January 2011 - Allegheny County Medical Society

Transcription

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BULLETIN
January 2011
Vol. 101 No. 1
of the Allegheny County Medical Society
ARTICLES
PERSPECTIVES
DEPARTMENTS
Feature ...................................... 22
Editorial ....................................... 6
Society News ............................. 15
2011 ACMS President and Other Officers
Helmet to Helmet
Frank Vertosick, MD
♦ Ophthalmology, December
♦ Ob/Gyn, December
Long-Term Care: An Issue You Can’t Afford
to Avoid
Malachy Whalen
President’s Message .................. 10
ACMS Alliance Update ............. 17
Health Care Peregrinations
Leo R. McCafferty, MD
Activities & Accolades ............... 19
Feature ...................................... 30
Medical Student Musings .......... 12
In Memoriam............................ 19
2010 Year-in-Review
Providing a Forum for Expression
Alan Rosenbaum
E. David Cherup, MD
Financial Health ........................ 26
Profile ........................................ 36
Dear Doctor .............................. 19
Leo R. McCafferty, MD—Physician, Advocate,
Musician, Family Man
Christina E. Morton
Calendar .................................... 21
Board of Directors .................... 40
Special Report............................ 38
Medical Records Reproduction Fees
Classifieds ................................. 42
GRAND PRIZE WINNER
2010 Bulletin Photo Contest
“
If you learn from a
mistake, it really
wasn’t a mistake
after all.
—Vince Lombardi
”
Cover Art:
Fall in Pennsylvania
by Elias Hilal, MD
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Dr. Hilal specializes in otolaryngology, head
and neck surgery.
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Bulletin
Affiliated with Pennsylvania Medical Society and American Medical Association
2011
Executive Committee and
Board of Directors
President
Leo R. McCafferty
President-elect
Rajiv R. Varma
Vice President
Amelia A. Paré
Secretary
Kevin O. Garrett
Treasurer
John P. Williams
Board Chair
John F. Delaney Jr.
DIRECTORS
2011
Melinda M. Campopiano
Doris K. Cope
David J. Deitrick
Donald B. Middleton
Karl R. Olsen
Adriana M. Selvaggio
G. Alan Yeasted
2012
Vijay K. Bahl
Sharon L. Goldstein
Adam J. Gordon
Lawrence R. John
Anthony Spinola
2013
Robert W. Bragdon
Douglas F. Clough
Christopher J. Daly
Steve Evans
Adele L. Towers
PEER REVIEW BOARD
2011
Krishnan A. Gopal
William M. Swartz
2012
Dennis F. Stull
Bruce L. Wilder
2013
Judith S. Black
James E. Wilberger Jr.
PMS DISTRICT TRUSTEE
Paul W. Dishart
COMMITTEES
Bylaws
Amelia A. Paré
Communications
Amelia A. Paré
Finance
G. Alan Yeasted
Membership
Sharon L. Goldstein
Nominating
Christopher J. Daly
Occupational Medicine
Joseph J. Schwerha
Primary Care
Lawrence John
Anthony Spinola
ADMINISTRATIVE STAFF
Executive Director
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(jkrah@acms.org)
Assistant to the Director
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Bookkeeper
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Communications
Bulletin Managing Editor
Linda L. Smith
(lsmith@acms.org)
Assistant Executive Director,
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Services
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(jireland@acms.org)
Manager
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(dmeister@acms.org)
Field Representative
Nadine M. Popovich
(npopovich@acms.org)
Medical Editor
Scott Miller
(millers8@upmc.edu)
Associate Editors
Melinda M. Campopiano
(campopianomm@gmail.com)
Fredric Jarrett
(jarrettf@upmc.edu)
Timothy Lesaca
(tlesaca@hotmail.com
Deval Paranjpe
(reshma_paranjpe@hotmail.com)
Stuart G. Tauberg
(tlindsey@nb.net)
Frank Vertosick
(vertosick@acms.org)
Gary S. Weinstein
(garyweinsteinmd@aol.com)
Michael W. Weiss
(mww@tririversortho.com)
Managing Editor
Linda L. Smith
(lsmith@acms.org)
Contributing Editors
(bulletin@acms.org)
Gregory B. Patrick
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Carey T. Vinson
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Joyce Orr
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Corresponding Secretary
Doris Delserone
Treasurer
Josephine Martinez
Assistant Treasurer
Sandra Da Costa
www.acms.org.
Leadership and Advocacy for Patients and Physicians
EDITORIAL/ADVERTISING
OFFICES: Bulletin of the Allegheny County Medical Society, 713
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The Bulletin of the Allegheny County
Medical Society welcomes contributions from readers, physicians, medical students, members of allied professions, spouses, etc. Items may be
letters, informal clinical reports, editorials, or articles. Contributions are
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ALLEGHENY COUNTY
MEDICAL SOCIETY
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ISSN: 0098-3772
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EDITORIAL
Helmet to Helmet
FRANK VERTOSICK,
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he phrase du jour of this past
football season was helmet to
helmet, symbolizing the increasingly
violent play that carries a higher risk
of brain injuries. Comedian Jerry
Seinfeld once joked that the helmet
may be the stupidest invention of all
time because it offers a false sense of
security. Nature gave us a wall of
solid bone around our brains,
Seinfeld reasoned, and any activity
that requires added protection should
probably be avoided.
Football was once a running
game played by small men wearing
minimal padding and leather helmets
without any face guards. The average
weight of a Pittsburgh Steeler offensive lineman in 1950 was less than
200 pounds, and even the revered
Jack Lambert weighed barely more
than 200 pounds during his career.
Today the game has become passoriented, thereby encouraging high
speed collisions between behemoths
emboldened by high tech body
armor and facial shields. The idea of
“tackling” an opponent has given way
to “hitting” him instead. Tackling
takes skill; hitting requires only blind
momentum, hence the trend to larger
and faster players.
As such, the NFL now finds
itself in a Catch 22. The increasingly
bloodthirsty public demands that the
“simulated warfare” of sport carry the
same hazards as real combat. How
else to explain the rising popularity of
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“ultimate fighting” and other socalled extreme sports? But realism is
taking its toll on professional players
and, by extension, the amateurs who
imitate them. Football at all levels
now faces an epidemic of concussions. To make matters worse,
emerging evidence suggests that even
minor concussions can have lasting
psychomotor consequences, particularly in younger brains. These effects,
albeit subtle, can be cumulative,
debilitating and possibly fatal. The
NFL officially discourages vicious
impacts; yet, while the front office
fines James Harrison $75,000 for
one such impact, the league’s website
simultaneously markets a glossy print
of it suitable for framing.
Ironically, the real problem lies
neither in the beefy NFL nor in any
major college program. In those
arenas, athletes are of consenting age
and their fully myelinated brains are
at less risk. Furthermore, they are
serviced by competent training staffs
and receive monetary compensation
for their risks in the form of scholarships or salaries. The real looming
disaster is at the high school level and
younger, where vast numbers of
poorly conditioned boys expose
themselves to long-term cognitive
problems under the guidance of
potentially undertrained staff. In fact,
with an estimated 70,000 high
school football concussions reported
annually, and an equal or greater
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number unreported, the disaster may
already be upon us.
The NFL can do what it wants;
it’s a free country, but they must be
aware that the style of play they
encourage necessarily trickles down to
the youngest, most vulnerable and
least skilled players. Every kid who
straps on pads thinks he’s headed for
Notre Dame and the pros, just as
every person who buys a lottery
ticket thinks he’s a dollar away from
playing golf with Donald Trump. It’s
all a big lie, of course; statistically,
few high school players get scholarships and virtually none of them will
be pros. Nevertheless, this fantasy
fuels the need to play the game like
the pros do: dangerously. Thus, each
fall legions of pencil-necked beginners anxiously go helmet-to-helmet
with each other, egged on by coaches
urging them to suck it up and deal
with the pain (i.e., hide it) like men.
High school teams can be grossly
mismatched, putting players of vastly
different sizes and skill levels on the
same field of battle, something
schools would never allow in, say,
wrestling. But schools see gate
revenue, parents see a paid college
education and the boys see glamour
and girls. A recent Toyota television
commercial shows a mother lauding
the company for sharing its knowledge of high speed auto crashes with
her son’s football program. We are
shown computer images of a brain
Bulletin :: January 2011
EDITORIAL
smashing into a windshield while the
mother coos, “That makes me feel a
little better about my son playing
football.” In other words, the mother
frankly admits she’s letting her son
electively play a sport that carries the
risks of a car crash. If that woman
owned a $1 million Ming vase, I
wonder if she would trust it inside
a Toyota-designed football helmet
during a game. But her son’s cerebrum, well, that’s different.
I’m not against violent sports.
I watch football, professional bull
riding and Ultimate Fighting as
much as the next guy, but high
schools don’t have PBR or UF
teams—at least not yet—and adults
can assume whatever risks they want.
But are children under 18, or their
parents, being told of the risks? Do
we even know all the risks yet? Of
course, proponents of youth football
can point to the fact that hundreds of
thousands of kids participate in
contact sports and yet society doesn’t
seem to be teeming with braindamaged adults (insert your own
sarcastic comment here). Nevertheless, the damage is there if one
bothers to look for it.
There are numerous anecdotal
cases of high school players experiencing demonstrable reduction of IQ
months, even years, after concussions.
Society doesn’t see the A student
struggling to get Bs or even Cs
because of a football trauma. In fact,
the media has until recently done a
good job obscuring the dangers of
high school contact sports. This
summer, to its credit, the Post Gazette addressed this issue, highlighting
instances where children had cogni-
tive damage severe enough to be held
back a calendar year in their studies,
and for what? If we tolerate sacrificing our children’s health on the altar
of sport, why stop with football?
Why not full-contact karate?
The attitude of sports medicine
to this epidemic is perplexing. Rather
than taking the correct stance—
namely that underage minors with
soft, unmyelinated brains should be
strongly discouraged from engaging
in adult recreational contact sports
that carry a clear risk of concussion
and long-term cognitive deficits—the
medical community has instead
become enablers. Sports medicine
often deals with short-term issues,
such as when a player can get back
onto the field again; that may overshadow what is the best medical care
continued on page 9
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Does
ACMS
Membership
Doo FFor
What D
oes ACM
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ship D
or Me?
ACMS members have exclusive access to vendors of physician
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quality and value, so you don’t have to.
Membership Group Insurance
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Malachy Whalen, 412.281.4050
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EDITORIAL (from page 7)
in the long-term. Incorporating
short-term team goals into medical
decision-making may be (arguably)
acceptable for pros but not for
amateurs. I’ve witnessed neurosurgeons debating whether an amateur with a fresh Jefferson fracture of
the cervical spine should be allowed
to play in an “important” game the
next day. “Well,” said one, “It is a
‘stable’ fracture, generally…” Huh?
As John McEnroe would say: YOU
CANNOT BE SERIOUS! The same
may be happening with brain injuries. When should a fifteen-year-old
boy who is knocked unconscious for
five minutes return to football? Does
any physician have the courage to say,
how about next year? Or when you
are eighteen and can appreciate the
risks you are taking for yourself?
How about never?
We, as a medical profession, have
no problem officially discouraging
adults from any number of activities
they find enjoyable, from smoking to
eating red meat. New York City even
wants to take salt shakers off restaurant tables because we are obviously
too stupid to know what’s good for
us. But for organized medicine to
take an official stand against a recreational activity that renders 140,000
of our precious children unconscious
every year, damaging many of them,
even killing a few… why, that would
be un-American! No, we’ll formulate
guidelines instead, really strict stuff,
like, “If your son gets knocked
senseless, he should wait a whole
week before he slams his head into
something again!” Don’t you feel
better knowing the best neuroscientists are on top of this problem?
The argument these scientists
make is that they are striving to
“minimize the risk of concussion” in
underage athletes. A valid point, but
here’s a better idea: Don’t play high
school football. Then the risk is zero.
In his recent biography, rock star
Keith Richards claims he found a way
to “minimize” the risk of heroin use.
Perhaps, with his help, we could
make that a safe sport too. The real
issue becomes not minimizing the
risk, but asking why any risks are
being taken in the first place. Who is
really benefiting from this epidemic?
Not the children, I fear. Remember,
this is your kid’s brain, not his ACL.
Aren’t football scholarships the
only way some kids go to college?
Studies suggest that only a small
fraction of football recruits graduate
and, even when they do, it’s often
with a marginally useful degree. And
there’s the little-mentioned flipside of
athletic free rides: The average football recruit at schools like Stanford
rarely meet the academic acceptance
criteria demanded of non-athlete
applicants. Given that most colleges
are overflowing, is it fair for a football player to edge out someone
better qualified academically? Besides,
if a boy can only afford college by
submitting to eight straight years of
head trauma, God help us. And a lot
of college educations have been paid
for by wages earned in the tobacco
industry, but that wouldn’t stop us
from shutting that industry down if
we could.
Boys under 18 serious about
football can learn the fundamental
skills of the game without being
constantly exposed to weekly, fullcontact games for four or more years
at their most vulnerable ages. Only
those men demonstrating solid
fundamentals and the necessary size
and conditioning would be eligible,
as adults, to begin full contact
training and enter a ladder system
into the pro ranks. This would not
harm the NFL, only high school and
college programs. This system works
for other high risk ventures like Indy
car racing. Somehow, skilled professionals emerge even when the local
high school doesn’t have a strong
Formula One program.
Of course, no one would listen if
the medical community came out
against children playing helmeted
contact sports like football and
hockey; life will go on as it always
has. No one listens to us about
cigarettes or exercising regularly
either, and at least we’d be true to our
mission. Taking a stand against
minors playing adult contact sports
doesn’t mean we would quit working
with organized sports to study and
reduce the problem. Our stance
against cigarettes doesn’t require us to
quit researching and treating smoking-related illnesses.
Life is a game of balancing
rewards versus informed risk. My
concern for the average high school
player is that the risks are great, the
rewards few and the “informed” part
almost non-existent. In the meantime, my recommendation to parents
is simple; follow the advice of
another comedian, the late George
Carlin: Never participate in any high
school sport in which an ambulance
has to be called to the field before
play even starts!
George was a wise man, wiser
than many brain surgeons I know.
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Dr. Vertosick is a semi-retired neurosurgeon
practicing in Washington County and associate
editor of the ACMS Bulletin. He can be reached
at vertosick@acms.org.
The opinion expressed in this column is
that of the writer and does not necessarily reflect the opinion of the Editorial
Board, the Bulletin, or the Allegheny
County Medical Society.
9
PRESIDENT’S MESSAGE
Health Care Peregrinations
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LEO R. MCCAFFERTY, MD
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am honored to be your president
and grateful for the chance to
serve. I joined the Allegheny County
Medical Society in 1990 when I
returned to Pittsburgh after training
and specializing as a plastic surgeon in
Miami. ACMS was the first organization I joined in Pennsylvania upon
my return. I still believe that was one
of the best decisions in my professional career. Becoming a member of
ACMS instantly made me feel at
home within the medical community
and gave me a voice in Allegheny
County and Pennsylvania health care.
As president of ACMS I welcome and encourage you to become
an active member of the society; if
you’re already a member, please
encourage your cohorts to join by
visiting www.acms.org or calling
(412) 321-5030.
There continue to be many
unresolved issues changing the face of
medicine nationwide such as medical
liability and Medicare payment
reform, as well as health care reform.
Share your opinions. Make your
voice heard. Organized medicine
provides the ideal platform for
physicians to join forces and work
together as a profession. ACMS is
there for you and your patients. The
society’s mission says it all—Leadership and Advocacy for Patients and
Physicians.
10
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The concept of reducing costs and improving
efficiency when it comes to patient care is
something most of us would like to achieve,
but at what cost?
I would like to take this opportunity to address some of the global
concerns that I have with the health
care reform law that passed about 10
months ago. There is perhaps too
much focus on cost savings and not
enough focus on promoting competition. The combined effect, I suggest, will ultimately take the wind
out of the sails of what has traditionally been recognized as the planet’s
best medical care.
A recent article in the New York
Times (November 20, 2010) addressed what some consumer advocates fear: that the health care law
could worsen some of the very
problems it was meant to solve by
reducing competition, driving up
costs and creating incentives for
physicians and hospitals to stint on
care in order to retain their costsaving bonuses.
These fears have been spurred by
the growing frenzy of mergers
involving hospitals, physician groups
and clinics eager to share costs and
savings while earning government
incentives for controlling costs.
The concept of reducing costs
and improving efficiency when it
comes to patient care is something
most of us would like to achieve, but
at what cost? While the new law
encourages doctors, hospitals and
other health care providers to come
together and jointly take responsibility for the cost and quality of care of
patients, I believe it must be done
without compromising basic tenets,
laws and values of American society.
Lawyers and lobbyists, in an
alarmingly unsettling movement, are
trying to persuade officials in Washington to relax or waive antitrust laws
that are intended to prevent health
care monopolies and to protect
against careless patient care and
fraudulent billing of patients or
Medicare. Some believe that the
current anti-trust laws are obstacles
that will make it difficult for hospitals to reward doctors for cutting
costs or following best practices.
Relaxing anti-trust laws is comparable
to relaxing freedom of speech or
PRESIDENT’S MESSAGE
other basic values cherished by
Americans. How would this affect
the care of the high risk/high cost
patient? Would care be rationed or
denied to keep costs down or to take
advantage of government-based
incentives?
Care delivery markets should be
constructed to be competitive, thus
increasing efficiency, innovation and
quality, as well as to reinforce a
physician’s ability to compete.
Anything that stifles competition
works against innovation and advancement. Integrated care can be
beneficial, but it must be done so
that “destructive, exploitative and
costly forms of collusion and monopolistic behaviors do not emerge
and thrive, disguised as cooperation.”
This is a controversial topic and is an
issue surrounding the health care
reform law nationwide. It deserves
debate and I welcome your opinions
and thoughts.
Physicians today run the risk of
becoming trivialized by direct-toconsumer advertising stemming from
the pharmaceutical industry, medical
device industry, large insurance
networks and large health care
systems. These entities tend to create
a perception that they are more
important than the individual physicians providing the care.
The fact is we need each other.
Physicians need to be on the same
playing field with an equal voice for
the health system to thrive and
continue as the world’s best. Being
part of organized medicine is a
partnership. Physicians cannot work
in a vacuum. Whether you operate
your own practice or are employed
by a health system, group practice or
other entity, you play a vital and
indispensable role in building and
leading the best health care delivery
system our patients need and deserve.
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Dr. McCafferty is a plastic and reconstructive
surgeon and 2011 ACMS president. He can be
reached at mccafferty@acms.org.
11
MEDICAL STUDENT MUSINGS
Providing a Forum for Expression
ALAN ROSENBAUM
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T
his past summer I found myself
in Tanzania, a nation known for
being one of the more stable, accessible and beautiful places on the
African continent. Home to the
beaches of exotic Zanzibar, the
heights of Mount Kilimanjaro and
the wilds of the Serengeti, it is no
surprise that Tanzania is such a
popular destination to those who are
willing to sacrifice some of the
comforts of home.
I was drawn to Tanzania by an
opportunity to volunteer in a rural
government-run health dispensary in
the small town of Kwala. When I
discovered that even GoogleEarth
couldn’t pinpoint the location of
Kwala, Tanzania, I knew it was time
to purchase the plane ticket. I had
hoped that working in a sub-Saharan
African rural setting would be an
exciting opportunity to learn a
different kind of medicine from what
I was accustomed to in western
hospitals, but by the end of the
summer, I had discovered that it was
really the same.
Upon arriving, I toured the
village to become familiar with my
new surroundings, navigating the dirt
paths that surrounded the only road.
I eventually came across the dispensary, a cement and sheet metal
building consisting of a large, open
waiting room, a few small closets,
one examination room, a basic lab
12
and an open-air doctor’s office. The
windows had horizontal metal bars
that lacked any glass, permitting the
occasional gust of wind to give the
workers a reprieve from the heat,
although the bars also allowed
insects, birds or bats to swoop in and
out. In fact, a space under the roof
was a favorite haunt of bats; despite
attempts to remove them, their
presence persisted. The floors were
covered with pervasive dust and dirt,
making it appear as though the dull,
gray cement was covered by a brown
cloak. The ceiling was littered with
spider-webs, and throughout the
day’s work I could turn my eyes
upwards and witness the demise of
some unfortunate creature thanks to
a spindly-legged arachnid. It was
evident that the walls were painted at
some point, but over time chunks
had disintegrated away, leaving gaps
in the finish. In the sole examination
room, the walls had been splattered
and stained with various liquids over
the years, as if it were the setting of a
gory video game. Indeed, the aesthetics of the dispensary were more akin
to a haunted house than a health care
center.
Working there certainly met my
expectations and, throughout the
course of my stay, I saw many
conditions that were relatively alien
to me: terrible infections, crippling
traumatic injuries and debilitating
developmental disorders. While that
MUSINGS
area shares common diseases found
the world over, those ailments
seemed all the more intimidating
there. Often patients lacked access to
health care, so their illnesses festered
and advanced; they might have
delayed seeking treatment until their
state was unmanageable, waiting until
their condition became incapacitating. To make matters worse, it was
not uncommon that their ailments
had been complicated by a prior visit
to a tribal healer or witch doctor.
Within days, it was clear that a
large proportion of cases seen at the
dispensary fell into the category of
sexually transmitted infections (STI).
STIs are a familiar foe in Tanzania; an
estimated 7 percent of her people are
infected with HIV, and Kwala is no
exception, with 0.5 percent of the
village residents being registered as
new cases of HIV annually. Most
concerning was that it was often the
secondary school students who
sought care at the dispensary for STI
symptoms. As a result, I decided to
spend the summer creating and
implementing a sexual education
course in order to contribute to the
prevention of diseases that were
causing so much suffering in the
community.
After obtaining the support of
the school administration and local
community, I was ready to begin the
lessons. The students were divided by
sex and age, and at the different
sessions I was accompanied by a
physician or teacher to serve as a
translator. Their participation was
critical because the material was too
important to risk the language barrier
becoming an obstacle. It was imperative to create a comfortable environment for the students, and translators
greatly facilitated that goal. I was
entirely satisfied that we had accomplished this based upon the amount
of questions that our talks produced;
every seminar prompted at least 1520 questions.
The inquiries from the students
covered every topic I had hoped to
discuss and more: Can you get HIV
or get pregnant from anal sex? Is it
safer to be abstinent or use condoms?
Can you use a plastic bag instead of a
condom? Can I play football with
someone who has HIV? The prevailing theme was that the students were
curious about the subject and that
there had never before been a venue
in which they could find answers to
their questions.
Our discussions displayed what
makes the doctor-patient relationship
so unique; the patient discusses his
curiosities, secrets, concerns and fears,
no matter how personal or embarrassing they may be. Despite the vast
difference between the challenges
faced by Tanzanian medicine compared to our own system, the fundamental principles and essence of the
interaction remained the same. Of all
the roles a physician plays, I’ve found
one to be the most important:
providing a forum for patients to
express issues that they cannot
elsewhere.
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Mr. Rosenbaum is a second year medical student
at the University of Pittsburgh. He can be
reached at rosenbaum.alan@medstudent.
pitt.edu.
Got Something to Say?
If you’re an ACMS
member and would like to
write a student or resident
column, call Linda Smith
at (412) 321-5030, x105 or
e-mail lsmith@acms.org.
Tracy L. Prizant, M.D.
announces the opening of
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Phone: 412-281-5060 www.hh-law.com
14
SOCIETY NEWS
Ophthalmology (l. to r.): Dr. Norman Edelstein, president of the Pittsburgh Ophthalmology
Society, Dr. Frohman, featured speaker, and Dr. John Charley, neuro-ophthalmologist, who
invited Dr. Frohman to speak to the society members.
Ophthalmology, December
The Pittsburgh Ophthalmology
Society met on December 2. Dr.
Larry Frohman, professor of ophthalmology and neurosciences, University
of Medicine and Dentistry of New
Jersey (UMDNJ), was the featured
speaker. Dr. Emily Deschler, a
UPMC resident, spoke on a neuroophthalmological case.
Dr. Frohman is director of neuroophthalmology and vice chair,
ophthalmology, UMDNJ. He has
been president of the North American Neuro-ophthalmology Society
since 2004 and has been active on the
executive board since the early 1990s.
Also active in the American Academy
of Ophthalmology, Dr. Frohman has
been chair of the Panel on Establishing Curriculum in Neuro-ophthalmology (knowledge base project)
since 2002. Recipient of several
awards from the American Academy
of Ophthalmology, Dr. Frohman
also was winner of the Distinguished
Service Award in 2010 presented by
the North American Neuro-ophthalmology Society. Currently he is
president of the Faculty Practice of
New Jersey Medical School.
The ophthalmology society
voted to add Drs. Michael Alunni
and Roheena Kamyar as new members and introduced Drs. Michael
Campbell and Sean Pieramici as
potential new members. The society
announced the retirement of longtime member Dr. William Fronczek
Jr. Dr. Fronczek, who has practiced
most recently in the McMurray area,
said continued involvement with the
Trolley Museum located at the
Washington County Fairgrounds will
be one of his retirement activities.
Society members were reminded
to set aside Friday, March 18, to
attend the annual meeting at the
Omni William Penn Hotel. Guest
speakers will include Drs. Carmen
Puliafito (Thorpe Awardee), Steven
Newman and Shahzad Mian. In
addition to the clinical talks, Mr.
Edward Kabala, Esq, senior partner
with Fox-Rothschild, will speak on
the subject of physician asset protection, including estate and tax planning.
continued on page 17
Make the load a little lighter
for an area medical student
The Allegheny County Medical Society
Foundation offers two annual scholarships of
$2,000 to Western Pennsylvania students
attending medical school in the state.
To make your donation, send a check to:
ACMS Foundation Scholarship Fund
713 Ridge Avenue
Pittsburgh, PA 15212-6098
For more information contact the
medical society at 412.321.5030.
15
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SOCIETY NEWS (from page 15)
ACMS ALLIANCE
UPDATE
Ob/Gyn, December
The Pittsburgh Obstetrical and
Gynecological Society met on
December 6. Featured speaker
Christina Scifres, MD, (top photo)
focused her presentation on diabetes
and pregnancy. Dr. Scifres is assistant
professor, obstetrics, gynecology and
reproductive science, University of
Pittsburgh School of Medicine. Dr.
Eric Miller, society president, noted
that Dr. Scifres has written extensively. She took time to answer many
questions from the audience.
Dr. Miller (bottom left) presented a plaque to James Garver,
MD, the ob/gyn society’s immediate
past president, noting his service to
the society during 2009-2010.
On February 7, the ob/gyn
society will present a program on
treatment of varicose veins, featuring
guest speaker Mario Plaza-Ponte,
MD. To register for the meeting, call
Dianne Meister at (412) 321-5030.
A March meeting will feature Ms.
Luciaz DiVenere, ACOG director of
government affairs.
The ACMS
Alliance presented
Kathleen Reshmi
with its Thompson award at a
December 15
holiday luncheon,
held this year at
Ms. Reshmi
the Fox Chapel
Golf Club. The award is given
annually in recognition of dedication
and service to the community, to the
alliance and to family.
Ms. Reshmi currently serves as
president of the alliance.
Ob/gyn featured speaker: Dr. Christina
Scifres.
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The ACMS Alliance is an organization of
spouses and supporters of the Allegheny County
Medical Society membership. Information is
gleaned from the alliance’s newsletter, ACMSA
News Update. For information on becoming a
member of the ACMS Alliance, contact Sandra
Da Costa at (412) 343-2914 or Mary Kay
Schaner at (724) 941-5147 or visit
www.acms.org.
Ob/gyn: Dr. Eric Miller (left) presented a
plaque to Dr. James Garver.
17
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18
ACTIVITIES & ACCOLADES
Donald A. Fetterolf,
MD, MBA, was one
of 14 individuals
inducted as fellows at
the College of Physicians of Philadelphia
Dr. Fetterolf
at its annual College
Night in November. An honorific
college founded in 1789, it is the
oldest professional society in the
country, having been founded by
physicians from the Revolutionary
War period, including Benjamin
Rush. Known widely for an immense
closed stack library containing some
325,000 volumes and the famous
Mutter Museum, the college selects
fellows for their individual contribution to medicine.
Edwin C. Fischl, MD, MS, MBA,
was honored by the National Health
Care Anti-Fraud Association with its
2010 NHCAA Medical Director
Award for assisting in more than 450
cases, reviewing medical records and
claims, assisting with onsite audits,
spearheading revisions to medical
policy and providing invaluable
information and training to law
enforcement. Dr. Fischl is medical
director, medical management and
policy, Highmark Blue Cross Blue
Shield.
Freddie Fu, MD,
chair of Pitt’s department of orthopaedic
surgery, was recently
named Distinguished
Service Professor of
Dr. Fu
Orthopaedic Surgery.
Dr. Fu is the first from the department to receive this designation.
Grant J. Shevchik, MD, recently
appeared on Channel 4 Action News
discussing UPMC’s online
IN MEMORIAM
E. David Cherup, MD, age 88,
passed away on November 23. Dr.
Cherup (family practice) graduated
from the University of Pittsburgh
School of Medicine in 1951 and
completed a residency at Shadyside
Hospital. Prior to attending medical
school, he served as a naval aviator
officer in World War II. Dr. Cherup
set up his medical practice in Bethel
Park in 1952 along with his brothersin-law, Drs. James and Glenn
Rankin, where he cared for patients
for 35 years. He is survived by his
wife Naomi, daughters Lori and Lisa,
son David and nine grandchildren.
HealthTrak system that allows
patients to connect with a doctor
with a click of their mouse. Dr.
Shevchik, who is medical director of
HealthTrak, says, “Using HealthTrak
is just as safe and private as using
online banking,” but cautioned it’s
only designed to treat common
illnesses.
Anthony Spinola,
MD, was recently
quoted in a PAMed
News article, “Breathless in Pennsylvania,”
that focused on the
Dr. Spinola
problem of chronic
obstructive pulmonary disease
(COPD) in the Keystone State. Dr.
Spinola, who is an internal medicine
physician, says, “We can’t cure
COPD, but we can help patients
manage it.”
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Send your Activities & Accolades items to Linda
Smith at ACMS, 713 Ridge Ave., Pittsburgh,
PA 15212 or e-mail lsmith@acms.org. We also
encourage you to send a recent photograph
indicating whether it needs to be returned.
ACMS Medical Student
Scholarship...
$2,000 will be awarded annually
to each of two qualified medical
students. For information on how
to apply for the ACMS Student
Scholarship or how to contribute
to the scholarship fund, e-mail
studentservicesfoundation@
pamedsoc.org or call
(717) 558-7854.
(Note: The PaMedSoc
DEAR DOCTOR
○
Lisa A. Pawelski, MD, dermatology,
wrote a Dear Doctor column for the
Pittsburgh Post-Gazette’s health
section about psoriasis, a chronic skin
rash that is not curable, but controllable. Dr. Pawelski wrote that psoriasis is the result of an immune system
that revs up the growth rate of skin
cells. Mild psoriasis may respond to
topical steroid treatments, including
prescription creams, ointments,
lotions and foams. More severe skin
psoriasis is best treated by a dermatologist who can determine which
treatment is best for the patient.
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The Dear Doctor column is published regularly
in the Pittsburgh Post-Gazette’s Health
Section. To contribute a Dear Doctor column,
call Christina Morton at (412) 916-2421 or
e-mail cmorton@acms.org.
Foundation is
administering the
scholarship.)
19
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For brochure and online registration:
https://ccehs.upmc.com or call 412-648-6304
JANUARY/FEBRUARY CALENDAR
January is the month for the following national
awareness programs: glaucoma and birth defects
prevention. February 4 is National Wear Red Day and
February 14 is National Donor Day. (U.S. Dept. of Health
and Human Services, www.healthfinder.gov/library/nho/).
Feb 3, 4:30-8:30 pm ............ Pittsburgh Ophthalmology Society
Feb 7, 6-9 pm ....................... Pittsburgh Obstetrical/Gynecological Society
Feb 8, 10 am ......................... ACMS Alliance
Feb 10, 8:30 am-3:30 pm ...... PMS Videoconference
Commission on CME
Feb 15, 6-9 pm ..................... ACMS Board of Directors
Feb 18, 9 am-1 pm ................ Three Rivers Adoption Council
Feb 21 .................................. Holiday: ACMS office closed
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21
FEATURE
2011 ACMS President
and Officers
Dr. McCafferty
President
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Dr. Paré
Vice President
Dr. Varma
President-Elect
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Leo R. McCafferty, MD
2011 ACMS President
Dr. McCafferty, the medical society’s 146th president, is a
plastic surgeon certified by the American Board of Plastic
Surgery. He is in private practice and is affiliated with
UPMC Shadyside and Children’s Hospital of Pittsburgh
of UPMC. His office is licensed by the state of Pennsylvania as an Ambulatory Surgical Facility. At the University of Pittsburgh School of Medicine he is a clinical
assistant professor of plastic surgery.
Dr. McCafferty has been a member of ACMS since
1990 and, in addition to his service on the board of
directors, he serves on the Finance Committee. He served
on the Communications Committee from 1993 to
2006, chairing it for five years, and he participated on the
ACMS Managed Care Survey and Evaluation Team in
1996. Dr. McCafferty served on the Bylaws Committee
from 2008 to 2009, chairing the committee during that
time. He also participated on the Peer Review Board and
Awards Committee in 2009 and served on the ACMS
Foundation and Gala Committee in 2010. Dr.
McCafferty was ACMS treasurer in 2007, secretary in
2008, vice-president in 2009 and president-elect in 2010,
serving on the Executive Committee during that time. At
the state level he served as a delegate to the Pennsylvania
Medical Society in 1995 and 1996.
Dr. McCafferty is an active member of the American
Society of Plastic Surgeons and a member of the Ethics
Committee. He is a fellow of the American College of
22
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Dr.Garrett
Secretary
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Dr. Williams
Treasurer
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Surgeons and past-president of the D. Ralph Millard Jr.,
MD, Plastic Surgery Society.
Dr. McCafferty holds several key positions in the
American Society for Aesthetic Plastic Surgery, an association that unites a select group of plastic surgeons demonstrating expertise in all areas of cosmetic surgery. His
participation in the society includes member of the
Program Committee and New Member Committee, and
chair of the Industrial Relations Task Force and of the
Administrative Commission for which he is regional
spokesperson. He also serves as secretary of the society’s
board of directors and sits on the Executive Committee.
Raised in the Pittsburgh area, Dr. McCafferty received
his bachelor of science degree from The Pennsylvania
State University and medical doctorate from Temple
University; he completed his internship and residency in
general surgery at Cedars-Sinai Medical Center in Los
Angeles. His training in plastic surgery was at the University of Miami, Jackson Memorial Medical Center, under
the world-renowned plastic surgeon, D. Ralph Millard,
Jr., MD. Prior to returning to Pittsburgh, Dr.
McCafferty was assistant professor of clinical surgery at
the University of Miami and chief of staff services at the
Jackson Memorial Medical Center.
Dr. McCafferty has been the plastic surgeon consultant to the Pittsburgh Steelers since 1993. He and his wife
Susan reside in Mt. Lebanon. They have four children,
daughters Kristen, Kimberly and Kelly, and a son Lee.
FEATURE
Rajiv R. Varma, MD
2011 ACMS President-Elect
Dr. Varma is a pediatric neurologist certified in pediatrics
and neurology with special qualifications in child neurology. He is clinical director of the pediatric neurology
division of Children’s Hospital of Pittsburgh of UPMC.
A member of ACMS since 1987, Dr. Varma has been
very active with the medical society, in addition to his
service on the board of directors from 2003 to 2005 and
again in 2008 to 2010. He was a member of the Legislative Committee from 1993 to 2006. He was chair of the
Member Benefits Committee in 1999 and participated
on the Membership Committee from 2000 to 2005,
serving as vice chair in 2000 and chair from 2001 to
2005. Dr. Varma was the Board of Directors Presidential
Appointee from 2000 to 2002. He served on the Nominating Committee in 2006 and the Finance Committee
in 2008 and 2010. He was a member of the Awards
Committee in 2009. He participated on the Peer Review
Board in 2010 and was chair of the Bylaws Committee
that same year. Dr. Varma served as ACMS treasurer in
2008, secretary in 2009 and vice president in 2010,
serving on the Executive Committee during that time. At
the state level he served as an alternate delegate to the
Pennsylvania Medical Society from 1993 to 1995 and in
2002. Dr. Varma served as a delegate to the Pennsylvania
Medical Society from 1996 to 2001; 2003 to 2008 and
in 2010. Dr. Varma has also served on the PMS Strategic
Planning Committee for several years.
Dr. Varma is a member of many professional and
scientific societies, including the American Academy of
Neurology and the Child Neurology Society. In addition,
Dr. Varma volunteers with the United Mitochondrial
Disease Foundation.
Dr. Varma earned his medical degree from Prince of
Wales Medical College in Patna, India, in 1974 and then
served as senior house officer in Royal Gwent Hospital,
England. From there, Dr. Varma moved to Michigan
where he completed his pediatrics residency at the Hurley
Medical Center and Children’s Hospital of Michigan.
In 1980, Dr. Varma came to Pittsburgh as a pediatric
neurology fellow at UPMC and Children’s Hospital.
Prior to joining Children’s, Dr. Varma was chief, division
of child neurology and vice-chairman of pediatrics at
Mercy Hospital of Pittsburgh.
Dr. Varma and his wife, Dr. Swarna Varma, reside in
Upper St. Clair. They have three children, Manu,
Sumeeta and Anita.
Amelia A. Paré, MD
2011 ACMS Vice President
Dr. Paré is a plastic surgeon certified by the American
Board of Plastic Surgery. She is in private practice and is
affiliated with Jefferson Medical Center, Washington
Hospital, St. Clair Memorial Hospital and UPMC. She
is also affiliated with the University of Pittsburgh and is a
fellow of the American College of Surgeons.
Dr. Paré has been a member of ACMS since 2000. In
addition to serving on the board of directors since 2009,
she served on the Nominating Committee from 2003 to
2004 and in 2007. She has also served on the Communications Committee since 2006, becoming its chair in
2008. Dr. Paré participated on the Legislative Committee
in 2007 and the Awards Committee from 2007 to 2009.
Dr. Paré was a member of the Finance Committee in
2009 and was the Board of Director’s Presidential Appointee from July 2007 to 2008. She served as ACMS
treasurer in 2009 and secretary in 2010, serving on the
Executive Committee during that time.
At the state level Dr. Paré served as alternate delegate
from 2000 to 2002 and, since 2003, as delegate to the
Pennsylvania Medical Society; she has been on the Pennsylvania Medical Society Political Action Committee
(PAMPAC) since 2005. She is also a member of the
American Society of Plastic Surgeons, Pennsylvania
Medical Society, Pittsburgh Plastic Surgery Society and
the Harvard Alumni Society. On behalf of physicians in
this area, Dr. Paré has visited local legislative offices, as
well as those in Harrisburg and Washington.
Dr. Paré earned a bachelors of science degree in
chemistry from Harvard University and studied at Oxford University in England. She received her medical
degree from Hahnemann University School of Medicine
in 1992. She trained in general surgery at St. Luke’sRoosevelt Hospital Center, University Hospital of
Columbia University College of Physicians in New York
City, where she served as chief resident of general surgery.
She completed specialized training in aesthetic, plastic and
reconstructive surgery at UCLA, where she also served as
chief resident. She has worked with Doctors Missions in
Honduras.
Dr. Paré and her husband Kyung Park, MD, reside in
Upper St. Clair with their son Liam.
23
Look for details in the February Bulletin, or visitwww.acmsgala.com.
Physician Awards
John A. Straka, MD
Ralph C. Wilde Award
Judith S. Black, MD, MHA
Frederick M. Jacob Award
Community Awards
Benjamin Rush
Community Organization
Public Health Award
Chris Allen, MD
Nathaniel Bedford Award
(posthumously)
Jan D. Smith, MD
Physician Volunteer
Award
Pride in Pittsburgh Awards
Fredric V. Price,
MD, FACS
Ann McGaffey, MD
Greta K. Rooney
Mark J. Laskow
Benjamin Rush
Individual Public Health
Award
Awards to be presented at the ACMS Foundation Gala on March 19, 2011. Call 412-321-5030 for tickets.
24
FEATURE (from page 23)
Kevin O. Garrett, MD
2011 ACMS Secretary
Dr. Garrett is a board certified general surgeon, practicing
at UPMC St. Margaret Hospital, where he serves as chief
of surgery. He is a clinical professor of general surgery at
the University of Pittsburgh School of Medicine.
Dr. Garrett has been a member of ACMS since 1985,
serving on the board of directors since 2006. He was a
member of the Nominating Committee in 1999 and the
Medical-Legal Committee from 2002 to 2004. Dr.
Garrett served on the Membership Committee in 2006,
the Awards Committee in 2007 and the Finance Committee from 2007 to 2010. Dr. Garrett was ACMS
treasurer in 2010 serving on the Executive Committee
that year, too. He also has been a delegate to the Pennsylvania Medical Society since 1998, serving as vice chair and
chair of the ACMS delegation in 2008 and 2009 respectively. Dr. Garrett has served as an alternate delegate to the
AMA from the Pennsylvania Caucus since 2007.
Dr. Garrett has been a member of the American
College of Surgeons since 1995 and has served as a
governor since 2007. He has also been active with the
Southwestern Pennsylvania Chapter of the American
College of Surgeons, serving as treasurer, council member
and program chair.
Dr. Garrett received his bachelors of science degree in
chemistry from Carnegie Mellon University. He earned
his medical degree at the University of Pittsburgh School
of Medicine and served his surgical internship and residency in general surgery at the University of Pittsburgh
School of Medicine.
He and his wife Jennifer reside in Allison Park with
their three children, Kevin Jr., Kelly and Megan.
John P. Williams, MD
2011 ACMS Treasurer
Dr. Williams is chair of the department of anesthesiology
at the University of Pittsburgh where he is the Peter and
Eva Safar Professor of Anesthesiology. Board certified in
anesthesiology and critical care medicine, Dr. Williams is
a diplomate of the American Academy of Pain Management and was a member of the Analgesic Guidelines
Committee of the American Society of Clinical Pharmacology and Therapeutics from 1994 to 2004.
A member of ACMS since 1998, Dr. Williams was a
member of the Communications Committee from 2000
to 2001. He was a member of the Legislative Committee
from 2002 to 2007, serving as its chair in 2007. Dr.
Williams has served on the Board of Directors since
2006. He was a member of the Membership Committee
from 2008 to 2010 and was chair of the Awards Committee in 2010. He has also served as an alternate delegate
to the Pennsylvania Medical Society from 2002 to 2004
and as a delegate from 2005 to 2010. He served as an
alternate delegate to the AMA for the PMS.
Dr. Williams received his medical degree from the
Baylor College of Medicine. He completed his internship
at St. Joseph Hospital in Houston, Texas, and his residency in anesthesiology at the University of Texas Medical
School in Houston and a fellowship at Guy’s Hospital in
London, England.
Dr. Williams has dedicated his career to education and
research with a clinical emphasis on cardiac illness and
cardiac surgery. He previously served as chief at UMPC
Presbyterian Hospital from 1999 to 2001 and as interim
chair from 2001 to 2002. He has also served as the
director of cardiac anesthesiology and co-director of
intensive care at UCLA and prior to that at the University
of Texas, Houston.
Dr. Williams and his wife Valerie reside in Gibsonia
with their children Brynna, Connor and Victoria.
The ACMS Board of Directors meets
throughout the year on Tuesdays at
6 p.m. Board meetings are open to
members. If you wish to attend,
contact the medical society at (412)
321-5030 to receive a schedule and
meeting agenda. Board meetings in
2011 are scheduled for: February
15, May 24, September 27 and
December 6.
25
FINANCIAL HEALTH
Long-Term Care: An
Issue You Can’t Afford
to Avoid
MALACHY WHALEN
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L
ong-term care (LTC) is a subject that all Americans should consider in their overall financial
planning because it is for that period in our life
when we can’t take care of ourselves or need assistance to
perform the activities of daily living. It includes medical
and non-medical care for people who are critically ill or
disabled from an accident or an illness.
Why do we need to be concerned?
A critical illness or accident can be financially devastating regardless of age. While LTC is thought to be for
older people, it is actually applicable to younger people as
well because it applies to anyone who is critically ill or
disabled. A major insurer offers statistics that show 40
percent of people who receive LTC are between the ages
of 18 and 64.
A recent study by the U.S. Department of Health and
Human Services indicates that anyone who reaches
age 65 has a 40 percent chance of entering a
nursing home, with a 20 percent chance
of staying there more than five years.
While a very sobering statistic, it
doesn’t include the tremendous
amount of pre-nursing home health
care and assisted living care that
might be needed.
Overwhelming cost
The cost for LTC is overwhelming.
26
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Nursing home expenses exceed $100,000 a year in most
cities today and is increasing every year. Average costs in
the United States in 2009 included:
• $198/day for a semi-private room
• $3,131/month for care in an assisted living facility
(one-bedroom unit)
• $21/hour for a home health aide
• $19/hour for homemaker services
• $67/day for care in an adult day health care center
These are the national averages, but a local example of
nursing home charges in the Pittsburgh area shows $224/
day for a semi-private room and $340/day for a private
room. These are realities that must be faced by all of us,
so what are possible solutions?
Solution #1: Do Nothing. Your assets must be
substantial to afford $100,000 a year or more from your
interest or investment income and still
have enough for the rest of the family
to live comfortably. Of course, if your
spouse goes into a LTC situation at
the same time, you are looking at
$200,000 or more a year. If you
have to start using the principal of
your savings, home equity and
retirement funds, they will deplete
rapidly and perhaps be exhausted
completely depending on how
long you need LTC.
FINANCIAL
Solution #2: Move into a retirement community.
This entails buying into the concept of living in a community setting where essentially all your needs are taken
care of. You buy an independent living unit such as an
apartment, townhouse or villa. The community will
provide for most of your daily needs, as well as assistedliving accommodations or nursing home care if needed.
While it sounds good, this solution is expensive, including the original buy-in price plus a monthly fee that is
adjusted for inflation. In addition, you need to carefully
examine the business’s financial stability basis. Finally, you
must be in good health to secure full coverage, which is
expensive, but an option that should be considered.
Solution #3: Medicaid. There are very restrictive
income and asset provisions that need to be met. Even if
you plan ahead, it is not a very satisfactory solution.
Solution #4: Life insurance policy accelerated benefits.
Most policies will allow you to use a portion of your face
amount to cover expenses if your life expectancy is under
two years. If you chose this as a solution, you should
check your life policy to make certain it is included and
also read the definitions, as they vary. A competent
insurance broker will assist you in understanding coverage
and your options.
Solution #5: A combo life insurance policy with
built-in LTC. One high quality insurer offers this on
permanent insurance policies of up to $1,000,000 of
coverage. The policy has an LTC rider that allows you to
take a percentage of the face amount per month when
you qualify for long-term benefits. For example, a
$1,000,000 policy provides:
1% = $10,000 per month for up to 100 months
There are real advantages to this because it answers the
question:“What happens to all my premiums if I don’t
need long term care?” It also allows you to take whatever
you need without rate increases. This is a very good
option for some people.
Solution #6: Long-term care insurance. This is the
solution that appeals to many people. It is an insurance
policy designed to cover the expenses of long-term care,
including home health care, assisted living and nursing
home charges. Planning is needed to determine the right
package to fit your unique position. Of course, insurability becomes an issue, so you need an expert to assist in the
planning process.
Long-term care insurance policy highlights
1. Benefits are payable when the insured becomes
chronically ill, satisfies the elimination period, and is
receiving qualified long-term care services pursuant to
a written plan of care approved by the insurance
company. Chronically ill would be defined as lacking
the ability to perform two or more activities of daily
living without substantial assistance from another
individual. Activities of daily living are bathing,
dressing, toileting, transferring, continence and eating.
2. A severe cognitive mental impairment such as
Alzheimer’s is covered when you are a hazard to
yourself or others.
3. The contract itself is guaranteed renewable, which
means the insurance company can’t cancel or change
the policy. Individual policy premiums cannot be
increased; however, a company may file with the State
Insurance Department requesting approval for a
unified rate increase on all policyholders in that
particular state.
4. There are two types of LTC coverage.
a. Reimbursement plan: Means that you accumulate
your bills, submit them to the insurance company
and receive reimbursement up to the eligible daily
or monthly benefit amount.
b. Indemnity plan: Means that, once you qualify for
benefits, the insurance company will send you the
eligible daily or monthly benefit and you pay
your own bills. The indemnity plan is a little
more expensive, but it is far easier to administer;
plus the benefits will generally be higher, especially for the home health care and assisted living
coverage. I usually recommend this plan.
5. How a claim is established: Once an insured qualifies,
the attending physician certifies that the claimant is
disabled; a plan of care is developed by a home health
care agency in conjunction with your attending
physician and approved by the insurance company.
The plan may be for home health care, assisted living
or nursing home services.
Major benefit options
• Coverage is available up to $400 a day.
• There is always an elimination period, and it can be
anywhere from 20 days to 365 days. Normally a 90- or
100-day waiting period is used to keep the cost down,
plus Medicare benefits may be available up to 100 days.
:
:
January 2011 Bulletin
27
Doctors and Patients. Preserve the Relationship.®
Free. Members-Only Information
From the Pennsylvania Medical Society
Of the thousands of calls and e-mails we receive from Members every year, many concern the
same issues and questions. So, we’ve developed a series of brief publications that address
these common Concerns. They’re free and available only to Members.
Regulations
Practice Management
Practice Guidelines for Physician Assistants
and Certified Registered Nurse Practitioners
A resource for physician practices to understand licensure, scope of practice, and reimbursement rules and
guidelines for these positions.
Policy and Procedural Manuals/Employee
Handbooks for Medical Practices
Use this brief publication to find out the basic information that should be included in a comprehensive
employee handbook for your practice.
Setting the Record Straight: What You Need to Know
About Medical Records
From Ownership rights to copying fees, “Setting the
Record Straight” will help you make sure you’re handling
these vital documents appropriately and legally.
Selecting Computer Hardware
and Software for Your Medical Practice
Use this short paper to help you with the process of
selecting a practice management system for your
medical practice.
Disease Reporting
Includes lists of reportable diseases, how and where to
report, confidentiality rules and penalties for failing to
report.
Setting Up a Practice—Areas to Consider
For physicians who are considering starting a practice.
With all there is to consider, you’ll probably miss
something without a checklist like this.
Reimbursement
Medical Liability
Act 6: A Crash Course in Auto Accident
Reimbursement
A concise run-down of the steps you need to take to get
appropriately reimbursed for care of patients injured in a
motor vehicle accident.
Arbitration of Medical Liability Claims
Focuses on private arbitration outside the judicial
system that takes place if the physician and patient
have a voluntary agreement to engage in arbitration.
Your Right to Timely Payment Under Act 68
Provides details of physician’s rights under the Quality and
Health Care Accountability & Protection Act, including
provisions for prompt payment of clean claims within 45
days.
Collection Protocols for the Medical Practice
Manage your accounts receivable and prevent them from
becoming delinquent. “Collection Protocols” includes tips
on managing accounts and also useful collection techniques.
Workers’ Compensation:
The Application for Fee Review Process
FAQs and sample forms for when you have trouble getting
paid for workers’ compensation health care services or
when an insurer is making you wait for payment.
28
Medical Professional Liability Insurance Options
Basic information and definitions for physicians considering new as well as traditional medical liability insurance options.
Lawsuit Protection Strategies
Designed to be an instructional tool for physicians so
that they can have a more informed discussion with
their legal and financial advisors.
Order any of these publications
by calling (800) 228-7823
or on the Pennsylvania Medical Society
Web site store, www.pamedsoc.org/store.
FINANCIAL (from page 27)
Additional options to be considered
• The benefit period is the length of time that the insurance company will pay. That can be anywhere from two • Bed reservation pays the charges for the LTC facility if
you leave on a temporary basis.
years to lifetime. The lifetime benefit is recommended.
• Inflation or Cost of Living Benefits (COLA) are essential • Special services designed to allow you to remain at
home longer may be included.
in this type of coverage. They may be compound or
• Waiver of premium is provided while receiving benefits.
simple, and factors up to 6 percent are available.
• Non-forfeiture benefits are available that provide a
• There is a difference between simple and compound
shortened benefit period if you stop paying the preCOLA. If you have a $200 a day benefit and 5 percent
mium after three or more years.
simple COLA, that means the coverage would increase
• Survivorship rider eliminates the premium for the
by $10 each year, so at the end of 20 years, the benefit
survivor if the policy has been in force for 10 consecuwould be $400 a day. Five percent compounded for 20
tive years.
years would increase the benefit to $530. Depending
how long the coverage is in force prior to the use of the • Return of premium at death rider provides a benefit
equal to the total premium paid minus any claims paid.
benefits, the compound inflation rider is generally the
best.
Summary
• Home health care: Most everyone wants to stay at
Serious planning is needed to establish a plan that will
home as long as they can. Professional home health care
meet
your needs and provide you and your family with
is a very valuable benefit and should be included.
financial peace of mind.
• Accelerated payment options allow you to pay one
single premium, 10 annual premiums or payments to
Malachy Whalen is the founder of Malachy Whalen & Co, Inc., an
age 65 in addition to premiums for life. This option is
insurance agency serving health care practitioners and facilities nationattractive if the corporation is going to pay the prewide. He can be reached at (412) 281-4050 or help@malachy.com.
mium because it may be deducted and the benefits are
not taxable to the employee.
Age of insured Eligible LTC insurance premium deduction
• Tax consequences: If you are paying the
Age 40 to 50
$620
premium personally, a portion of the
premium may be deductible on your
Age 50 to 60
$1,230
1040. The inflation-adjusted tables for
Age 60 to 70
$3,290
2010 allow the following deduction on
Over age 70
$4,110
your federal tax returns (see table on
right).
**You should consult with your CPA on all tax matters including this information.**
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Help your patients talk to you about their BMI
Allegheny County Medical Society is offering free posters explaining body
mass index (BMI) and showing a colorful, easy-to-read BMI chart. The
posters can be used in your office to help you talk about weight loss and
management with your patients.
To order a quantity of posters, call the society office at 412-321-5030.
You can view or download a smaller version online at www.acms.org.
Allegheny County Medical Society
29
FEATURE
2010—
Year-in-Review
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A
Growth Rate) formula was statistically flawed at its
CMS President John F. Delaney Jr., MD, MPH,
inception, and each year proposes significant fee schedule
DrPH, and the Board of Directors relied on the
cuts for physician and hospital services. For the past six
ACMS Strategic Plan to address the challenging
years, Congress has appropriated additional funding to
issues of national health care reform
avoid deep cuts in the program. The year saw five shortlegislation, Medicare funding and
term payment “fixes” that froze physician payment
physician payment schedules, and the
schedules and caused financial disruptions, if not havoc,
Pennsylvania MCare fund in 2010. The
in medical offices. The medical society is focused on
officers focused on advocacy for physicorrecting the payment formula to reflect the costs of
cians and patients in a very challenging
practices and the growing demand for services from an
environment for physicians and mediaging population, and it is conducting ongoing legislative
cine.
Dr. Delaney
contacts to create a realistic methodology for the MediIn Pennsylvania, MCare funding
care fee schedule.
and the deepening Pennsylvania budget crisis led to the
The Allegheny County Medical Society also has been
misappropriation of MCare funds by the governor and the
legislature to reduce the state’s budget deficit. The Pennsyl- active in our community as Dr. Delaney and other board
members met with hospital medical staff to discuss local
vania Medical Society and the Hospital and Healthcare
Association of Pennsylvania filed litigation challenging the issues. The medical society maintains active liaisons with
a wide number of community partners, including the
constitutionality of the use of those funds and won a
favorable decision. The
outgoing Rendell adminisLeadership and Advocacy for Patients and Physicians
tration has appealed the
decision; cases are pending
Allegheny County Bar Association, Pittsburgh Regional
before the Pennsylvania Supreme Court.
The national debate over health care policy reform has Health Initiative, Consumer Health Coalition, Hospital
Council of Western Pennsylvania, Community College
been at the forefront of activity, and health care reform
of Allegheny County and the Allegheny County Health
resulted in a very broad, encompassing act that will have
enormous impact on health care. The bill creates sweeping Department.
Under the leadership of Co-chairs Lawrence John,
goals and structures with specific regulatory definition yet
MD, and Anthony Spinola, MD, the Primary Care
to be defined. The national elections in November reCoalition (PCC) represented family and internal mediflected ongoing contentious debate concerning the future
cine physicians in discussions with state and federal
of this legislation.
legislators, insurance companies and community groups
One national issue is clear: reform of the Medicare
to identify the challenges and issues facing primary care
program payment methodology. The SGR (Sustainable
30
FEATURE
physicians and to develop policies that will improve their
professional lives and attract medical students to these
specialties. The PCC sponsored a program exploring the
potential impact of the national legislation on primary
care physicians and also examined the Geisinger Health
Systems primary care network.
The Primary Care Coalition worked with the Institute of Politics at the University of Pittsburgh on a white
paper on primary care. The group has helped create
awareness of the shortages of primary care physicians and
the challenges presented to health care systems that
depend upon them. It has also achieved fee schedule
increases from carriers for primary care services.
Executive Committee and Board of Directors
The ACMS Executive Committee and Board of
Directors direct the medical society’s actions and provide
a forum for discussion for physicians, hospitals, insurance
companies, business and legislative representatives. They
have worked tirelessly for the society and continue to be
involved and supportive in community issues and organizations. During the past year, ACMS welcomed to its
board meetings the following groups and individuals:
• Christopher J. Olivia, president and
CEO, West Penn Allegheny Health
System, presented a historical perspective of WPAHS, the health care
environment in western Pennsylvania
and his vision for the future of the
system and associated physicians.
• Highmark’s Bonnell G. Irvin, vice
president of provider contracts &
Dr. Olivia
relations, and Carey T. Vinson, MD,
medical director, quality improvement, discussed the
Quality Blue Incentive Program for participating
physicians and the impact of change in Medicare policy
and payment for consultations upon private insurance
business.
• Donald R. Fischer, MD, senior vice president, chief
medical officer; and Atiya Abdelmalik, nurse manager,
provided information on national health care reform
legislation and its impact on physicians and Highmark.
Dr. Fischer noted that, while the legislation has passed,
many of the provision’s details will be addressed
through the development of regulatory policies, and
that there is a great deal of uncertainty regarding the
specifics of the majority of the issues contained in the
legislation.
:
:
January 2011 Bulletin
• Wellspring Worldwide’s Robert
Lowe, CEO, and Brian Bricker,
vice president, provided information on their company’s SEED
program. Wellspring Worldwide, a
global leader in technology commercialization that works on
transforming research and creative
Mr. Bricker
ideas into successful products, is
funded by Pittsburgh-based foundations to develop
entrepreneurs in technology in the Greater Pittsburgh
area. The SEED Program (Services for Entrepreneurship
and Economic Development) provides individuals and
emerging companies with support and resources in
business planning, engineering and development,
product design and usability testing and infrastructure.
One area of expertise is in health care information
technology.
• A. J. Harper,
Hospital
Council of
Western
Pennsylvania
president,
discussed the
Medicare Wage
Index and its
impact on
Western
Pennsylvania
and the payment disparity A. J. Harper HCWP president (l.) and Dr.
among medical John F. Delaney, ACMS president
assistance payments between hospitals in eastern and
western Pennsylvania. The hospital council covers 32
counties in Western PA. Mr. Frederick Peterson, hospital council vice president, professional services, disaster
preparedness, discussed West Penn Allegheny Health
System’s restructuring of clinical services and its possible
impact on the community. He also noted the ongoing
disaster preparation and emergency planning being
conducted by the hospitals, as well as work on the
Medicare Wage Index project.
• Dr. David Perlmutter, chair of the department of
pediatrics at UPMC and a pediatric gastroenterologist
at Children’s Hospital of Pittsburgh, outlined what he
calls health care’s biggest challenge, here and in the
31
Legislative Committee
ACMS continues to meet with legislators, most
recently Congressmen Jason Altmire, Tim Murphy and
Mike Doyle, focusing on the Medicare program and
health care system reform legislation. The medical society
is working with Pennsylvania House Majority Leader
Mike Turzai to evaluate medical policy issues, particularly
additional professional liability reform.
Bruce A. MacLeod, MD, will succeed Dr. Paré as
representative to the PAMPAC board. Dr. Paré will
continue to serve as an at-large member and will chair the
PAMPAC board in 2011.
Ralph Schmeltz, MD, was installed as the Pennsylvania Medical
Society’s 161st president at October’s House of Delegates. Drs. Carol
Rose of Pittsburgh and Jonathan Rhoads of York look on.
Delegation
ACMS had a full contingent of 29 physicians participating at the 2010 House of Delegates, including a
number of medical students. The Allegheny County
Medical Society and the Philadelphia County Medical
Society again held a joint caucus at the House of Delegates. Several local physicians serve on the PMS Board.
Representing ACMS are: Ralph Schmeltz, MD, PAMED
president; Bruce A. MacLeod, MD, emergency medicine
trustee; Paul W. Dishart, MD, 13th District trustee; and
Adam Z. Tobias, MD, PMS resident and fellows trustee.
country: an enormous need for pediatric subspecialists
and a very small pool of subspecialists to draw from.
This is especially true for certain subspecialties such as
pediatric rheumatology and nephrology. In 2001,
children’s hospital did not have sufficient staff for these
specialties. Children’s Hospital of Pittsburgh is unique
because there is no other hospital in the western PennACMS meetings and activities
sylvania service area that has pediatric subspecialties.
ACMS thanks the many guests who participated in
• Jaan E. Siderov, MD, PMSLIC president; Timothy J.
the medical society’s meetings and activities, including:
Friers, ACAS, MAAA, senior vice president, PMSLIC
underwriting & policyholder services; and Lisa Klinger, • Ralph Schmeltz, MD, and Paul W. Dishart, MD;
PMSLIC representative, all met with the ACMS board • Zeyad Schwen and Hilary Michel, medical students;
in 2010. PMSLIC, a medical
liability insurance company, was
formed by the Pennsylvania Medical Society (PAMED) in 1978 and
was acquired by NORCAL Mutual
Insurance Company in 2002.
NORCAL is the fourth largest
physician carrier in the United
States with an “A” rating. PMSLIC
is an endorsed vendor for ACMS.
• ACMS delegates who participated
in board meetings include: Drs. H.
Jordan Garber, Dwight F. Heron,
Todd M. Hertzberg, Maria J.
Sunseri, Robert L. Thompson, Karl
E. Bushman, Jennifer L.
Middleton, Robert C. Oelhaf Jr.,
More than 200 office staff and technicians participated in the Pittsburgh Ophthalmology
Society’s annual meeting’s break-out sessions in March.
and David B. Palko.
32
FEATURE
• Carl A. Sirio, MD, AMA Trustee;
• Fateh Entabi, MD, resident;
• Guest speakers at the Primary Care Coalition Spring
Program, including Jonathan Darer, MD, medical
director, clinical transformation for the Division of
Clinical Innovation, Geisinger Health System; and
Keith T. Kanel, MD, chief medical and learning officer
for the Jewish Healthcare Foundation;
• The medical society provides office and administrative
staff services to specialty societies, including Pennsylvania Geriatrics Society-Western Division, Pittsburgh
Obstetrical/Gynecological Society, Pittsburgh Ophthalmology Society, Pittsburgh Pediatric Society, Pittsburgh Urological Association, Pittsburgh Surgical
Society and SWPa Chapter of the American College of
Surgeons (Joint Surgical Association).
ACMS Alliance
The ACMS Alliance
continues to promote its
international community
project, Henry the Hand, a
hand-washing technique
program presented to
school age children. The
group’s fund-raising
activities help to benefit
the AMA Foundation and
the Community College of
Allegheny County Allied
Healthcare Scholarships.
Other projects provide
gifts to the Auberle Home
in McKeesport and “Socks
for the Homeless.”
Community College of Allegheny County Educational Foundation: health career scholarships
(from proceeds of ACMS Foundation Gala .......................................................................................... $8,500
Contact Pittsburgh: Suicide Prevention Program ........................................................................................ $2,500
Focus on Renewal Sto-Rox Neighborhood Corporation: Lift-equipped small transit
buses and radio ..................................................................................................................................... $1,720
Foundation of the Pennsylvania Medical Society: ACMS Foundation Medical Student Scholarship
Fund (Two scholarships given by Allergy & Clinical Immunology Associates, PC, in memory of
Dr. Gilbert Friday) .................................................................................................................................. $5,000
Foundation of the Pennsylvania Medical Society benefiting ACMS Foundation Medical Student
Scholarship Fund (from proceeds of ACMS Foundation Gala) .......................................................... $8,500
Foundation of the Pennsylvania Medical Society benefiting ACMS Foundation Medical Student
Scholarship Fund ................................................................................................................................. $15,000
Medical Student Awards (to three students, one each from Drexel University School of Medicine,
Temple University School of Medicine, and University of Pittsburgh School of Medicine) ............... $1,500
Pittsburgh Action Against Rape: Emergency On-Call Medical Advocate Program ................................. $5,000
Pittsburgh Schweitzer Fellows Program: Support for three medical student fellows for 2010-2011
projects addressing unmet needs of children or elderly in an underserved community in SW
Pennsylvania.......................................................................................................................................... $6,000
South Hills YMCA: Camp AIM for special needs youth ages 5-21 ............................................................ $5,000
St. Margarets Foundation: Fitwits Zones Evaluation Proposal Pilot Study ............................................... $5,000
United Mitochondrial Disease Foundation (2009 Benjamin Rush Community Organization Health
Service Award)....................................................................................................................................... $1,000
University of Pittsburgh Graduate School of Public Health (2009 Benjamin Rush Individual Public
Health Service Award) .............................................................................................................................. $500
Woodlands Foundation Inc.: Healthcare services for children with disability and chronic illness
who participate in the year round programs offered at the Woodlands............................................ $10,000
TOTAL................................
................................
................................
................................
........................
$ 85,920
Kathleen Reshmi (l.), ACMS
president and Patty Barnett,
immediate past president
Occupational Medicine Committee
Approximately 75 participants attended the Occupational Medicine Committee’s 2010 Medical Office
Occupational Health and OSHA Update. Committee
chair, Joseph J. Schwerha, MD, MPH, served as moderator of the seminar, focusing on relevant medical office
topics relating to bloodborne pathogen standards, updates
on OSHA regulations for the medical office, emerging
food pathogens and medical office safety.
ACMS Foundation
Created, funded and led by physicians since 1960, the
2010 ACMS Foundation Grants
Anchorpoint Counseling Ministry: Youth Development Summer Tutoring Program ................................. $5,000
Angels’ Place: Showcase of Scholars Scholarship Program ..................................................................... $5,000
Carnegie Institute SciTech Initiative: Two student awards in the field of Medicine and Biology ................. $700
Allegheny County Medical Society Foundation has given
more than $2.2 million to various community programs,
including $85,920 in grants in 2010 (see above chart for
breakdown). It also gifted three students $500 each for
the 2010 Medical Student Awards, including Sean
Tackett, University of Pittsburgh School of Medicine;
Peter Maropis, Drexel University College of Medicine
(Allegheny General Hospital); and Chinyere Ogbonna,
Temple University School of Medicine (West Penn
Hospital).
The Allegheny County Medical Society and the
ACMS Foundation held its Community Awards Gala in
January to recognize the achievements of its physician
members and community partners and to raise funds for
the foundation’s charitable works. The celebration took
place for the first time at the Heinz Field East Club
Lounge and featured a reception and silent auction,
dinner and award presentations.
Communications and community relations
In 2010 ACMS represented physicians as patient
advocates and educators, participating in public health
and community events and voicing physicians’ concerns
regarding the practice of medicine.
Health care reform dominated the media agenda.
33
Drs. Maryann Miknevich (l.) and Amelia Paré confer on winning
entries at the 71st Pittsburgh Regional Science and Engineering Fair
at Heinz Field on March 26.
Physicians and medical students gathered for Medical Student Career
Addressing concerns of physicians and patients, ACMS
Night at UPMC Shadyside’s Herberman Conference Center on
members served as sources for opinion/editorial
November 16.
pieces and news articles for the Almanac, American
Red bag waste services, auto/home owner insurance
Medical News, Dynamic Business, Hospital News,
discounts and banking services were made available to
Observer-Reporter, Pittsburgh Business Times, Pittsburgh
members.
Post-Gazette, and Pittsburgh Tribune-Review, as well as
Two exciting member benefits were made available
coverage on WTAE-TV, KDKA-TV, WQED-TV, and
only to members: the Wellspring Seed Program (see page
KQV and KDKA radio. Issues covered included chal31, Executive Committee and Board of Directors for more
lenges for physicians in primary care, electronic health
information) and the ACMS
records, health care programs, healthy living, retail-based
DocBook iPhone app. The
health clinics, reconstructive surgery, the malpractice
ACMS DocBooks iPhone app
climate in Pennsylvania and Medicare funding.
provides searchable directory of
The medical society provided physician judges and
ACMS members and pharmasponsored two awards in the health and science category
cies. The app is currently availat the 71st annual Pittsburgh Regional Science and Engiable only for iPhone, iPad, and
neering Fair at Heinz Field in the spring.
iTouch, but an Android version
Also, ACMS distributed health-related information at
is slated for early 2011.
a senior health fair sponsored by Pennsylvania state
Medical students had opportunities in 2010 to chat
representative Mike Turzai.
informally with physicians from various specialties, gather
insight into different practice modalities and discuss their
Membership Committee
future at a medical student Career Night in November.
ACMS and the PennsylThe ACMS also encouraged students to improve their
vania Medical Society created
knowledge of organized medicine by attending board
a collaborative field staff
meetings and the annual state meeting.
contact program with staff
members Nadine Popovich
Community outreach
and Debbie Kocak. The
ACMS collaborates with many groups to provide
committee works throughhealth care education and information to physicians,
out the year to improve
Nadine Popovich (l.) and
schools, groups, business and the community at large.
physician outreach programs Debbie Kocak initiated the
Towards its goal of community outreach, ACMS has:
and develop new programs to joint ACMS/PAMED
• …met with representatives from the Pittsburgh Center
membership development
help members in both their
for Deaf and Hard of Hearing to examine the initial
professional and private lives. program.
34
FEATURE
results of the pilot project to provide translation services
for primary care offices under a grant from the FISA
Foundation.
• …provided publicity for the Caregiver Champions
program underwritten by the Jewish Healthcare Foundation, which provides support groups for those
providing care for family members and loved ones.
• …provided support for the 2010 Pittsburgh Business
Group on Health for its annual educational conference.
• … worked with the Allegheny County Bar Association
program, How to Document and Implement Client/
Patient Health Care Decisions. This ongoing program is
part of the Advanced Directive Living Will project that
provides both continuing medical education credits and
continuing legal education credits.
• …collaborated with the Consumer Health Coalition
on the Health in Latino Communities grant provided
by the Pennsylvania Medical Society.
• …participated in the Community Partners Program
established by the University of Pittsburgh School of
Nursing to involve the community on public health
care issues such as diabetes, health assessments.
• …participated in the
Medication Clean-Up
Campaign, a pilot
project of Drug Free
Pennsylvania and the
Pennsylvania Medical
Society, carried out in
cooperation with
pharmacy students,
Allegheny County Police
David Bluestein, MD, and John
and the DEA.
F. Delaney Jr., MD, participated
• …participated in the
in Pittsburgh’s first Medication
Gateway Medical
Clean-up Day on May 8.
Society’s town hall
meeting and supported its Healthy Lifestyles in Ethnic
Communities project.
• …endorsed the American Heart Association’s Mission
Lifeline program, designed to save lives by closing gaps
in the system of ST-Elevation Myocardial Infarction
(STEMI) care. The program will require the participation of physicians, nurses, emergency medical service
providers and hospital teams. The medical society will
support communications to physicians on the project.
Another ongoing objective of the medical society is to
bring awareness to the community. ACMS officers met
with groups outside the health care industry to discuss
health care reform, including speaking to Rotary Clubs,
the Pittsburgh Business Group on Healthcare and the TriState Association of Physicians of Indian Origin (TAPI)
on health care reform and the importance of membership
and participation in the ACMS.
ACMS Editorial Board and the Bulletin
The Editorial Board said goodbye to two associate
editors in 2010: Michael Chapman, MD, began serving a
residency at the Medical College of Georgia after serving
nearly four years, and Adam Tobias, MD,
completed a maximum allowed three, twoyear terms, expressing the desire to serve
again in the future. The Editorial Board
thanks Drs. Chapman and Tobias for a
combined ten years of faithful service. Also
Dr. Tobias
in 2010, medical student Jacob Esquenazi
joined the Editorial Board as contributing editor and
assists by recruiting writers for the Bulletin’s student
column.
The Bulletin’s 2010 annual photo contest attracted 34
entries, from which 12 were selected to grace the
magazine’s covers in 2011. This month’s cover features
the grand-prize winning photo, Fall in Pennsylvania, by
Elias Hilal, MD.
Bulletin articles in 2010 featured its semi-annual
legislative update, listing responses from candidates to
questions of interest to our readers, as well as articles on
legal concerns facing physicians, pharmacy topics, implementing electronic health records and advice on practice
management and financial health, member profiles and
perspectives. A number of special reports provided
information on community activities and programs.
Regular columns also keep readers updated on society
business, including specialty societies, information about
our members’ awards and activities and on the ongoing
work of the ACMS Alliance.
The Bulletin invites its readers to submit letters to the
editor for its “Mailbox” column or to pen a “Perspective”
column (less than 1,000 words) expressing opinion on a
topic of choice; send them to bulletin@acms.org or call
managing editor Linda Smith with any questions at (412)
321-5030. Past issues are available online at www.acms.
org; click on Bulletin information/past issues.
35
PROFILE
Leo McCafferty, MD: Physician,
Advocate, Musician, Family Man
CHRISTINA E. MORTON
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eo R. McCafferty, MD, is the Allegheny County
Medical Society’s 146th president. A board certified
plastic surgeon, Dr. McCafferty is in private
practice. A member of ACMS since 1990, he also is a
member of several other professional organizations,
serving leadership roles in many (see page 22).
Dr. McCafferty was born and raised in Pittsburgh,
growing up in Mt. Lebanon and graduating from Mt.
Lebanon High School. He received a bachelor of science
degree from The Pennsylvania State University and
medical doctorate from Temple University; he completed
his internship and residency in general surgery at CedarsSinai Medical Center in Los Angeles. Dr. McCafferty
completed his training in plastic surgery at the University
of Miami, Jackson Memorial Medical Center, under
world-renowned plastic surgeon, D. Ralph Millard, Jr.,
MD.
Dr. McCafferty recently talked about being a physician, his mentor Dr. Millard, and his beloved family, as
well as his hobbies and
interests outside of medicine.
Dr. McCafferty, what
inspired you to become a
doctor?
My pediatrician, Dr.
Wunderlich, was a very big
influence. He made house
calls and I remember being
fascinated by all of the
things he carried in his
medical bag. I knew from a
very young age that I
wanted to become a
physician.
36
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Why did you choose the specialty of plastic surgery?
When I was a third-year student in medical school I
attended a lecture by a plastic surgeon that was about a
small child mulled by a pit bull. I saw that and thought,
“Wow, I would like to do that.” When I was completing
my surgery residency in Los Angles, I always found
myself sneaking into the operating room with a plastic
surgeon to help and watch. Later I went to visit Dr. D.
Ralph Millard in Miami and ended up training with him.
He was a world famous physician and I was so impressed
with what he did. Training and working with Dr. Millard
really helped to seal the deal in terms of what I wanted to
specialize in.
Can you tell me a little bit about your mentor, Dr. Millard?
I was very privileged to train with Dr. Millard in
Miami. He taught me to think, not only as a doctor or
plastic surgeon, but as a human being, too. He encouraged me to never accept the written word or the stated
word of so-called experts
without really questioning
and investigating what was
being stated. He has been a
big mentor in my life. One
of his favorite sayings was,
“Avoid the rut of routine.”
He was an amazing individual.
Dr. McCafferty and family at 2009 Super Bowl
You received your medical
training outside of
Pittsburgh. What made you
decide to come back to the
area?
I completed my
training in plastic surgery at
PROFILE
the University of Miami, Jackson Memorial Medical
Center. Prior to returning to Pittsburgh, I was assistant
professor of clinical surgery at the University of Miami
and chief of staff services at the Jackson Memorial
Medical Center. I was on the full-time faculty, and my
superiors were actually in the process of offering me a
promotion. Practicing medicine in Miami was great from
a medical and university standpoint, but I just didn’t feel
like Miami was a good place to raise a family. My wife
and I were both from Pittsburgh and so, with a lot of fear
and trepidation, we decided to move back. We moved
back on September 17, 1990.
You are very active with the American Society for Aesthetic
Plastic Surgery. Does your work with that specialty society
compliment your involvement with ACMS?
My involvement with ACMS allows me to bring a
more open-minded approach to the specialty society. In
the specialty society, we are sometimes blindsided by
issues that just pertain to plastic surgery, whereas ACMS
addresses issues that encompass the whole spectrum of
medicine. That perspective is very helpful for me when
dealing with the specialty society and vice versa. My
involvement with ACMS and that of the specialty
societies play off of each other. I have been privileged to
be a member of both organizations.
Talk about the role you play with the Pittsburgh Steelers
organization.
The Pittsburgh Steelers probably has one of the best
medical staffs in the NFL. I have been a consultant for
them since 1993. I am not on the field every week like
Drs. (Joseph) Maroon or (James) Bradley, but there is an
occasion when my services are needed. The whole Steeler
organization and especially the training staff are superb.
They have really put together a superb medical staff that
virtually covers every specialty for the men, women and
children within the Steeler organization.
Tell our readers a little bit about your family.
My beautiful wife Susan is a graphic artist. She has
done a lot of wonderful things in the art world, in
addition to raising four children. My son Lee, who is 25,
graduated from The Pennsylvlania State University (PSU)
in 2006 and almost immediately began working for NFL
Films. He has already won three Emmys for his work.
My daughters Kristin (22); Kimberly (20), and Kelly (18)
are all currently students at PSU, where I first met my
wife. When our youngest daughter Kelly entered PSU,
she became the 48th member of the family, between my
side and my wife’s side, to attend Penn State.
What are your interests or hobbies outside of medicine?
I’ve always enjoyed music. In 2001 I made a conscious decision to learn how to play the guitar. My friend
Frank Cappelli, who had a children’s show several years
ago, said he would teach me how to play. Now I know
how to play a little bit of mandolin, bass guitar and banjo
as well.
I am also part of a group called the
Monongahela Duck Club Band. After
Frank started teaching me how to play
the guitar, we started to play old Bob
Seger tunes. We found that there was
an audience out there for that type of
music. He is a very good entertainer
and the group just came together with
Frank and some other friends. We play at different events
like the Saxonburg Summer Arts Festival and the UPMC
Shadyside talent show, which took place this past fall. It’s
been fun. I also collect guitars and mandolins.
It’s a great outlet. You can’t think about anything else
when you play because you are working a different part of
your mind. I also do some artwork. I draw and that’s the
same thing. You have to shut off one part of your brain
and use the other. My wife is a much better artist though.
I definitely take a back seat to her when it comes to art,
but both music and art are great outlets for me.
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Ms. Morton is a communications consultant. She can be reached at
cmorton@acms.org.
Dr. McCafferty and the other 2011
ACMS officers will be recognized at
the ACMS Foundation Gala and
community awards ceremony on
Saturday, March 19, 2011, at Heinz
Field. Look for more details about
the annual event in upcoming
issues of the Bulletin (see page 24
of this issue).
37
SPECIAL REPORT
Medical Records Reproduction Fees
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nder 42 Pa.C.S. §§6152 and 6155 (relating to
subpoena of records and rights of patients), the
Secretary of Health (secretary) is directed to
adjust annually the amounts which may be charged by a
health care facility or health care provider upon receipt of
a request or subpoena for production of medical charts or
records. These charges apply to any request for a copy of a
medical chart or record except as follows:
(1) Flat fees (as listed in this notice) apply to
amounts that may be charged by a health care facility
or health care provider when copying medical
charges or records either for the purpose of supporting any claim or appeal under the Social Security Act
or any federal or state financial needs based program,
or for a district attorney.
(2) An insurer shall not be required to pay for
copies of medical records required to validate medical services for which reimbursement is sought under
an insurance contract, except as provided in: (a) the
Worker’s Compensation Act (77 P.S. §§1—1041.1
and 2501—2506) and the regulations promulgated
thereunder; (b) 75 Pa.C.S. Chapter 17 (relating to
motor vehicle financial responsibility law) and the
regulations promulgated thereunder; or (c) a contract
between an insurer and any other party.
The charges listed in this notice do not apply to an
X-ray film or any other portion of a medical record that is
not susceptible to photostatic reproduction.
Under 42 Pa.C.S. §6152.1 (relating to limit on
charges), the secretary is directed to make a similar
adjustment to the flat fee which may be charged by a
health care facility or health care provider for the expense
of reproducing medical charts or records where the
request is: (1) for the purpose of supporting a claim or
appeal under the Social Security Act or any federal or state
financial needs based benefit program; or (2) made by a
district attorney.
The secretary is directed to base these adjustments on
the most recent changes in the Consumer Price Index
reported annually by the Bureau of Labor Statistics of the
United States Department of Labor. For the annual
38
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Medical Records
Reproduction Fee Schedule for 2011
2001
HIPAA
Retrieval Fee ... $19.92 .............................. $0
Pages 1-20 ......... $1.34/page ....... Cost to copy & mail
Pages 21-60 ........ $ .99/page ....... Cost to copy & mail
Pages 61+ .......... $ .33/page ....... Cost to copy & mail
Microfilm copies $ 1.97/page ....... Cost to copy & mail
period of October 31, 2009, through October 31, 2010,
the Consumer Price Index was 1.2 percent.
Accordingly, the secretary provides notice that,
effective January 1, 2011, the following fees may be
charged by a health care facility or health care provider for
production of records in response to subpoena or request:
The Department of Health and Human Services has
stated that, under HIPAA, medical record copying fees
for patients may not include costs associated with searching for and retrieving the medical record. For a subpoena,
attorney, or insurance company requests, you may charge
the fees, including the search and retrieval fee. To determine your cost for copying and mailing medical records
for a patient request under HIPAA, you should consider
the following:
• Salary and benefits of the person who does the copying.
Include all steps of the process, i.e., verifying validity of
authorization, pulling the chart, reviewing the record,
removing the records, copying, preparation for mailing,
re-assembling the chart, and re-filing the chart.
• Cost of the supplies, i.e., paper, toner, envelopes, etc.
• Cost of equipment, i.e., prorated lease or depreciation
expense.
In addition to the amounts listed, charges may also be
assessed for the actual cost of postage, shipping and
delivery of the requested records.
Neither PA Law or HIPAA mandates that charges be
assessed for copies of medical records. It merely sets the
maximum fees that can be charged.
If a district attorney requests a medical record for an
action or proceeding, a flat fee of $19.92 may be charged.
No independent or executive agency of the Commonwealth is required to pay any costs associated to medical
charts or records unless required by law. At this time,
Workers’ Compensation (utilization review) and Auto
(peer review) pay $.12 per page, plus actual mailing costs
(scope of release is limited to the treatment of the work
related or auto injury). Attorney requests for Workers’
Compensation and Auto treatment records are not
subject to the $.12 limitation.
If the medical record is requested for the purpose of
supporting a claim or appeal under the Social Security
Act, a flat fee of $25.24 plus postage may be charged (the
attorney should be able to supply a copy of the Appointment of Representative from the Social Security Administration).
Note: Some health insurance contracts may require
the physician to forward patient records to another
physician within a network at no charge.
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A Professional Corporation
Certified Public Accountants
"Specializing in Physician Practices Since 1978"
Let us be the key to your future . . .
412-281-1901
www.3kcpa.com
○
The Pennsylvania Medical Society provided the information for this
Special Report. For more information, call (800) 228-7823.
Know a Physician in Need?
If you know a
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with an impairing
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(717) 558-7817
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No matter how you slice it, the Kell Group serves up a
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Call the Kell Group today for an evaluation of your
medical billing process, 412-381-5160.
777 East Park Drive • P.O. Box 8820 • Harrisburg, PA 17105-8820
www.kellgroup.com
39
ACMS BOARD OF DIRECTORS
The Allegheny County Medical
Society Board of Directors met on
October 12, 2010. Board Chair
Douglas Clough, MD, called the
meeting to order at 6 p.m.
D
r. Clough introduced guests
from the American Heart
Association who reviewed the
Mission Life Line Program to
improve response time to heart
attacks in southwestern Pennsylvania.
The program’s mission is to save lives
by closing gaps in the system of STElevation Myocardial Infarction
(STEMI) care, requiring the participation of physicians, nurses, emergency medical service providers and
hospital teams. The ACMS Board of
Directors voted to endorse the
Mission Life Line Program and to
support communications to physicians concerning the project.
Dr. Clough
introduced Dr.
Carl Sirio, trustee
of the American
Medical Association (AMA), who
provided an
update on current
Dr. Sirio
issues. Dr. Sirio
discussed the status on the campaign
to prevent mandated cuts to the
Medicare fee schedule and to revise
the Sustained Growth Rate (SGR)
Medicare payment formula. He also
discussed the AMA’s participation in
the ongoing regulatory framework of
the national health care reform
legislation. He thanked the board of
directors for supporting his campaign
for the AMA board and pledged to
report to them periodically and to
respond to individual questions and
comments sent directly to him.
Dr. John Delaney reported on
the Executive Committee’s Septem40
ber 8 meeting. The committee
recommended the board approve the
nomination of Bruce A. MacLeod,
MD, both as PAMPAC district
trustee in 2010 to succeed Dr. Amelia
Paré and for vice president of the
PAMED in 2011. The board approved the nominations.
Nadine Popovich and Debbie
Kocak, who serve as ACMS and
PAMED membership field staff
representatives, reported on their
initial meetings with ACMS board
members and their first visits to
several group practices and practice
administrators. They requested the
board’s assistance in identifying
individuals and group practices that
should be contacted concerning the
benefits of society membership.
Drs. Lawrence John and Anthony
Spinola reported on the activities of
the Primary Care Coalition (PCC),
reviewing minutes from the group’s
August 4 meeting. They noted that
the PCC would review a draft of the
white paper on primary care being
developed by the Institute of Politics
of the University of Pittsburgh and
report back to the board.
Dr. Christopher Daly, chair of
the Nominating Committee, presented the 2011 slate of candidates
for office; nominees have agreed to
run for election. He also noted that
the election would be conducted by
mailed ballot at the end of October
in accordance with the bylaws. The
Board of Directors approved the slate
of candidates as presented.
In the absence of Finance Committee Chair Alan Yeasted, MD, Dr.
Rajiv Varma presented the
committee’s report containing the
2011 proposed budget, noting that
dues would remain at the current
level and that a modest year-end
surplus is projected. The Board of
Directors adopted the proposed 2011
budget as presented.
Dr. Kevin Garrent, chair, and Dr.
Amelia Paré, vice chair, ACMS
Delegation to the PAMED House of
Delegates, to be held October 22-24
in Hershey, PA, noted the following:
• Dr. Ralph Schmeltz will be installed as PAMED president;
• Dr. Daniel R. Lattanzi will receive
the PAMED Physician Award for
International Voluntary Service;
• ACMS will receive the R. William
Alexander Award for Political
Advocacy from PAMPAC;
• ACMS will also be recognized for
receipt of the 2010 PAMED Grant
for Healthy Living in Minority
Communities for a collaborative
wellness program with the Gateway
Medical Society targeting the
African-American community in
Allegheny County.
Dr. John Delaney reported on the
status of planning for the 2011
ACMS Foundation Gala to be held
on March 19, 2011, at Heinz Field.
He requested the support of board
members in securing auction items,
attendance at the event, sponsorships
and ads in the program. He also
noted that information regarding the
gala can be found on the ACMS
website: www.acmsgala.com.
Dr. Delaney next reported on his
participation in the Gateway Medical
Society annual conference and on
Gateway’s anticipated collaboration
on the PAMED Wellness Grant.
Kathleen Reshmi, ACMS Alliance president, expressed the alliance’s
appreciation to the Board of Directors for its support of the group’s
85th jubilee.
In a written report, Dr. Scott
Miller, ACMS Bulletin medical
editor, asked for board approval of
terms for associate editors :
BOARD OF DIRECTORS
• Timothy Lesaca, MD, (1st term),
• Frank Vertosick, MD (2nd term),
• Melinda Campopiano, MD (3rd
term),
• Deval Paranjpe, MD (3rd term),
• Stuart Tauberg, MD (3rd term).
The board approved the appointments.
Zeyad Schwen, medical student
representative, reported on medical
student activities, noting that the
ACMS and the University of Pittsburgh School of Medicine would
collaborate on a Medical Student
Career Night on November 16 at the
Herberman Conference Center at
UPMC Shadyside. He encouraged
ACMS board members to participate
as faculty members, noting that more
than 40 faculty members had signed
on and that student participation is
expected to exceed 100 students.
Member Benefit
A. J. Harper, Hospital Council of
Western Pennsylvania president,
reported on activity concerning the
health care reform legislation, noting
the contentiousness of the debate in
the upcoming election. He also noted
the impact of the hospital assessments to Pennsylvania resulting in
additional medical assistance payments, Medicare Wage Index and
ongoing negotiations with respect to
payment for observation status with
commercial insurance carriers.
The meeting ended at 8:20 p.m.
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Savings on
Auto Rentals
You’re entitled to receive the
medical society’s corporate rate
on automobile rentals at
Enterprise rent-a-car, for
everything from compact cars
to luxury cars, trucks and
passenger vans.
Simply call any Enterprise rent-acar office and ask for details. Use
Society Customer I.D. #40A7256.
○
This is a summary report. A full report is
available by calling the ACMS office at (412)
321-5030. Board meetings are open to
members. If you wish to attend, contact the
society to receive a schedule and meeting agenda.
The next regular Board of Directors meeting is
Monday, February 15, 2011.
ALLEGHENY COUNTY
MEDICAL SOCIETY
Leadership and Advocacy
for Patients and Physicians
ACMS Members
New Partner?
New Address?
Retiring?
Congratulatory Message?
Announce it here...
Professional announcement advertisements in
the Bulletin are available to ACMS members at
our lowest prices.
Contact Linda Smith at 412-321-5030
for more information.
Please visit our website
(www.acms.org/express) to
share your thoughts in a
number of ways:
Article Ideas
√ Favorite Websites
√ Letter to Editor
√
Please let us hear from you!
41
CLASSIFIEDS
FOR RENT
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2,000 sq. ft., private street level
parking, two entrances. Includes
three exam rooms, waiting room,
reception room, physician’s office,
laboratory, kitchen, and two
restrooms; all furnished, ready to
move in. Some utilities included.
Call 412-922-3333.
FOR SUBLEASE
OFFICE SPACE in Shadyside
Medical Building for sublet. 1-3
days per week. Three exam rooms
+ front office. Telephone: 412681-8720.
HELP WANTED
PHYSICIAN with active/or can
activate PA license, any specialty.
Work 4-16 hours/monthly. Malpractice insurance provided. Ideal
for retired physician. PITTSBURGH FAMILY PRACTICE.
412-734-1100.
PHYSICIAN with active license,
any specialty, for two to three halfdays per month, malpractice insurance provided. 412-855-9032.
NURSE/PA WANTED. Pittsburgh Cardiovascular Institute is
hiring a full-time CRNP and/or
Physician Assistant to provide patient care services to cardiology and
internal medicine patients including assessing and managing patients in the outpatient and/or inpatient environment, by following
established standards and practices.
Located in the Monroeville area of
Pittsburgh, Pittsburgh Cardiovascular Institute is considered one of
the foremost outpatient focused
facilities. Responsibilities: -Assess
patient health status. -Determine
appropriate diagnostic and therapeutic procedures and develops
treatment options. -Provide acute
and chronic patient care including
taking histories, doing physicals,
monitoring therapies, giving injections and medications. -Triage patient calls and evaluates patient
problems. Basic Qualifications:
PA: -A graduate of a Physician Assistant program accredited by the
Accreditation Review Commission
on Education for the Physician
Assistant (ARC-PA) is required.
-BS or MS candidate is preferred.
-Experience as a physician assistant
and/or experience in a clinical setting is preferred. -Cardiology and/
or Internal Medicine experience
preferred. CRNP: -The successful
completion of an approved Nurse
Practitioner program is required.
-BSN, MSN is preferred. -Professional nursing experience and/or
nurse practitioner experience is
preferred. -Cardiology and/or Internal Medicine experience preferred. Licensure/Certifications:
PA: -A current state PA license, certified by the National Commission
on Certification of Physician Assistants (NCCPA) is required. -A
current CPR certification is required. CRNP: -A current state
RN license and CRNP certification
is required. -A current CPR certification is required Submit resumes
and three references online to:
josephineoria@mhs-pci.com or fax
to (412) 373-6861.
Looking for one place to get
answers to your questions about
government benefits and services?
USA.gov has you covered. It’s your
offi cial source for government
information.
The medical society appreciates
and depends on its advertisers.
Please remember to tell them
you saw their ad in the Bulletin.
Free classified ad on the world wide web!
www.
acms.
org
42
Place a classified advertisement in the BULLETIN
and your ad will also appear on the Allegheny
County Medical Society’s website for the duration
of the advertisement at NO ADDITIONAL COST. Check
out your ad at http://www.acms.org. For more
information, call Linda Smith at (412) 321-5030.
Offering financial strength, superior customer service and litigation protection to our
physician policyholders and their staff for over 30 years.
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For additional information, please contact Lisa Klinger, CISR, Sales
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Phone: 800-445-1212, ext.5478 or 717-802-9236
E-mail: lklinger@pmslic.com
WWW.PMSLIC.COM
800-445-1212
Exclusively sponsored by the
ALLEGHENY COUNTY MEDICAL SOCIETY
43
Malachy Whalen & Co., Inc.
Visit www.malachy.com
(412) 281-4050
(800) 343-5382
FAX (412) 261-5955
Why should you call us for insurance????
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Your ACMS
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Insurance Source
endorsed by
Peggy McNamee
peggymc@malachy.com
Allegheny County
Medical Society

January 2011 - Allegheny County Medical Society

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