatedly called for additional research (namely FDA-approved clinical trials) and a reclassification of the drug from a Schedule I controlled substance to a Schedule II to pave the way for additional study.

Nurse practitioners continued their quest for independent practice authority this session with the introduction of legislation in both chambers (SB 717

and HB 765) that would eliminate collaborative agreements with physicians. The House Professional Licensure Committee held a public hearing on the issue in late October, at which PAMED testified. PAMED strongly supports the “team-based” approach to health care delivery and continues to oppose any legislation that jeopardizes that model.

In an effort to help physicians cut through mountains of frustrating paperwork and clear the countless hurdles imposed by health insurers, PAMED sought the introduction of legislation that would address lengthy credentialing processes and transparency in prior authorization requirements.

HB 1663, introduced by Rep. Matt Baker (R-68th), aims to streamline

the credentialing process and make it more uniform across all insurers in Pennsylvania. In 2015, PAMED also led discussions with the state’s Department of Human Services (DHS) that resulted in changes to credentialing timeframes set for Physician Health Managed Care Organizations beginning Jan. 1, 2016. Learn more at www.pamedsoc.org/credentialing.

Legislation to increase transparency and standardization in the prior authorization process — HB 1657 — was introduced by Rep. Marguerite Quinn (R-143rd) in February. 2016. Learn more at www.pamedsoc.org/priorauth. ◆

David Thompson is PAMED’s director of legislative affairs. Email him at [email protected].


OP-ED

BUSINESS-SAVVY PHYSICIANS: A SOLUTION TO RISING HEALTH CARE COSTS

BY DAVID S. SPENCER, MHA

The rising cost of health care services and concerns about quality and access to care have been at or near the top of our national agenda for decades. Since passage of the Medicare Act of 1965, the federal government has developed and implemented a range of legislative tactics in an attempt to stem the cost of care while measuring the quality of the care provided more effectively.

Included among these government initiatives over the decades are a

national, cost-based reimbursement system, HMOs, capitated reimbursements, financial incentives, accountable care organizations, and dozens of other public and private schemes intended to control costs and quality. And yet more than 50 years later, we still face the same issues.

There is no “silver bullet.” But the old adage may also be true: “If we always do what we’ve always done, we’ll always get what we’ve always got.”

THE ALTERNATIVE TO GOVERNMENT COST CONTROL I’ve spent most of my career as the CEO of large health care provider organizations. And in these 30-plus years, I also have had the privilege of serving on the Master of Health Services Administration (MHSA) faculty at several universities and the management teams of large university hospitals. I have worked closely with medical schools, faculties, medical interns and


residents, and key executives to discover insights into cost-vs.-quality issues.

As a result of these experiences, I have arrived at this conclusion: We will not achieve sustainable, high-quality, cost-effective care across the industry unless we accept the fact that our historical efforts to control and improve care solely from the top down were not good enough — nor will they ever be.

Most industries learned decades ago that the individuals closest to the problem understand it best — and they can often achieve the most sustainable cost/quality improvements from the bottom up. This is in sharp contrast to changes installed by those at the top of the pyramid, who are often disconnected from the realities of a rapidly changing system.

To me, it is clear that the most powerful instrument for reducing waste, containing costs, and improving quality in the long term is the pen of the practicing physician. The physician’s hand orders virtually all diagnostic and treatment services, and this same hand can achieve permanent improvements.

Only an informed, business-savvy physician who understands the financial consequences of clinical decisions can control the costs of care. Only these individuals can attempt to optimize the cost/quality ratio for every patient, every day, through actions such as avoiding unnecessary laboratory tests or ensuring the timely discharge of patients.

But physicians are not always business-savvy or informed. A vivid example was a situation last week in which a surgeon friend of mine was distraught over an encounter with an angry patient. The patient had limited insurance coverage and was upset about

the fact that the doctor had prescribed a medication that cost $400 per refill. The doctor’s comment to me was simply, “I had no idea.”

BUILDING THE INFORMED PHYSICIAN Given that blind spots like these are common among physicians, how can we begin the process of changing physician behavior? I believe it is important to rethink the process under which we educate physicians during clinical rotations, enabling medical students to gain a better appreciation for the realities of the business environment in which they practice.

For example, medical students might be exposed to the various business activities that take place in tandem with patient care while completing clinical rotations. By expanding their scope of learning, they can better understand issues related to cost constraints, recruitment and training, and the mitigation of medical errors. Through such experiences, they can develop a greater awareness and appreciation of the business environment in which they function, and upon which they depend.

At LECOM, we have taken these insights and opportunities to the next level with a dynamic distance-learning tool that enables medical students dual-enrolled in our MHSA program to develop an awareness of the business environment in which they work. Students are guided through a structured process based on interviews with hospital managers that helps them learn to ask the right business questions during a rotation.

Medical schools wishing to produce business-savvy physicians must train future physicians to develop a situational awareness of the people,

systems, and organizations that help them care for their patients. And the innovative immersion tools currently being implemented in our MHSA program can help.

THE BENEFITS OF BUSINESS SAVVYBusiness-savvy physicians are interested in a broad range of business initiatives, including financial management, nurse staffing, patient safety systems, marketing, and operating costs. My personal findings show that behavioral changes flow naturally from better-informed physicians — “good information in the hands of good people always leads to improvement,” the saying goes.

This critical step in achieving our national health care goals lies in the hands of our medical and business educators, who must take a more interdisciplinary leadership role in their approach to traditional medical school clinical rotations. These improvements can provide medical students with new insights into the business environments in which they work, as well as the tools needed to improve patient care.

This strategy requires an admittedly long-term view of the health care system, but I believe that such an innovative approach to medical education will help us change the system from within. Only then will we be on the road to cost-effective, high-quality care that’s sustainable for generations to come. ◆

David S. Spencer, MHA, is an assistant professor at the LECOM School of Graduate Studies’ Masters in Health Services Administration program. He can be reached via email at [email protected].


LIFE IN THE BALANCE

EXPERTS AND DOCTORS IN THE TRENCHES OFFER ADVICE ON RECOGNIZING THE SIGNS OF STRESS AND BURNOUT, AND WAYS TO MITIGATE THEIR EFFECTS.

BY ED FINKEL

15pennsylvania physicianSPRING 2016

P hysicians work long hours, face increasing financial and regulatory pressures, and see and alleviate all manner of human suffering on a daily basis. And yet, the culture of the medical profession demands that they put their own needs last and soldier on to care for others — never

mind the effect on their health and well-being. “The situation is similar to that faced by firefighters, police, soldiers, emergency medical technicians,

nurses, and other health care workers,” says David Steinman, MD, a psychiatrist who has treated physicians with addictions and other disorders for more than 15 years. “We learn in medicine that the patient’s needs come first. Burnout occurs when taking care of patients leaves no room for physicians to take care of themselves.”

But this traditional culture is under increasing scrutiny as doctors, their employers, groups such as PAMED, and physicians’ own families strive for better work/life balance and integration. Statistics tell part of the story:

• 82 percent of physicians display signs of burnout, according to a study from the Physicians’ Health Program (PHP), a program of The Foundation of the Pennsylvania Medical Society.

• 46 percent of more than 20,000 physicians surveyed by Medscape said they feel burned-out.


• 54 percent of physicians were considered burned-out in 2014, up from 45 percent in 2011, according to a four-year study of nearly 7,000 physicians from the American Medical Association (AMA) and the Mayo Clinic.

• 400 physicians, on average, commit suicide each year, according to Medscape estimates.

Physicians in the trenches and those who care for them can attest to the impact burnout can produce in patient populations. Studies show that doctors with burnout have patients with lower treatment adherence rates, and their patients have poorer outcomes.

WHY BURNOUT HAPPENSJon Shapiro, MD, medical director of the PHP, says doctors often ignore the very advice they give their own patients about getting a good night’s sleep, eating a balanced diet, and exercising regularly, instead letting the job control them. “It’s being awakened in the middle of the night to take care of someone and feeling like you want to roll over and go back to sleep,” he says. “We model ourselves after the folks we train with — not wanting to miss any opportunities for learning, always wanting to be at the hospital, and not developing other parts of our lives.”

Dr. Shapiro says that medical school teaches physicians to be externally rather than internally focused, ingraining a sense of perfectionism and infallibility. “Most of us identify as physicians — as who we are,” he says. “But that’s different from recognizing that being a physician is what we do. Who we are should be more of a balance.”

Doctors are trained to focus on clinical goals instead of their own emotional and physical needs, Dr. Steinman says. That focus begins in medical school and deepens in residency,

when there is little time for socializing and leisure, and it does serve a purpose during a formative period in doctors’ careers. “It is good to have residents trained to have a strong work ethic,” Dr. Steinman says. “But it is also necessary to help them learn to care for themselves.”

Donna Rovito, editor of Physician Family magazine, which recently published an issue on work/life balance, says her husband trained surgical residents for 26 years. “They tend to feel that if they have problems, they have to ‘man up’ and deal with them,” she says.

Jon Shapiro, MD

David Steinman, MD Donna Rovito

HOW PAMED CAN HELP INTEGRATE WORK AND LIFE, PREVENT BURNOUT

Work/life integration (a.k.a. work/life balance) is a buzzphrase we hear from physicians throughout Pennsylvania. We know that physicians have many demands at work and at home, and many feel challenged by the need to manage competing

priorities and avoid burnout. So how can PAMED help?

BY PROVIDING TIPS AND TOOLS Pennsylvania physicians have told us that they need resources to help integrate work and life, and identify signs of physician burnout and prevent it. We heard, and created the following resources to help you in your life as a physician.

Physician Burnout. PAMED offers several online, on-demand courses, many of which offer CME credit, to help physicians identify, cope with, and prevent burnout. These include:

• Physician Burnout: Resolution and Restoration (CME)• Physician Resilience (CME)• Alleviating Physician Burnout (CME)

Members can access these courses for free at www.pamedsoc.org/lifeofmedicine.

Work/Life Integration. PAMED talked to several Pennsylvania physician families and learned some of the strategies they use to manage competing priorities at home and work. Get tips to add to your toolbox through our convenient podcasts, which can be listened to online at www.pamedsoc.org/podcast or on the go on your smartphone. iPhone and iPad users can download the Podcasts app free from the App Store, search for

Pennsylvania Physician Podcast, and hit “Subscribe.” Android users can download the Podcast Addict app from Google Play, search for Pennsylvania Physician Podcast, and click “Subscribe.”

BY SAVING YOU TIMEWe hear from members that one of the biggest challenges in medical practice is staying in compliance — toeing the legislative and regulatory line. Trying to keep up with the barrage of new laws, regulations, and policies at the state and federal levels can be extremely intimidating, and requires a considerable commitment of time and resources from doctors and staff.

There is a better solution. The practice management and regulatory experts at PAMED make it their business to be informed about regulatory changes impacting physicians, so you can leave the heavy reading and analysis to PAMED and spend the extra time with family and friends. If you have any questions, PAMED’s Knowledge Center is only a phone call away at 855-PAMED4U/855-726-3348. You can also access additional time-saving information at our website, www.pamedsoc.org, and through our daily all-member email, the Daily Dose. —Rachel Damrauer, MPA



Surgeons tend to feel this way even more than other specialties, Rovito says. When her husband tore a hamstring completely off his hipbone in a waterskiing accident, he put patients first. “Instead of having surgery the following Monday, he did surgery the following Monday,” she says. “That’s indicative of so many surgical personalities: ‘I’m invincible. I can do anything.’ ”

Physicians also tend to take their work home with them, says F. Wilson Jackson, MD, of Jackson Siegelbaum Gastroenterology in Camp Hill, Pa. “The nature of taking care of patients becomes emotionally ingrained in what you do,” he says. “You’re dealing with, at some level, human suffering or disease management. It’s something that seeps in more deeply” than the issues faced in most other professions.

NEW BURDENS ADD TO BURNOUTDr. Shapiro notes that physicians are facing newer stresses such as the introduction of electronic health records (EHRs), which often need improvement before they can be as user-friendly and clinically helpful as they are intended to be. More physicians are in employed arrangements, which allows them to concentrate on caring for patients but leads to a loss of control over their practices. And younger doctors face daunting amounts of debt when they come out of medical school, which can “color the kind of work they do, and how much they work,” he says. “It may interfere with raising a family.”

High debt has become paired with team-based care, which — however much it makes sense in terms of medical outcomes — has placed limits on some practitioners’ earning potential, says Monty Duke, MD, chief medical officer at Lancaster General Hospital in Lancaster, Pa. “I’ve gone to medical school, I now have $250,000 in debt. Between my income expectations and what is available, there’s a big gap,” he says.

Robert Richards Sr., MD, a retired orthopedic surgeon from Chambersburg, Pa., guesses that physician and hospital mergers add to the stress, although he was able to go into private practice. “Medicine used to be an individual practice, primarily,” he says. “Now, we find that the multi-specialists are all getting together and practices are owned by hospitals — and that makes a difference, because you’re not really on your own anymore. You’re a salaried physician of a conglomerate, and that didn’t appeal to me.”

His son, Robert Richards Jr., MD, who now runs the Richards Orthopaedic Center, says that outside employment contributes to the stresses of private practice in a community where he estimates 90 percent of physicians are in such arrangements. “That makes it more difficult because we lose referrals,” he says. “But one of the advantages of being in a community for a long time is that you kind of get name recognition.”

Dr. Jackson, who also has remained independent, says mergers lead to “lots of meetings” and structured workplaces. “That does put some traditional restraints on the freedom to practice in the way they would if they were an independent physician,” he says. “Employment status does change the freedom of caring for your patients on your own personal schedule. By the same token, it does relieve physicians of the administrative workload. There’s a trade-off there.”

Statistics confirm that each situation has benefits and drawbacks in work/life integration. According to a 2014 Medscape survey of more than 4,600 doctors, 20 percent chose an employed situation for improved work/life balance, and the majority of them (54 percent) were satisfied with their work/life balance. What’s more, 54 percent of the doctors who left private practice for an employed situation also said that their work/life balance improved. Nonetheless, 70 percent of the physicians who transitioned from employment into private practice reported they are happier overall.

FAMILY PRACTITIONERSAnother issue facing younger physicians is the rise of two-career couples, Dr. Duke says. “The assumption is that the physician is the difficult one to schedule around, but all too often, the families have more than one difficult career to schedule around,” he says. “Medical schools are more than 50 percent female, and a lot of young physicians marry. That’s got to be a difficult juggle.”

Physician Family recently featured two articles by female physicians about the work/life balance in two-career physician couples. “If you add children to that mix, it can get even worse,” Rovito says. “Children are a blessing. But when you’ve got two Type A-personality physicians trying to be the best physicians

Caryl Schmitz

PHYSICIAN MOMS FIND COMMUNITY AND

CONNECTION ONLINE

K ristin Ondecko Ligda, MD, an anesthesiologist practicing in Pittsburgh, has a secret weapon when it comes to

dealing with the challenges of being a physician, wife, and the mother of two young daughters, ages six and three. It’s a Facebook group of more than 1,400 women anesthesiologists who know what it’s like to be in her shoes.

Her idea for the Physician Anesthesiologist Moms group took shape when she realized that a physician mom group she had joined was discussing a variety of different specialties’ issues. She says she created the anesthesiologist-specific group “as a way to foster camaraderie, friendship, support, and encouragement, and provide an opportunity to commiserate.”

The group includes physicians who work in private practice, hospital systems, academia, research, and the U.S. Department of Veteran’s Affairs. Some members are just starting out as residents; others are retired. The wide range of the group members’ professional experiences works to their benefit, Dr. Ondecko Ligda says.

The physicians talk about salaries and benefits, including differences in maternity leave. They also use the group to discuss hypothetical case scenarios in a “What would you do?” format. Conversations extend beyond the professional, too — childcare is a common topic, for instance, and participants weigh the pros and cons of options such as daycare and nannies.

Most importantly, they provide an invaluable support system for one another. “We are there to celebrate graduations, promotions, and new babies, but also there to support in times of need,” Dr. Ondecko Ligda says.

Ultimately, though, Dr. Ondecko Ligda says that it’s the strong partnership with her husband, Erik, that enables her to find balance between her work and family life. “He’s my rock, and nothing I do would be possible if it weren’t for his commitment to us and our family,” she says.

Dr. Ondecko Ligda and her husband, a network security engineer, were high-school sweethearts and co-valedictorians of their graduating class in Northern Cambria, Pa. They have

plenty of experience weathering challenges together, including a four-year period when she took a scholarship to attend the Virginia Commonwealth University School of Medicine, while his career kept him in Pennsylvania.

Now, the couple has developed a routine that suits them. Erik Ligda telecommutes, and is able to take care of daycare drop-offs and pick-ups, as well as prepare family meals. “Our running joke is that we’d starve if I was the one left to cook,” Dr. Ondecko Ligda says.

Their teamwork enables her to keep up with her role as a high-energy professional with responsibilities including patient care, teaching anesthesiology at the University of Pittsburgh Medical School, and serving on the Board of Directors of the Pennsylvania Society of Anesthesiologists.

Dr. Ondecko Ligda also finds time for family and fun. She enjoys being a homeroom mom, a Beachbody health and fitness coach, and an enthusiast for all things Disney. And of course, there are the dynamic online communities through which she finds connections and friendship.

She appreciates being part of a group that truly relates to her experience as an anesthesiologist and a mom. Her fellow group members “understand the unique role of a physician mom, where we care so deeply about our patients and their health and safety, and oftentimes go above and beyond our physician-patient relationship to make sure our patients have everything they need for their wellness,” Dr. Ondecko Ligda says.

Her advice for a physician looking to start a similar online group? “Go for it. Start with a few colleagues and add them to the group.”

Anesthesiologist moms interested in joining Dr. Ondecko Ligda’s group can find out more by emailing [email protected]. —Susan Wigger


Kristin Ondecko Ligda, MD

20

they can be, and then they also want to be the best parents they can be, and the best spouses they can be, and the best everything they can be — clearly, they reach the point where something’s got to give.”

Caryl Schmitz, president of the Pennsylvania Medical Society Alliance, says that her anesthesiologist husband experienced more burnout due to administrative and political issues than to physical or emotional exhaustion. “It was having to deal with the other parts of the hospital and the administration, and who needed you to do tasks that had nothing to do with patient care,” she says. “It has so much less to do with the practice of medicine in the clinical sense — interaction with patients and the procedures you’re doing.”

But being on call also contributed to burnout, Schmitz says, particularly as her husband got older. He addressed these issues by going into private practice, despite the financial hit involved. Fortunately, by that point, he no longer had to exhaust himself to keep up. “We had a pretty low need for high finances,” she says.

RECOGNIZING THE WARNING SIGNSDoctors need to be honest to recognize signs of burnout in themselves, Dr. Steinman says, and co-workers and families should be on the alert for symptoms, too. “Burnout presents with physical and emotional exhaustion, diminished sense of personal accomplishment, and depersonalization,” he says. “Depersonalization is ‘going through the motions,’ rather than being present in the situation.”

Dr. Shapiro cites a loss of empathy, fatigue, irritability, getting behind schedule, a lack of enjoyment of recreational activities, and a sense of separation from one’s work and family as warning signs of burnout. Getting off one’s schedule is both a cause and an effect of burnout, he notes. “A lot of this is going to be subjective, and we look toward the individual physician for recognizing or policing” themselves, he says.

Jennifer Schelter, a professional meditation and yoga teacher, instructs doctors, lawyers, and others in high-powered professions “to listen mindfully to the body.” Sleeplessness, physical pain, or an imbalance in the sympathetic and parasympathetic nervous systems can lead people to feel stuck, desperate, and restless, she says. This is an indication that they need to restore balance to their minds and bodies.

“Burnout is real when we become exhausted,” Schelter says. “There are many factors that contribute to this condition. In essence, your fight/flight response is stuck on, and pumping an unhealthy abundance of cortisol through the body. It can be a scary feeling when you feel unable to relax.”

Dr. Jackson figures the path toward burnout has started when a doctor wakes up in the morning and doesn’t have any enthusiasm about going into the office. That points to job dissatisfaction, frustration, and a loss of passion. This, in turn, can impact interactions with family negatively, disrupt marriages and other relationships, and lead to endpoints such as depression and substance abuse, he says.

For Dr. Duke, among the first warning signs are physicians who seldom smile or laugh. “That’s usually not a good sign,” he says. Other signs include “when people are showing up late for clinic, when patients are complaining that the doctor didn’t spend enough time with them, or that the doctor didn’t hear what was important. Sometimes that bubbles up into quality and safety issues, like wrong-side surgery or discharge summaries that aren’t taken care of.

“It’s hard work, and it is consuming if you care about what you do,” Dr. Duke adds. “You don’t turn it on and off. If there isn’t a passion there about patient relationships and solving problems, it can be terribly unrewarding — I don’t care what they pay.”

Schmitz’s anesthesiologist husband realized he was getting burned out when he started to get depressed that he wasn’t able to spend as much time with their children as he wanted. “It wasn’t just, ‘Gee, I wish I could have done this,’ ” she says. “When he sensed he was feeling sadder and disconnecting from the family a little so he wouldn’t be so sad, he pretty quickly knew — and we started discussing leaving the hospital and starting our own practice. He acted on it much quicker than many people would have.”


Ravi Dukkipati, MD, practices yoga guided by his instructor, Bobbi Misiti.


The couple has friends and colleagues whose depression “went places it shouldn’t have,” she adds, adversely impacting their marriages and families. “It’s really important that you have other medical families in your world,” Schmitz says. “That helps your marriage because you are able to talk about issues with friends in the same type of field.”

TOWARD BETTER BALANCETo achieve better work/life balance, physicians need to sit down and schedule “protected” time for themselves, and set up formal relationships with other doctors to monitor their own health rather than attempting to self-diagnose or “get informal consults in the hallway,” Dr. Shapiro says. Connecting with the larger profession through vehicles such as PAMED can help reduce the stress of economic and regulatory changes by providing social support, he notes.

The medical profession also needs to move beyond its sense of infallibility, Dr. Shapiro says, particularly regarding end-of-life issues. “We’re trained to cure disease, and eventually, that’s bound to fail. Every patient is bound to be deceased at some time, and that’s not a failure of medicine.” Physicians can recalibrate by making their mission to help patients as much as possible and build strong relationships with them. “We always tell people to harken back to a sense of renewal — of why we got into this in the first place,” he says.

Individual doctors need to be willing to make course corrections like her husband’s, Schmitz says. “It’s okay to deviate from that path once you have established yourself and you want to do something that benefits the rest of your life and your family,” she says. “Part of burnout is feeling like you are stuck — this is it, this is where you are, and you can’t change it. You need to feel like you can make that change.”

To facilitate improved work/life balance, physician employers need to consciously plan schedules, Dr. Duke says. “People get sick. Babies get born. People shouldn’t feel compelled to miss these important events because of duty to their service and their profession,” he says. “That means facilities have to have coverage available so people can step away. It’s not a sign of weakness to step away from your professional life to do other things. It’s a sign of strength.”

Dr. Jackson urges colleagues to focus on maintaining a passion for their work; he maintains his by following the constant evolution in medical technologies and knowledge. But solely focusing on a work-related passion isn’t the answer to creating balance, he notes.

“You do need a balance — whether that’s exercise, whether that’s making time for hobbies, whether that’s taking adequate time for vacations,” he says. “Whatever gets people to take time away from the day-to-day work. Exercise is critical for most, but it’s different for different people.”


“It’s not a sign of weakness to step away from your professional life to do other things. It’s a sign of strength.”— Dr. Monty Duke

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DOCTOR, HEAL THYSELFA NEW BOOK FROM SARAKAY SMULLENS OFFERS STRATEGIES PHYSICIANS AND OTHERS CAN USE TO COPE WITH STRESS AND AVOID BURNOUT.

Social worker and therapist SaraKay Smullens, MSW, LCSW, ACSW, BCD, CGP, CFLE, from Philadelphia, has seen burnout in action in the mental health field since returning to work in the 1970s as a therapist assisting the courts in domestic violence cases. “What I saw is that experienced and young social workers and mental health professionals were leaving a field they trained for and wanted to remain in,” she says. “They could not due to burnout.”

Since then, Smullens has become a recognized expert in diagnosing and treating burnout, writing about the topic in The Huffington Post and penning bestselling books on the topic. While her latest, Burnout and Self-Care in Social Work, addresses the concept of burnout in universal terms, Smullens has particular expertise in recognizing and diagnosing its effects among doctors, having been married to one for more than 30 years.

“No profession has burnout waiting in the wings to a greater extent than medicine,” she says. “I have been married to Stan for 36 years, and only those who share lives with doctors can realize the enormous and diverse pressures they face in our ever-changing, fast-paced, wired society where doctors are expected to be available 24/7, despite pressures, responsibilities, and exhaustion.”

There are three major, omnipresent causes of burnout among doctors, she notes. First is vicarious trauma, when the doctor experiences a patient’s illness like his or her own. Next is countertransference, when one is exhausted dealing with

impossible demands, including financial, as well as ruthless people. And finally, there’s compassion fatigue, when the person feels like they have nothing left to give.

The book offers multiple case studies of people who have faced burnout and evidence-based strategies to alleviate and prevent it. There is no one-size-fits-all answer, Smullens says, so doctors must find the self-care strategies that work best for themselves and their situations. Self-care offers “the strength to claim the joys of living and endure what we must,” she writes. “And it will help us ensure that our [patients] are able, whenever possible, to do the same.” —Ian P. Murphy



SEPARATING PROFESSION AND PRIORITIESDr. Duke agrees that rediscovering one’s professional passion is at least part of the answer. “What makes you want to put on your scrubs in the morning and smile when you go home in the afternoon?” he says. “To me, that’s about relationships with patients, working as a team, delivering outcomes, and solving challenging problems.”

But he also agrees that one needs to take time away and sometimes put other priorities first. Married for 39 years with three children, “I coached almost all of my kids’ teams, I connected with other parents at the school,” Dr. Duke says. “The ability to have flexibility of schedule and adapt to unforeseen things allowed me to be a husband, a father, and a community member. I wasn’t totally consumed by the profession.”

Part of finding a balance can include outsourcing tasks around the house, Rovito says. She and her husband hired college students to take care of their lawn shortly after buying their first home (those kids changed their majors to landscape architecture and started the lawn-care company Rovito still employs). “I love that my husband doesn’t need to worry about that,” she says. “Being able to take a couple of things off your plate helps you to achieve a balance and prioritize the important

things. It lets us chill out in a way we wouldn’t be able to if we were running around clipping bushes.”

Physicians can best protect the elasticity of body and mind by practicing a regular activity that creates a relaxation response, Schelter says. “I recommend a regular time to practice rejuvenating body and mind: Go on a retreat, listen to your favorite music, take a yoga class, or take a walk in the park. Work a time for relaxation into your routine — like enjoying a great meal, for example — and most likely, you will see improvements in your well-being.”

Dr. Steinman strongly suggests that physicians schedule time for relaxation, time with their families and friends, and time to recharge their batteries. “Although we need to attend medical conferences, these usually don’t serve the function of recharging our batteries,” he says. “All physicians need to ask themselves if they can make small changes toward achieving work/life integration.

“More broadly, this involves a consideration of personal goals,” he adds. “We think of goals related to our work life, but we often neglect to make personal goals. Work is a part of life. I want to look back and say that I used my time wisely.” ◆

Ed Finkel is a freelance writer and editor based in Evanston, Ill., who writes about health care and other topics.

Over 250 years ago, Benjamin Franklin implored the colonies to join together with his “join or die” political cartoon. In 2016, the choice for physicians is similarly stark. This year an attorney general, 25 state senators and 203 states representatives will be elected. Every one of them can impact the way medicine is practiced in Pennsylvania. Let your voice be heard in the 2016 elections and join PAMPAC today.

PAMPAC is the political arm of the Pennsylvania Medical Society. Membership in PAMPAC is voluntary and serves as the united voice of physicians in the political arena. PAMPAC contributes to candidates for state office who support the priorities of the Pennsylvania Medical Society membership.

Learn more about PAMPAC and join at www.pampac.org

Dear Colleague:

MyPAMED is a way to do my personal best for myself, colleagues, and patients.

As you can tell from my photo, running is a passion of mine. The mentality I bring to my races is “Get your sneakers on and keep on running.” One of my favorite quotes from Nelson Mandela that sums up the runner’s drive is “It always seems impossible until it’s done.” I’ve tried to extend that same mindset to my practice and life in general.

The demands of work and family life mean I need a helping hand when it comes to advocating on behalf of my profession and my patients. The Pennsylvania Medical Society (PAMED) helps me to keep on running.

How can PAMED help you do your personal best? Let us know by calling 855-PAMED4U (855-726-3348).

We’re looking forward to hearing from you.

Judy Pryblick, DO PAMED Member since 1992

Are you a woman who is a licensed MD or DO in Pennsylvania? Earn your choice of a:

• $50 Visa gift card • $50 credit toward PAMED membership dues

Here’s how: Tell us one thing you would fix or change concerning your daily practice if you had a magic wand.

YourPAMEDIS LISTENING

Call the Knowledge Center at

855-PAMED4U (855-726-3348) today to share how PAMED can help you succeed in your business, practice, and life of medicine.


RECENT INNOVATIONS IN HEALTH CARE TECHNOLOGY AND DELIVERY ARE HELPING PENNSYLVANIA PHYSICIANS SLASH COSTS WHILE GUARANTEEING QUALITY CARE

IN A VARIETY OF ENVIRONMENTS.

THE FUTURE IS NOW


ELIMINATING EHR HASSLES

ENT Specialists of Northwest Pennsylvania in Erie, Pa., has figured out a way to embrace EHRs as a positive quality-of-life factor — and one that even helps keep late-career physicians in practice. The seven-member team turns to scribes.

The term “scribe” elicits a vision of the days of kings and queens, when courtiers equipped with quills and scrolls recorded stories for posterity. Not here — these scribes have access to the latest technologies and up-to-the-minute knowledge of recording and coding for the most complex medical situations.

During a scribe-assisted patient visit, an ENT Specialists physician enters the exam room and explains that there is an assistant “in their ear.” The scribe listens in on the visit, recording everything that the physician says into the patient’s chart using templates that the medical staff has enhanced beyond those that came with the system.

The patient also gets a detailed explanation of the physician’s exam, findings, and thought processes. For example, the physician might say, “I am going to check your right ear,” and explain his observations and diagnoses aloud. The patient hears the tangible part of the process.

“The use of scribes in our office has revolutionized our practice of medicine,” says otolaryngologist Sidney Lipman, MD. “Our scribes are comprehensive data managers — not merely transcriptionists who allow us to devote our time to patient care. We touch patients, not keyboards.”

Meanwhile, the scribe navigates the patient record, charting and coding in real time under the direct supervision of the physician. Before a patient leaves, the office provides instructional and educational materials, orders tests, sends prescriptions, and communicates with schedulers.

The physician then closes the record, and the office sends documentation to the referral source via fax and transfers billing data to the business department.

The patient’s record is available immediately to the entire office staff for follow-up. In addition, the practice subscribes to an online software system to manage ICD-10 coding.

The technology ENT Specialists uses include a wireless headset; a 32-inch, flatscreen monitor in the exam room that the physician and patient use to look over test results and follow the documentation process together; Internet service to allow the scribe to work remotely; and an iPad the physician uses to close the note. “This, in turn, means no charting at the end of the day — leading to better quality of life,” says Bob Budacki, practice manager. “Our doctors put their headsets on the chargers, put on their jackets, and go home.”

“Using scribes allows us to quickly and efficiently manage our EHRs with a minimum of work on our part — accurately reviewing records, entering data, coding, billing, and prescribing,” Dr. Lipman says. “The modern physician sits at a computer terminal. Not us — we spend our time with patients.”

“We asked ourselves: Why would we have the most highly trained, highly compensated person in the office entering clerical data?” Budacki adds. “The physicians are on staff at three hospitals and three surgical facilities. Each of these facilities uses its own records-management system, which the physician must learn to navigate and use to document the patient record. Our office system represents one less application that the physician must learn; the scribe handles that on behalf of the physician.”

Another otolaryngologist at the practice, Rick A. Fornelli, MD, says that using a live scribe in conjunction

T he challenge inherent in the evolving health care marketplace is to continue to deliver quality care while navigating the constraints imposed by necessities of cost management and other administrative tasks. And by embracing innovations such as scribes, telemedicine, social media, and other new strategies, doctors throughout Pennsylvania are easing administrative burdens while furnishing their patients with a complete continuum of care. What follows are just a few of the methods doctors are already using or testing to build the efficient practices of the future.

The ENT Specialists team, left to right: Sidney P. Lipman, MD; Jack B. Anon, MD; Ruthann I. Lipman, DO; Sean Carroll, DO; Rick A. Fornelli, MD; Kirk W. Steehler, DO; (not pictured) Stephen E. Schell, MD.

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with the EHR system has helped his practice of medicine significantly. “It allows me to interact directly with my patients and maintain contact with them without the distraction of trying to enter data into a laptop,” he says. “It allows us to be more efficient because two of us — the physician and the scribe — are working in conjunction during the entire patient visit.

“While I am discussing the medical plan with the patient, my scribe is listening to me and working on documenting our conversation, preparing lab and radiology order slips, and messaging my surgical schedulers regarding surgical plans for the patient,” he notes. “The patients get to hear me dictate

their physical exam findings aloud, which helps reinforce my findings with them. It has revolutionized the way we see patients, and has maximized efficiency.”

Budacki reports that these efficiencies allow each physician to see one to two more patients each half-day, affecting the practice’s bottom line. It also helps keep physicians in the practice longer.

“I am very limited in [my] computer savvy,” Dr. Lipman says. “I can’t cut and paste, let alone do what my scribes do. Scribes have allowed this 65-year-old physician to remain in full, active practice in a 40-year-old’s world. I could not imagine practicing without scribes. I would have retired years ago.” —Kerry Royer

Sidney Lipman, MD

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The persistent work of PAMED and physician members made the Mcare settlement a

reality. Become part of the strongest physician voice for your

business, practice, and life of medicine in Pennsylvania.”-Scott Shapiro, MD, FACC, FCPP, PAMED President

Why did we need the Mcare settlement? Learn more at www.McareRefund.org

Not a member? Join PAMED at www.pamedsoc.org/Join

We offer: • Scholarship and loan programs at favorable interest rates for medical students.• The Physicians’ Health Program that confidentially support physicians who are at risk or require

help addressing health concerns including those that arise from addiction and substance abuse.• LifeGuard® that offers unbiased clinical skills assessment and a personalized plan to assist those

who have fallen behind in clinical skills.

The Foundation of the Pennsylvania Medical Society cares for those who provide for the health of others, and your support can continue to make that possible.

Physicians can turn to us for guidance, support and advocacy during life’s most challenging moments.

Contact UsThe Foundation of the Pennsylvania Medical Society

777 East Park DriveP.O. Box 8820Harrisburg, PA 17105-8820

717.558.7750Donate now at www.foundationpamedsoc.org

The official registration and financial information of the Foundation of the Pennsylvania Medical Society may be obtained from the Pennsylvania Department of State by calling the toll-free number within Pennsylvania, 1(800)732-0999. Registration does not imply endorsement.


DIALING UP COST-EFFECTIVE CARE

Telemedicine and telehealth are key components in the health care industry’s shift to value-based care as a strategy to cut costs and enhance patient care. Fueled by growing consumer demand for affordable, accessible care and an explosion in personal technology, telemedicine is experiencing rapid growth and deployment across a variety of applications.

Telemedicine is offering users the ability to access care outside the typical provider office hours and settings, bringing advice and care into homes, long-term care facilities, schools, workplaces, and prisons. By improving access to primary and necessary specialty care, telemedicine could soon provide timely, accessible care at a lower cost, and help reduce expensive emergency room visits. Telemedicine can also assist family caregivers in their support of efforts to “age in place,” reducing the need for institutional care.

Offering tools that capitalize on technology to deliver health care and other health services remotely, telemedicine will be able to help providers eager to adapt their business models to the new health care marketplace. A recent survey from the American Academy of Family Physicians found that nine out of 10 family physicians say they would use telehealth to aid in patient treatment if they were compensated for offering it. And 15 percent of the survey respondents say they already offer telehealth today.

PAMED is helping lead the charge in Pennsylvania by introducing legislation that would eliminate some barriers to telemedicine in the state. The proposed legislation would

require insurers to pay for telemedicine, as well as establish a set of safeguards and standards that support the appropriate use of the technology, granting consumers access to qualified providers while providing physician protections. A PAMED task force comprised of representatives from several specialties led development of the legislation, and PAMED is leading stakeholders in its advancement.

In terms of clinical outcomes and cost-effectiveness, most agree that more research needs to be done on telemedicine. A recent review of 93 randomized control trials from the Cochrane Collaboration concluded that the effectiveness of telehealth often depends on factors such as patient populations, how telehealth is used, and the health care practitioners and systems involved in delivering it. Limited data was available on the impact that patient and provider satisfaction and costs have on telemedicine outcomes.

The idea of treating patients remotely could affect almost every aspect of health care, however. Neurologists can use telemedicine to provide instant assessments of stroke victims that save lives. Patients recovering from surgery at home can have the equivalent of an electronic house call, using a video link to their surgeons for follow-up appointments. And in one of the newest applications of telemedicine, psychiatrists can create avatars to help patients act out difficult scenarios in virtual worlds. We are not far from a future in which seeing a doctor no longer requires being in the same room — or even the same building. —Dennis Olmstead


EXPLORING ADDITIONAL INNOVATIONS

Health care innovation is thriving in Pennsylvania. The Penn Medicine Center for Health Care Innovation and Jefferson Innovation at Thomas Jefferson University — each recently named as one of the top “Five Health Care Innovations Centers to Watch” by FierceHealthcare — are two incubators that are putting innovation at work for patients in the city of Philadelphia.

David A. Asch, MD, MBA, is the executive director of the Penn Medicine Center for Health Care Innovation. Improving patient health and the patient experience is the focus of the Center’s work. His team — a multidisciplinary group that includes physicians, designers, project managers, Web developers, and economists — is always looking for ways to make things better for patients. “Everything is subordinate to improving service delivery,” Dr. Asch says.

Dr. Asch believes in the potential of health care innovation. “We see it as a discipline, not a fad,” he says. To that end, the Center has set ambitious goals including substantially improving health, reducing the cost of care, and ensuring the future of “connected” health, in which people are able to monitor chronic conditions through technology.

One example of innovation in action at Penn is a program developed for the management of postpartum hypertension. Hypertension is the leading cause of maternal morbidity

and mortality in the U.S., and the leading cause of seven-day readmissions for obstetrics patients at the Hospital of the University of Pennsylvania.

Since it can be difficult to reach new moms by phone, Dr. Asch says, the pilot project has developed a text-based intervention program. Supplied with blood pressure cuffs, women are asked to take their own readings and text the results. Among the patients in the program, there have been no seven-day readmissions.

Jefferson University is another organization that’s exploring how health care innovation can help transform lives. Jefferson Innovation tests new business models and nurtures a spirit of entrepreneurship among students, employees, and other members of the Jefferson community.

The Jefferson Accelerator Zone is the hub for innovation activity at Jefferson, and it hosts an Innovation Engagement Speaker series in which experts share insights on topics such as strategic design and fostering innovation in large organizations.

The Accelerator Zone is also the site of the Independence/Jefferson Health Hack, a three-day event held most recently in November 2015. Multidisciplinary teams competed to solve challenges related to access and health care delivery, concentrating on drone-based health care delivery, reducing hospital readmissions, and wearable devices.


FIND OUT MORE ABOUT THE INNOVATION CENTERS ONLINEPenn Medicine Center for Health Care Innovation: www.healthcareinnovation.upenn.eduPenn Medicine Social Media and Health Innovation Lab: www.socialmedialab.upenn.eduJefferson Innovation: www.jefferson.innovation.edu

GOING SOCIAL WITH CAREHealth care innovation often requires doctors to look at ways to use social media to improve patient health. Penn Medicine’s Center for Health Care Innovation is tackling the challenge through its Social Media and Health Innovation Lab. Program Director Raina Merchant, MD, MSHP, says that one of the goals of the lab is to “study more about what people are thinking and feeling about health.”

In 2012, Penn’s Social Media and Health Innovation Lab launched its first major project, the MyHeartMap Challenge, to find out if it could locate defibrillators in Philadelphia. Using the public as citizen-scientists, the lab asked people to send pictures of defibrillators in the city. The project was successful in engaging the community in their health, identifying more than 1,500 automated external defibrillators (AEDs) in more than 800 unique buildings. The Social Media Lab now offers an online AED registry and continues to encourage citizens to contribute.

Other research projects for the Social Media and Health Innovation Lab include a study that looks at what patients are saying about heart disease on Twitter and an examination of Yelp! reviews of hospitals. “How do we listen and learn from patients using these different tools?” is the question, Dr. Merchant says.

PUTTING INNOVATIONS TO WORKHow can practicing physicians incorporate innovation and technology into their daily work? Dr. Asch acknowledges that the demands of patient care and the need to balance work and family can create limitations when it comes to innovation, and believes that it takes time to examine the opportunities available.

“To learn something, you have to do something,” Dr. Asch says, noting that experimentation has been liberating for him and his team. “The best innovation will come from trying things out in clinical practice.”

From a social media perspective, Dr. Merchant also has advice for physicians. She reminds physicians to think of social media as a tool for communication. In terms of patient satisfaction, she says a social media account such as a Facebook page can help. There, physicians can acknowledge patient comments and offer to continue the conversation offline. “It goes a long way when someone gets a response to their post,” Dr. Merchant says.

When asked about the future role of social media and technology in health care, Dr. Merchant foresees a more “personalized” medicine, in which patients use digital information to manage their health, and physicians use it to stay engaged with patients.

Patients and health care providers alike will have an effect on the innovations that define the future of health care. Health care transformation through innovation can happen in small- and large-scale ways, too — perhaps even through something as simple as crowdfunding, by allowing patients to be advocates for disease awareness by making small donations.

With the stewardship of organizations such as Jefferson Innovation and Penn Medicine’s Center for Health Care Innovation, however, it looks like patients in Pennsylvania are in good hands. —Susan Wigger ◆

Kerry Royer is editor-in-chief of Pennsylvania Physician and communications director of the Foundation of the Pennsylvania Medical Society; Dennis L. Olmstead, MPA, is PAMED’s senior advisor of health economics and policy, and Susan Wigger is PAMED’s communications coordinator.


COST$1,500 for PAMED members, $2,500 for non-members. This price is for the entire series.

If you’re not sure if you’re a PAMED member or are a non-member interested in joining to take advantage of the member rate, please contact PAMED’s Knowledge Center at 855-PAMED4U (855-726-3348).

HOW TO REGISTERRegister online at www.pamedsoc.org/CMOLeadership.

CMOsEnhance Your Leadership Skills

WHY

Here’s what a past attendee has to say:

“It is important to learn skills that are suited to the unique

challenges of a CMO’s job where you live with one foot in

the medical world and one foot in the administration (and

another foot in finance, another in compliance, another in

marketing, another in recruitment, etc.). The PAMED CMO

leadership series provides an opportunity to gain a different

perspective on the job or on the health care industry and

network with other CMOs. Each of us likely only knows

his or her world. For example, OB/GYN might be the

same everywhere. But, being a CMO is different in every

institution.”

Thomas Bader, MD, CMO, Crozer-Keystone Health System 2013-2014 CMO Leadership Program participant

WHATA 15-month comprehensive training and networking series for proven leaders to sharpen their leadership skills

WHOFor CMOs, Medical Directors, Chiefs of Staff, VPs for Medical Affairs

WHEREThe Pennsylvania Medical Society (PAMED) in Harrisburg

WHEN* • June 3, 2016 • Aug. 5, 2016 • Sept. 30, 2016 • Nov. 4, 2016 • Apr. 7, 2017 • June 2, 2017 • Aug. 4, 2017

8:30 – 9:30 a.m. – Networking breakfast and open discussion of current issues/concerns

9:30 a.m. – 3 p.m. Educational session with light lunch provided

TOPICS • Being the Team Leader When You’re Not the Subject Matter

Expert: Best Practices in Managing Project Teams

• Crucial Conversations: Establishing Accountability, Expectations, and Consequences

• Improving Patient Experience and Engagement: Moving Patients and Providers to Action

• Navigating Physician Relationships: Employed versus Independent Physicians

• PHOs and ACOs – Best Practices in Health Care Team Interactions

• Physician Career Cycle Challenges: Managing the Competency and Performance of Resident and Senior Physicians

• Two Hats, One Team: Challenges Associated with the Dual Roles of Administrator and Clinician

*Course order TBD

Questions? Contact Leslie Howell at (717) 909-2624 or email [email protected].


PRACTICE MADE PERFECT

EMBRACING THE BENEFITS OF WORKFLOW ANALYSIS

BY JENNIFER SWINNICH

With the practice of medicine evolving from volume- to value-based care and a greater emphasis placed on quality metrics, the result is new benefits for wellness and care management.

In last issue’s Practice Made Perfect, Pennsylvania Physician identified the reimbursement opportunities Medicare wellness visits present. Care plan oversight, chronic care and transitional care management, and advance care planning round out additional covered services that focus on overall health, wellness, and care coordination.

The components required of these visits are considerably different than typical medical exams, however. While physicians are often expected to simply start performing such services, little consideration is given to whether a practice has the resources to carry them out successfully.

In surveys of medical practices, workflow issues are often cited as the greatest barriers to offering new services or implementing new processes. Interruptions to workflows are costly, and bottlenecks and duplications exacerbate the inefficiencies. When the process is not running well, it can cause frustration — especially if you are attempting to provide a new service. It may cause you to abandon the process completely, negating any benefits related to bringing new services to your patients or increasing your reimbursements.

Addressing the functions of a new process prior to implementation will help anticipate pitfalls and improve your chances of success. If you are just getting started on providing a new service, become familiar with its requirements. You will need to make sure you meet the requirements within your workflows, and don’t miss out on potential reimbursements.

If you are looking to add new services, change how your practice functions, or improve efficiency, consider doing a workflow analysis to get and keep your practice running smoothly. A workflow analysis is the study and organization of tasks within a process to achieve an intended result. For example, patient registration is a process; checking insurance eligibility is a task within that process.

Many different processes within an organization can be studied. Practices can use studies’ results to streamline that process, and consequently improve the process, saving time and money.

What are the steps in a workflow analysis?

Select the process to be analyzed. For example, you might select the patient

process during a wellness visit, or the documentation requirements of chronic care management for your study.

Create a preliminary process map. This is a flowchart that identifies the start and end of the process, and the major steps and activities in-between.

Observe and document the details. Walk through the process three to five times and document what really happens — not what is supposed to happen.

• Include who, what, how, and where the task is performed.

• Be aware of actions that trigger other actions and document them.

• Identify influential factors.• Interview those who contribute to,

and are affected by, the tasks. Don’t overlook any details. What

may seem inconsequential now may

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have real influence on the actual progression of the tasks.

Update the original flowchart to add detail. It will provide a clear visual of the steps that make up the process. Define the roles within the process.

Isolate gaps, bottlenecks, and duplications. Look for ways to streamline tasks. Take the practice’s limitations into account, whether they lie in facilities, personnel, or policies. Brainstorm with involved staff for possible solutions.

• Modify tasks and update your flowcharts to reflect the modifications; re-analyze.

• Look for inefficiencies and improve; re-analyze. Test and retest all new workflows using your updated flowchart as a guide.

• Once you have refined the process, the workflow analysis is complete.

REALIZING THE BENEFITS Although a workflow analysis can seem complicated, time-consuming, and detailed, its benefits are long-lasting. It usually results in greater efficiency, increased productivity, and higher revenue. You also may realize better communication among providers, staff, and departments, as well as higher staff satisfaction. Participation from staff promotes buy-in, and encourages widespread acceptance and adoption of the changes in the process. In addition to saving time and money, it can also enhance the patient experience.

The updated flowchart communicates changes in workf lows effectively

to staff, minimizing variations and misunderstandings. It also adds accountability, aids in training new hires, and helps refine job descriptions.

There are no special skills required to perform a workflow analysis. You may have someone in your organization who can complete one easily. Qualities to look for are a strong sense of organization, attention to detail, and the ability to facilitate collaboration with others.

If your organization is committed to introducing a new service or improving current workflows, the workflow analysis is a valuable asset to consider — and the entire practice can benefit. ◆

Jennifer Swinnich, CPPM, is PAMED’s associate director of practice support. Email her at [email protected].

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PHYSICIANS & PHILANTHROPY

TWO STORIES OF SUCCESS

BY KERRY ROYER

The Foundation of the Pennsylvania Medical Society is celebrating the 30th anniversary of the Physicians’ Health Program (PHP) this year by sharing 30 Stories of how the program changed people’s lives. Here are some excerpts from a couple of them.

On Oct. 12, 1988, DEA agents invaded my home in search of evidence regarding distribution of controlled substances. More than 70,000 doses were registered to me and not accounted for. That day was the first time I ever admitted (to the agents) that I was a drug addict. They had “other ideas.” This was the end of life as I knew it.

My Pennsylvania medical license and DEA registration were suspended/revoked, as were my hospital privileges. Felony charges were issued three years later. I had to stop using narcotics, and that didn’t seem possible.

Two days later, knowing my supply was frighteningly low, I did prepare for suicide. I prepared two syringes, one with Midazolam and one filled with Pavulon, and placed them in my top drawer. That same day, an old acquaintance of mine who had previously been in trouble accepted my call. He gave me a phone number and said, “You do not have to feel this way anymore. Life can be beyond your wildest dreams.”

The phone number was for the PHP. I spoke somewhat honestly for the first time about my addiction. They sent a gentleman to my home to escort me to Marworth, a rehabilitation facility. I have been involved with the PHP as a participant, monitor, and committee member for the past 27-plus years, with continuous sobriety since Day One. PHP provided the framework for my recovery, monitoring, and letters of support whenever needed. I owe them my life.

I resumed practicing anesthesia in 1989 and have been professionally successful since that time. This is a direct result of PHP intervention. My story is a miracle. My path would not have been feasible without the

support and guidance of PHP. —Dean Steinberg, MD

As a medical student, my experience in the PHP has been quite interesting. Initially, I was hesitant, mainly because I had never imagined myself in a program like this. However, after almost a year, I can honestly say this program is the best thing that has ever happened to me.

My family and closest friends constantly remind me how much better I am since joining the PHP. The staff is very kind, and it is clear they care about you

and your well-being. My most memorable patient experience to remind me how great the program has been for me was on my psychiatric rotation. I was talking to one of my patients, and another patient happened to be sitting at the table with us. I had never met her before, and I felt a very unique connection to her.

She mentioned she no longer drinks because no one likes being around her when she drinks. This patient went on describing her story, and I was able to relate on a very personal level. I understood her intimately, as my family and friends have been telling me how great I am to be around since I’ve stopped drinking.

Through the PHP, I feel like I am finally in a place where I have always wanted to be. I feel happier than I ever have before. Mainly, I am grateful to the PHP for making me a better person, and I know I will be a better doctor. —Anonymous

Go to www.foundationpamedsoc.org every month throughout the year to read new stories and donate online. ◆

Kerry Royer is editor-in-chief of Pennsylvania Physician and communications director of the Foundation of the Pennsylvania Medical Society.

The Physicians’ Health Program (PHP), a program of The Foundation of the Pennsylvania Medical Society, the charitable arm of PAMED, provides support and advocacy to physicians struggling with addiction or physical or mental challenges. The program also offers information and support to the families of impaired physicians and encourages their involvement in the recovery process.

SAVING LIVES AND CAREERSFor 30 years, the PHP has helped more than 3,000 physicians enjoy life without drugs or alcohol and continue successful careers.

To learn how you can make a difference by contributing to the PHP Endowment, contact Marjorie Lamberson, CFRE, at [email protected] or (717) 558-7846. Or mail your gift to:The Foundation of the Pennsylvania Medical SocietyPhysicians’ Health Program Endowment Campaign777 East Park DriveP.O. Box 8820Harrisburg, PA 17105-8820

777 East Park Drive • Harrisburg, PA 17105-8820

“ONE IN TEN people suffer from addiction. At any time, there could be

as many as 3,000 doctors in the state whom we could be helping.”

Raymond Truex Jr., MD, FAANS, FACS

PHP is a program of The Foundation of the Pennsylvania Medical Society – the charitable arm of PAMED. The program assists all physicians, physician assistants, medical students, dentists, dental hygienists, and expanded function dental assistants.

Contact the PHP at (717) 558-7819 or

[email protected].

The official registration and financial information of the Foundation may

be obtained from the Pennsylvania Department of State, Bureau of Charitable

Organizations, by calling toll-free within Pennsylvania, (800) 732-0999. Registration

does not imply endorsement.

“Physicians, like the rest of the population, are vulnerable

to chemical dependency, physical disability or breakdowns in mental

health. Your support of the 30 Years of Change Campaign

will make sure the Physicians’ Health Program will always be available to our

fellow health care providers.”

Raymond Truex Jr., MD, FAANS, FACS, Honorary Chair of

2016 PHP 30 Years of Change Campaign

WHY SHOULD I SUPPORT THE PHP?

• For 30 years the PHP has provided confidential support, monitoring and advocacy to those who may be struggling with addiction or physical or mental challenge.

• The PHP relies on contributions from physicians, hospitals and others so that the cost to the participant can be kept as low as possible during challenging times.

• Your gift TODAY is an investment in an established endowment ensuring that the PHP will have funding support in perpetuity.

• Your gift provides a transformational opportunity for your fellow health care providers who deserve a chance to live life in recovery

and good health.

HOW CAN I HELP? Please consider a gift to the PHP in honor of this anniversary to ensure that physicians will always have a place to go to when help is needed. Let’s make the most of it! In celebration of this milestone, the campaign has received a $30,000 challenge grant from an anonymous physician – by making your gift TODAY you will help us to take full advantage of this generous matching fund opportunity!

Go to www.foundationpamedsoc.org to see true stories of transformation and recovery.

If you want to learn more about how to make a contribution to the PHP Endowment, visit www.foundationpamedsoc.org. You can also contact Director of Philanthropy

Margie Lamberson, CFRE, at [email protected] or 717-558-7846.

The Foundation of the Pennsylvania Medical Society

30 Years of Change – Transforming Lives

HEALTHPhysicians’

Program


CONSULTING PHYSICIAN

THE EVOLUTION OF THE ELECTRONIC HEALTH RECORD

BY LINDA BENNER

Electronic health records (EHRs), like all computerized technologies, have undergone rapid transformation over the past 20 years. The evolution of the EHR has taken an accelerated track since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in January 2009. This was a $30 billion effort to transform health care delivery through the widespread use of EHR technology. Tying incentives to the effort through the establishment of Meaningful Use (MU) also helped drive the transformation.

HISTORY OF THE EHRThe history of EHRs in the U.S. goes back almost 50 years. Early efforts include:

• Lockheed Corp.’s creation of the system that eventually became Eclipsys, now part of Allscripts (1971)

• The Health Evaluation through Logical Processing System (HELPS) from the University of

Utah, 3M, and the Latter Day Saints Hospital (early 1970s)

• The Regenstrief Medical Records system from the Regenstrief Institute in Indianapolis, which introduced the incorporation of structured data such as laboratory and pharmacy data into the medical record (ca. 1972)

• The Department of Medicine & Surgery’s Computer-Assisted System Staff (CASS) Office (1977), which evolved into the Veterans Health Information Systems and Technology Architecture (VistA, early 1980s)

While systems have matured and continue to exploit advancements in hardware and software technology quickly, EHR adoption among providers has not kept pace. Fragmentation of health care delivery has allowed each hospital and physician to practice medicine in their own way, encouraging the customization of EHRs according to the particular needs of a single physician

or hospital. EHR systems have not become standardized because their users are not standardized, and it has created an issue in regard to common technical standards, guidelines, and measurement capabilities for population health.

In 1991, the Institute of Medicine (IOM) published The Computer-Based Patient Record: An Essential Technology for Health Care, giving new life to the way in which we view EHRs. In it, the authors noted barriers related to EHR systems and other, non-technical obstacles to adoption. The technical barriers were grouped into three categories: disparate definitions of an EHR, poor system usability, and lack of standards. At the time, EHRs were electronic versions of paper records — sort of an electronic filing cabinet that mimicked the existing recordkeeping approaches, typically dictation-focused, paper-based systems.

Little time was spent developing workflows appropriate to an electronic medium; subsequently, paper-based



workflows were force-fitted into computer-based systems. Lack of common standards for content and format prevented data-sharing across care settings. “Until standards exist for uniquely identifying individuals and coding and exchanging health data, the value for capturing and aggregating data will go unrealized, and each organization will be its own pioneer,” IOM warned.

HITECH’S EFFECTSHITECH introduced the term Meaningful Use, and beginning with the 2011 calendar year, the Centers for Medicare and Medicaid Services (CMS) offered incentives to physicians who invested in EHR systems. This was a major step forward in implementing standards for EHRs and their use. In order to qualify for these (substantial) incentives, the individual provider had to meet a certain set of criteria. The main focus of HITECH MU requirements was to:

• Improve quality, safety, and efficiency, and reduce health disparities

• Engage patients and families• Improve care coordination, as well

as population and public health• Maintain privacy and security of

patient health informationThe objectives and measures designed

to meet this focus have been tweaked and refined over the last few years. To transition into this new frontier, MU requirements started with Stage 1 — the first step toward health information and quality reporting. Stage 2 stepped up the requirements, implementing flexibility options for 2014. Additional adjustments to Stage 2 came about as a result of the Final Rule in 2015, which introduced the term “Modified Stage 2.” This change streamlined the measures, so that both Stage 1 and Stage 2 providers reported on the same measures. The Final Rule wasn’t enacted until mid-October, however, leaving providers little time

to make the changes necessary to meet the revised requirements.

Beginning with the 2015 calendar year, instead of beginning to “receive incentive payments,” practices’ focus became “trying to avoid payment adjustments.” This was the first year that eligible professionals received a payment adjustment for not successfully meeting MU goals, based on 2013 attestations.PAMED was among the stakeholders that advocated for a law signed into effect by President Obama — the Patient Access and Medicare Protection Act — that included a provision granting CMS the authority to expedite applications for exemptions from MU Stage 2 requirements for the 2015 calendar year.

In January 2016, CMS provided a new, streamlined application for its hardship exemption, reducing the amount of information needed to complete the application. Multiple physicians can be listed on the same application, provided they list the same hardship. Physicians unable to meet MU requirements in 2015 due to the timing of the publication of the Final Rule are allowed to apply for hardship exemptions. The hardship application deadline is July 1, 2016. Learn more at www.pamedsoc.org/MUhardship.

THE FUTURE OF EHRS So where does that leave us? When questioned, many providers have a hard time justifying the benefits of an EHR. Some say that while it was a hard transition, they would never go back to paper. Others feel that the process has been onerous and invasive, and have decided to take the penalties associated with not adopting EHRs.

What is the future of Meaningful Use? Rumors abound that we may see an end to it before Stage 3, so how will that affect payment methodologies already in process? In January 2016, CMS Acting Administrator Andy Slavitt outlined

four themes guiding the implementation of a replacement program:

• Focus on Outcomes: The focus will move away from rewarding providers for the use of technology and toward the outcomes they achieve with patients.

• User-Centered, Customizable Technology: Providers will be able to customize their goals so tech companies can build around the needs of an individual practice, not the needs of the government. The technology must be user-centric and support physicians instead of distracting them.

• Level the Playing Field for Start-Ups and New Entrants: The goal is to make it easy to connect to new apps, analytic tools, and plug-ins, so that data can be securely accessed and directed where and when it is needed in order to support patient care.

• Interoperability: CMS will begin initiatives in collaboration with physicians and consumers to focus on real-world uses of technology, such as closing referral loops and patient engagement. And it will not tolerate “data blocking” — preventing one computer system from talking to another.

Whether or not we continue down the MU path, implementing an EHR is the first step toward the future of health care. Payment methodologies are changing, and in order to avoid getting caught up in compounding payment adjustments, EHRs will be an integral part of that change.

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) reforms Medicare payments through three important changes in how Medicare payments are awarded to care for Medicare beneficiaries. These changes include:

• Ending the Sustainable Growth Rate (SGR) formula for



determining Medicare payments for health care providers’ services

• Making a new framework for rewarding health care providers for giving better care vs. more care (Volume-to-Value) [Editor’s note: PAMED members have access to a six-part CME series to help them enhance the skills necessary to succeed in the volume to value transition. Learn more at www.pamedsoc.org/valuebasedcare.]

• Combining existing quality reporting programs into one new system (PQRS, MU, VBM)

MACRA reform will be realized via two streamlined processes:

• Merit-Based Incentive Payment System (MIPS) — Learn more about MIPS in the Fall 2015 issue of Pennsylvania Physician,

pp. 10-12, available online at www.pamedsoc.org/fall2015.

• Alternative Payment Models (APMs)

Under MIPS, the existing Physician Quality Reporting System (PQRS), the value-based payment modifier (VBM) and the Medicare EHR incentive programs will be rolled into one single program based on:

• Quality• Resource usage• Clinical practice improvement• Meaningful Use of certified EHR

technologyUnder APMs, a new way to pay

health care providers for the care they give Medicare beneficiaries is being devised. Some examples of APMs include:

• Accountable Care Organizations (ACOs)

• Patient Centered Medical Homes (PCMHs)

• Bundled payment modelsAs you can see, the way we view

the business of medicine today is not necessarily the way we will view it tomorrow. Payment methodologies are changing, and incorporating the use of clinical data into the ways reimbursements are paid is the future. EHRs are poised for significant changes in the coming decade, as technology evolves and the health care system reforms. As a source of health care information, the effective use of EHRs has the potential to transform every aspect of health care in the United States. ◆

Linda Benner, CPC, CPMA, CASCC, COBGC is an AHIMA-Approved ICD-10-CM/PCS trainer.

Send the Pennsylvania Medical Society (PAMED) your nominations for a new program that honors our state’s top early career physicians.

Award Rules • PAMED member under the age of 40 • Leader and mentor for other early career physicians • Advances medicine or patient care, or serves their

community either through employment or volunteer work

Go to www.pamedsoc.org/Physician40U40 to learn more and complete nomination form.

Nomination Deadline: May 15, 2016

Section Process: A committee will review candidates. Awards recipients will be notified over the summer. Each recipient will receive a plaque, which will be presented at their local county medical society meeting. Each recipient will also be recognized at PAMED’s 2016 House of Delegates in October in Hershey, Pa.

Questions? Contact Stacia Pearce, associate director, hospital & healthsystem physician engagement, at [email protected].

UNDER 4

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ICIAN

40

WHO ARE THE BEST 40 PENNSYLVANIA

PHYSICIANS

UNDER 40?

Change is really beginning to happen

at the speed of light. A lot of it is going

to happen at the ground level, so this

content really enabled me to think more

intelligently about what I can do locally,

with my hospital, with my elected

representatives, to advocate for the

right decision making. We’ll get there,

but I think we’ll get there more quickly

and with fewer speed bumps if

doctors are as engaged as this

education can enable them to be.

Jaan Sidorov, MD PAMED member

Regardless of your practice type, specialty, or location, to succeed in value-based delivery will take investments of your money, time, energy, and the learning of new skill sets.

Where Can I Hone These Skills?The Pennsylvania Medical Society (PAMED) offers educational programs to help ensure you have the skills necessary to succeed in the transition from volume to value.

Addressing Physician Uncertainty about Payment Reform: Skills for Success in Value-Based Delivery Systems Six online, on-demand courses facilitated by PAMED member Ray Fabius, MD, a nationally respected expert in quality and population health. Earn up to 1 hour of CME for each online course.

Making Sure You Have the Skills to SucceedValueFromVolume to

EFFICIENCYEFFECTIVENESS

EXPERIENCE

Member Cost 6 online, on-demand courses – FREE

www.pamedsoc.org/valuebasedcare

Non-member Cost* 6 online, on-demand courses – $199

www.pamedsoc.org/store

Members Save More! You may be eligible for introductory membership for $95. Join now and get the online courses for free. Join at www.pamedsoc.org/join or by calling PAMED’s Knowledge Center at 855-PAMED4U (855-726-3348).

*


LIFE AFTER MEDICINE

WITH AGE COMES WISDOM

BY KERRY ROYER

In early 2016, Raymond Grandon, MD — at age 96, one of the world’s oldest practicing physicians — decided to retire from treating patients at his Harrisburg, Pa., office, where he had practiced since 1950. Prior to opening his office, he had served in the U.S. Army, and completed a residency in internal medicine at the Harrisburg Hospital.

During the more than six decades that his “The Doctor Is In” sign appeared on the door, Dr. Grandon demonstrated a commitment to the ever-evolving profession by paving the way for physicians to follow in his footsteps. His advice for today’s doctors? “Enjoy people, help them, and savor the challenges of medicine.”

The medical profession comprises generations of people who stand on the shoulders of those who practiced before them, he says. They learn, practice, and then teach and mentor those who choose to carry on in this noble pursuit.

Dr. Grandon’s office is in the center of downtown Harrisburg, looking east toward the historic state Capitol building, and west toward the mighty Susquehanna River. The three-story brick building has hosted multiple generations of patients, and was once

owned by Ramsay Black, Assistant Postmaster General under presidents Franklin Roosevelt and Harry Truman, and later Pennsylvania’s state treasurer.

When he first hung his shingle, Dr. Grandon was one of 22 physicians in an area of the city then called “Doctor’s Row.” The neighborhood has since changed to include upscale restaurants,

trendy coffee shops, and attorneys’ offices; he was the last physician on the block.

Dr. Grandon’s decision to retire was spurred by the advent of EHRs, and his health is not what it once was. But he is not finished with medicine; his love for it continues as he reviews his files and writes about the interesting cases he has come across. Dr. Grandon treated patients’ changing needs as they advanced through life, became parents, and dealt with disease, and he plans to publish his papers or a book that shares his experience and knowledge.

Dr. Grandon says that treating patients is a fundamentally altruistic pursuit. Doctors are not going to see the same kind of compensation they have seen in the past, and he is concerned about future physicians and the large debts they incur for medical school. He believes doctors are being

driven to large system practices that dictate how they care for patients based on economics. Dr. Grandon’s experience was far different. He generally spent at least a half-hour with each patient to help them develop a global approach to their health. As an uncle once told him at the age of seven, “You will always be able to help people.”

Dr. Grandon has served as president of PAMED and in several other state and national leadership positions. He has also shared generously: He is a Foundation Fellow of the Foundation of the Pennsylvania Medical Society, making long-term gifts to the charitable arm of PAMED. He and his wife Doris, age 93, have also endowed his medical school alma mater, establishing a Professorship of Health Policy at Philadelphia’s Thomas Jefferson University (now Sidney Kimmel Medical College), from which he graduated in 1945.

As an uncle once told him at the age of seven, “You will always be able to help people.”

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David Nash, MD, MBA, dean of the Jefferson College of Population Health, has held the professorship since 2003. He says that Dr. Grandon’s clinical career spanned revolutions in health care from the post-WWII explosion in scientific research to the creation of Medicare and Medicaid in 1965, and from the introduction of the “DRG” reimbursement system in 1983 to the passage of the Affordable Care Act in 2010. “What is particularly remarkable is that Dr. Grandon was actually a practicing physician throughout this evolution,” Dr. Nash says.

Looking back, Dr. Grandon is proud to have been involved in health care policy at the AMA, having served as Chairman of the AMA Medical Legal Committee for seven years. As president of the Tri-County Heart Association, he orchestrated the first televised cardiac surgical operation, which was performed at the Presbyterian Hospital in Philadelphia and transmitted to the Harrisburg area.

Another first for Dr. Grandon was when he served as president of the Harrisburg Academy of Medicine, and invited a Patriot Evening News reporter to attend its Medical Education lectures to help educate the public.

Dr. Grandon notes that another change he sees is that now more than 50 percent of the students in medical school classes are women. This represents a change in family life, he says, and physicians face many challenges in balancing professional and personal pursuits. “Hopefully, they can strike more balance in their life and not have to be ‘on’ 24 hours, as in my day,” he says. ◆

Kerry Royer is editor-in-chief of Pennsylvania Physician and communications director of the Foundation of the Pennsylvania Medical Society.

ON CALLBoard of Trustees Meeting

MAY 17, 2016PAMED Opioid Awareness Day, Harrisburg Capitol

MAY 18, 2016 PAMED Headquarters, Harrisburg, Pa.

AUG. 16-17, 2016 PAMED Headquarters, Harrisburg, Pa.

OCT. 21-23, 2016 Hershey Lodge, Hershey, Pa.

CMO Leadership SeriesJUNE 2016 – AUG. 2017

For CMOs, Medical Directors, Chiefs of Staff, and VPs for Medical Affairs

COURSES INCLUDE:

Crucial Conversations: Establishing Accountability, Expectations, and Consequences

Physician Career Cycle Challenges: Managing the Competency and Performance of Resident and Senior Physicians

Two Hats, One Team: Challenges Associated with the Dual Roles of Administrator and Clinician

Navigating Physician Relationships: Employed Versus Independent Physicians

PHOs and ACOs: Best Practices in Health Care Team Interactions

Being the Team Leader When You’re Not the Subject Matter Expert: Best Practices in Managing Project Teams

Improving Patient Experience and Engagement: Moving Patients and Providers to Action

Learn more and register at www.pamedsoc.org/CMOLeadership

2016-2017 Year-Round Leadership AcademySEPT. 2016 – JUNE 2017

Eight online courses, plus the following in-person day-long live sessions:

Oct. 14, 2016: Transforming Conflict, Restoring Productivity

April 7, 2017: Physician in Management: Negotiation

June 23, 2017: Building and Leading Effective Teams

Learn more and register at www.pamedsoc.org/YRA. Scholarships are available.

2016 House of Delegates & Annual Education ConferenceOCT. 21 – 23, 2016

Hershey Lodge, Hershey, Pa.www.pamedsoc.org/hod

www.pamedsoc.org/calendar


MEDICINE BAG

PENNSYLVANIA PHYSICIANS: THE UNSUNG HEROES OF PAMED CME

Have you ever wondered how a PAMED CME course is brought to life? As you can imagine, there’s a lot of behind-the-scenes work that happens to bring a new CME activity to members.

When a concept for a new activity is under consideration, the first question is always “what patient safety or risk management issue for physicians does this activity address?” First, it must address patient safety and risk management issues. Physician practice challenges are identified through several channels including an examination of legislative actions, liability risk assessment data, and member feedback.

Finally, an activity has to meet the following organizational goal: To advance physician leadership, enhance professional satisfaction, promote the delivery of affordable, quality health care, and strengthen the physician-patient relationship by providing training and other resources for physicians and physicians-in-training that address needs associated with the practice, business, and life of medicine.

Who puts the final stamp of approval on a CME activity? PAMED member physicians who volunteer their services to PAMED’s Council on CME. The Council is a diverse group of 12 men and women that includes a private practice physician and physicians from large and small health care systems. In some cases, members have served for a decade or more. Whether a new member to the Council or a seasoned veteran, these physician volunteers are all committed to helping PAMED provide members with quality educational products.

The final CME product is the result of careful discussion and collaboration. PAMED recently asked Council members the question, “Why do you serve?”

Donald Hess, MD, a preventive medicine physician in Williamsport,

Pa., says, “Initially, I wanted to be part of the Council because I wanted to be part of a ‘community of practice’ — to get to know and learn from other physicians who were involved with CME. It has been such a valuable experience for me that I didn’t realize until recently that I was considered a volunteer.”

Council member Joel C. Rosenfeld, MD, chief academic officer for St. Luke’s University Health Network in Bethlehem Pa., was inspired to serve because of his interest in medical education. “The education of a physician does not end with medical school, residency, and fellowship training,” he says. “Post-graduate, continuing medical education enables the physician to keep his/her knowledge and skills up to date, so that patients receive the best possible treatment.”

So when you’re taking PAMED’s courses addressing Pennsylvania’s opioid abuse crisis or child abuse recognition and reporting, take a moment to remember the physicians who work behind the scenes to ensure a quality finished product. They’re the unsung heroes of PAMED CME. ◆

WHAT MEMBERS ARE SAYING ABOUT PAMED’S CME ACTIVITIES

“PAMED CME is an excellent, educational, reliable source for CME credits.”—Judith Wolfe, MDJohnstown, Pa.PAMED member since 1986

“MyPAMED is CME that is timely, convenient, and easy to use. It has helped me get the necessary patient safety CME credits I needed, and allowed me to earn those credits at my own pace. Many of the case examples made the lessons much less about ‘checking the box’ and more about helping the patient. It’s definitely a plus for me when requirements can be made less burdensome and more clinically relevant. PAMED CME does just that.” —Kurt Miceli, MD Chester, Pa.PAMED member since 2011

“Child abuse is not rare, and it does not discriminate”

CMECHILDABUSE

REPORTING

www.pamedsoc.org/childabusecme

MANDATORY TRAINING3 hours – New license 2 hours – Renew license

As of Jan. 1, 2015, Pennsylvania physicians

are required—as a condition of licensure—

to complete an approved Department of

Human Services course on the topic of

mandated child abuse recognition

and reporting.

PAMED’s online, on-demand child abuse

reporting education is the best choice

for physicians.

Here’s why:

Designed specifically for physicians

FREE for all Pennsylvania physicians

Offers options for both two and three

hours of education

Includes eight case studies, such as

scenarios outside of clinical practice

like coaching


PAMED PULSE

A CONVERSATION WITH MARY STOCK KEISTER, MD, ON WORK/LIFE BALANCE

PAMED recently caught up with PAMED member Mary Stock Keister, MD, a family physician who practices in Bethlehem, Pa. Dr. Stock Keister is a Young Physician Scholarship recipient for the 2015-2016 session of PAMED’s Year-Round Leadership Academy. She is also active in her state specialty society, the Pennsylvania Academy of Family Physicians (PAFP).

HER APPROACH TO WORK/LIFE BALANCE While acknowledging that work/life balance is often elusive, Dr. Stock Keister offers some strategies that have worked for her and her husband, who is also a physician. Work/life balance is not something static, she says; it’s a long-term concept that changes all the time. “Every once in a while, you’re going to have to re-evaluate how everything is working. Make allowances for changes in your life.

“Know your own values,” Dr. Stock Keister adds. She feels that your values can help you figure out what you’re going to need in terms of things like childcare and financial decisions.

ON WORKING AS A PHYSICIAN PART-TIME Dr. Stock Keister has been working approximately three days a week since

2010. She made the decision primarily to spend more time with her two children. She has time during the week to run errands, prepare family meals, and take care of responsibilities outside of work, freeing up the weekends for family time.

She acknowledges that there are pros and cons to being a part-time physician. It can be challenging for career advancement, but she knows that she will have the option to make changes to her work schedule as her children get older. In the meantime, she finds other ways — such as PAMED’s Year-Round Leadership Academy — to gain valuable experience as a leader.

ON USING TECHNOLOGY TO MAKE BALANCE EASIERWhen it comes to social media and technology, Dr. Stock Keister knows that society is going through a cultural shift. Technology has become a part of everyday life in her household. She and her husband try maintain a family schedule using Google Calendar, for example.

Her favorite apps and websites, though, are the ones that save her time and aggravation. She’s become a huge fan of online grocery shopping, enjoying the convenience of being able to shop online and pick up her order instead of fighting crowds at the grocery store. ◆

PAMED RESOURCESLOOKING FOR RESOURCES TO HELP WITH WORK/LIFE BALANCE?

The Pennsylvania Physician Podcast. The first three episodes feature interviews with couples who have at least one physician in the family, sharing strategies for navigating challenges. Plus, episodes featuring the latest news can save you time by identifying issues that may impact your practice and patients. www.pamedsoc.org/podcast.

Education to help identify, cope with and prevent physician burnout — and get CME, too! Visit www.pamedsoc.org/lifeofmedicine.

LOOKING FOR RESOURCES TO ENHANCE YOUR LEADERSHIP SKILLS?

PAMED’s Year-Round Leadership Academy (YRA). The YRA is a year-long, comprehensive leadership training program that provides physicians with broad, practical leadership training, facilitates networking and mentoring, and can help physicians resolve challenges. It includes eight online courses and three day-long live sessions. Learn more on Page 43 and register at www.pamedsoc.org/YRA. Scholarships are available.

CMO Leadership Series. This 15-month, comprehensive training and networking series is designed for CMOs , Medical Directors, Chiefs of Staff, and VPs for Medical Affairs wishing to sharpen their leadership skills. Learn more on Page 33 and register at www.pamedsoc.org/CMOLeadership.

Members receive updates on the latest news and resources for Pennsylvania physicians, including tools for work/life balance. If you are not a current PAMED member, join the PAMED community at joinnow.pamedsoc.org. You may be eligible for a one-time introductory membership offer of $95.

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PSTE

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P

PAMED—Your Partner on Your Path to License RenewalFind Innovative Solutions • Meet Patient Safety Requirements • Sharpen Your Skills

Pennsylvania Medical Society (PAMED) members can access 50+ free and discounted CME credits at www.pamedsoc.org/cme2016

Step 4: Organize your CME activity online at www.pamedsoc.org/tracker. Easily record all Category 1 and Category 2 activities in one location.

STEP 1: It’s a licensure renewal year, and the deadline to meet this cycle’s CME requirements will be here before you know it. Take advantage of PAMED’s activities, all designed to meet patient safety and risk management requirements. New activities added frequently!

Access online, on-demand CME courses you can use to:

• Address PA’s opioid abuse crisis

• Get skills to succeed in value-based care

• Become a better physician advocate

• Improve patient satisfaction scores

and much more!

Step 2: Complete training on child abuse recognition and reporting, required for physicians as a condition of licensure in Pennsylvania. This online CME program is just for physicians.

• FREE for all PA physicians

• Offers options for both two hours (license renewal) and three hours (new license)

Step 3: Learn leadership skills through education

you can customize to meet your needs.

• Year-Round Leadership Academy—Join physicians from across the state for comprehensive leadership training on topics like strategic planning, negotiation, and building collaborative teams

• Online, on-demand courses—Learn more about issues such as ethical challenges, financial management, and quality improvement

• Onsite leadership training—Provide the physicians in your practice or health system with customized, cost-effective training at your location

www.pamedsoc.org • 855-PAMED4U (855-726-3348)

Access multiple patient safety CME credits in one handy compendium,

PAMED’s CME Consult, available in both print and online.


STRONG MEDICINE

BURNOUT AND BALANCE: IS HAPPINESS POSSIBLE?

Most physicians enter medical school because they want to help others with yet-to-be acquired knowledge, skills, and experience. There, we absorb the knowledge recorded in thousands of pages of books, as well as the experience and skills of our older, more experienced future colleagues.

We endure long hours and tremendous amounts of work, then a residency in our chosen future profession. And we hope that as time passes and seniority increases, the burden of training will change into the burden of using that training for good. The goal is to use our hard-won skills and experience to help.

Many of us have finally achieved that goal. So why are many of us burned out — or close to it?

Many physicians blame the system — and the regulations, requirements, paperwork, EHRs, authorizations, and other, seemingly endless non-clinical tasks that are part of our jobs. Few of us dislike seeing patients, but most of us dislike the associated, seemingly

unproductive busy work that goes with that. “Just let me do my job,” we say.

To meet numerical targets, we often see patients as problems to be processed as quickly as possible instead of as individuals with problems — or as obstacles in the path of minimizing the work we do for the hours we get paid.

Patients who want what they want regardless of what’s best are part of the problem. And a system that produces pressure to do better often highlights only our shortcomings, without taking stock of the good we have done.

Is it possible to accept the burden of regulation as part of the job, and still find joy in doing it? Is it possible to jump off the hamster wheel and engage with every patient, with the idea that we are there to help? Is it possible to fall short of certain measurements without losing sight of our successes and accomplishments?

STEPS AGAINST BURNOUTTo save yourself from burnout, remember this version of the serenity prayer: “Give me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Let’s break that down: First, you may not be able to change the onslaught of regulations, EHRs, and paperwork, but maybe you can minimize your personal involvement, delegate tasks, hire a scribe, or find other ways to get those tasks done.

Next, grant yourself control. You may be at the mercy of the powers that manage care and issue payment, but you can also exercise great control over elements of your practice. Having the wisdom to know the difference is

key, as is having the courage to change the things you can. Speeding through your day to hit assigned numbers and depersonalizing your interactions is not the way to go. What can you change to continue in a more fulfilling way?

Are you willing to take less pay, work fewer hours to have more time with your family, or explore alternatives to your current employment situation? Some of the happiest physicians I know have “escaped” the system and practice under alternative payment arrangements.

Does your employer encourage you to address these problems? If you’ve tried and failed to make your voice heard, you may need to make a change. Are you willing to pull up roots in search of a better arrangement? If not, seek the serenity to accept that you are not willing to do that right now, and accept the trade-offs.

Ask yourself what you want, what kind of health system or employment arrangement would help you make at least some of those wants into realities, and seek it out or make the most of where you are. Cultivate the wisdom to know the difference between what you can and cannot change.

Lead yourself out — follow by accepting the situation as it is, or get out of your own way by asking for advice from those who have been there. But don’t just sit there and suffer. ◆

Gus Geraci MD, FAAFP, FAIHQ, CHCQM, CPE, is consulting clinical advisor for PAMED. He is vice president of medical affairs and chief medical officer at Molina Healthcare. Read his blog at www.pamedsoc.org/qualityblog, and email him at [email protected].

GUS GERACI, MD, FAAFP, FAIHQ, CHCQM, CPE

As fellow clinicians—

Now, one call is all you need to get into the Milton S. Hershey Medical Center system via MD Network:

1-800-233-4082 (WANT TO CONNECT TO PEDIATRIC PROVIDERS? SIMPLY PRESS ‘4’ FOR KIDS TO BE CONNECTED

TO PENN STATE CHILDREN’S HOSPITAL.)

For the families you serve

what inspires you, inspires us.

For more information, please visit the MD Network web page at PennStateHershey.org/mdnetwork.

MD Network is reserved for clinicians and office support staff only.

MC 9706-16

Penn State Health’s MD Network serves as a resource to referring providers at any stage of the referral relationship.

This project is being funded by a grant received from the Pennsylvania Department of Health.

FREE Continuing Education about Concussion Prevention and management for the first 400 physicians to sign up; a $59.99 value. Online at your convenience. Visit concussionwise.com/pats

This course is designed for physicians and provides a basic overview of concussion etiology, pathophysiology, diagnosis, and initial management. The Pennsylvania Medical Society designates this enduring material for a maximum of 2 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This program is brought to you by the Pennsylvania Athletic Trainers’ Society in conjunction with the Pennsylvania Medical Society.

Increase the quality of care for the physically active individual within the Commonwealth.

248,418 estimated children In 2009 (age 19 or younger), were treated in U.S. EDs for sports and recreation-related injuries that included a diagnosis of concussion or traumatic brain injury

138 PEOPLEin the United States, every day, die from injuries that include traumatic brain injury

PATS_PAMED_Summer.indd 2 5/19/15 2:23 PM


LIFE IN THE BALANCE




THANK YOU

for your 2016

membership!


LIFE IN THE BALANCE




You aren’t a

member yet?

Please join at

JoinNow.pamedsoc.org!

life in the balance

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