In a Dec. 10, 2020, decision, the D.C. Circuit Court denied a woman’s second attempt to obtain a preliminary injunction to force a fertility clinic to take her back as a patient pending a lawsuit she had filed against them.¹ The case was decided on two factors. The first factor was the plaintiff’s likelihood of success on the merits, which the court determined was unlikely. The second factor was whether the issuance of a preliminary injunction was “in accord with the balance of equities or public interest.” Due to the deterioration of the physician-patient relationship, the court determined that her reinstatement as a patient was not feasible.

“Lead, follow, or get out of the way,” goes the old admonition, attributed variously to Thomas Paine, Gen. George S. Patton and Chrysler’s Lee Iacocca. When it comes to innovative health payment mechanisms, the Department of Health and Human Services (DHHS) has chosen the third path by adopting what they dubbed the “Regulatory Sprint to Coordinated Care,” beginning in 2018. The goal of this initiative is to remove or reduce regulatory obstacles that have frustrated the development and growth of alternatives to the traditional fee-for-service payment system, and to facilitate the transition toward value-based coordinated care models. Among the hurdles targeted for removal are elements of the Stark physician referral law (Stark), the Medicare and Medicaid Anti-Kickback statute (AKS) and the Civil Monetary Penalties Law (CMPL).

Opinion

Editorial …………………………. 369
Gratitude
Deval (Reshma) Paranjpe, MD, MBA, FACS

Editorial …………………………..370
Finding my niche: A kind, well-shaven face
Anthony L. Kovatch, MD

Editorial …………………………..373
Rightly forgotten
Richard H. Daffner, MD, FACR

Perspective ……………………..376
Reducing disparities in musculoskeletal care: Focusing on bone and joint health
Anthony M. DiGioia III, MD
Gina Edwards
Angela DeVanney
Gigi Crowley

Perspective ……………………..378
A physician’s reflection on Roberto Clemente and his leadership legacy
Johanna Vidal-Phelan, MD, MBA, FAAP

Departments

Society News …………………..380
• Fit with Your Physician walk held
• ACMS Foundation awards medical student scholarship
• ACMS member assists with removal of prior auth code
• Pennsylvania Geriatrics Society – Western Division

Classifieds ………………………381
Activities & Accolades………382
Membership Benefits………..384

October was National Cybersecurity Awareness Month, and government agencies and private cybersecurity companies alike offered tips to stay secure online. Cybersecurity awareness is particularly necessary in 2020: Ransomware attacks against health care providers and entities that support them have continued in full force after a 350% increase in the fourth quarter of 2019. Even the U.S. Department of Health and Human Services suffered a cyberattack in March. COVID has not slowed hackers and other cybercriminals. eResearch Technology, a company that sells software used in clinical trials – including trials for a vaccine for the coronavirus – suffered a ransomware attack in mid-September.

Opinion

Editorial …………………………..329
Fall nourishment
Deval (Reshma) Paranjpe, MD, MBA,FACS

Editorial …………………………..331
Roentgen and the discovery that changed medicine
Richard H. Daffner, MD, FACR

Miller Time ………………………335
A Viral Ode
Scott Miller, MD, MA, FAAHPM

Editorial ………………………….336
Physicians in mourning: Grieving with purpose
Anna Evans Phillips, MD, MS

Editorial …………………………..338
Lost too soon: An ode to Micah Man
Andrea G. Witlin, DO, PhD

Perspective………………………340
The Donora Smog
Kristen Ann Ehrenberger, MD, PhD

Perspective………………………342
Reflections on physician wellness and the challenges of COVID
Lawrence R. John, MD

Articles

Membership Benefits ……….344
Society News …………………..346
• ACMS Foundation opens Pediatric Asthma Clinic
• Pittsburgh Ophthalmology Society

Activities & Accolades ……..348

Physician recruiting can be expensive. Doing it wrong can be even more expensive, as a recent multimillion-dollar settlement illustrates.

When a group practice needs financial assistance to bring on an additional physician, hospitals may be willing to put up funds to protect the practice from incurring a loss as the new doctor becomes established in the community. Such recruitment agreements with hospitals are generally structured as monthly advances of the difference between the new physician’s collections and the cost of employing him or her, and treated as forgivable loans to the practice so long as the physician continues to practice in the hospital’s service area for a defined period.

In Leadbitter, J. v. Keystone Anesthesia v. Petraglia1 (Leadbitter), the Pennsylvania Superior Court (Superior Court) further eroded the evidentiary privilege afforded by the Peer Review Protection Act (PRPA).2 Over the last several years, the protection offered to the proceedings and records of a review committee has been whittled down by a series of cases that are inapposite.

Statutory background. The Pennsylvania General Assembly’s goal in passing PRPA was “to serve the legitimate purpose of maintaining high professional standards in the medical practice for the protection of patients and the general public.” The General Assembly determined that “because of the expertise and level of skill required in the practice of medicine, the medical profession itself is in the best position to police its own activities.”

Opinion

Editorial …………………………..234

The malady lingers on

Deval (Reshma) Paranjpe, MD, MBA, FACS

Editorial …………………………..238

Scientific misconduct

Richard H. Daffner, MD, FACR

Editorial ………………………….241

Reconnecting during COVID

Andrea G. Witlin, DO, PhD

Perspective ……………………..246

Telepsychiatry appointment adherence and productivity during COVID-19

Timothy Lesaca, MD

Pamela Pyle, AAS

Perspective ……………………..249

Reflections after 52 years

Richard L. Green, MD

Departments

Membership Benefits ……….244

Society News …………………..251

• Pittsburgh Ophthalmology Society

Activities & Accolades ……..253

Articles

Materia Medica …………………254

Istradefylline (Nourianz®)

Samantha DeMarco, PharmD

Rachael Cardinal, PharmD, BCPS

Legal Summary ……………….256

Pennsylvania Superior Court decision: Further deterioration of the peer review privilege

Beth Anne Jackson, Esq.