ACMS & IMD

ACMS & IMD

Regional Independent Physicians Band Together, Allegheny County Medical Society Steps in to support Small Business in Medicine

 Pittsburgh, PA. The long tug of war between the major health systems in Pittsburgh resulted in a number of physicians leaving healthcare systems and launching new medical practices.  In response, the Independent Medical Doctors (iMD) of Western Pennsylvania and the Allegheny County Medical Society have signed a two-year collaboration to incubate and support physicians as small business owners in the practice of medicine.

“Physician owned practices provide excellent quality of care at a much lower cost with unparalleled access and continuity of care at a personal level.

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Before you can choose the Medicare Advantage plan that is best for you, it’s important to understand the basics of Original Medicare.

Medicare is a federal health insurance program. In order to qualify, you must be a U.S. citizen or lawfully present in the United States. You also must be age 65 or older; or be under age 65 with certain disabilities; or have permanent kidney failure requiring dialysis.

Medicare has four parts: Part A hospital coverage, Part B medical coverage, Part C Medicare Advantage plans and Part D prescription drug plans.

Part A hospital coverage

Most people do not pay a monthly premium for Part A.

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Opinion

Editorial …………………………..406
Winter nourishment
Deval (Reshma) Paranjpe, MD, FACS

Editorial …………………………..410
Retirement
Richard H. Daffner, MD, FACR

Editorial …………………………..413
Then and now
Andrea G. Witlin, DO, PhD

Perspective ……………………..415
Choosing a Medicare plan
Namita Ahuja, MD

Departments
Society News …………………..418
• Greater Pittsburgh Diabetes Club
• Pennsylvania Geriatrics Society – Western Division
• Pittsburgh Ophthalmology Society
• Pennsylvania Medical Society announcements
Activities & Accolades………421
Membership Benefits………..422
In Memoriam ……………………424
• Robert Love Baker, MD
Editorial Index………………….440
Advertising Index……………..442

Articles
Materia Medica …………………425
Trikafta™ (ivacaftor/tezacaftor/elexacaftor): A breakthrough therapy
for cystic fibrosis patients who carry at least one F508del mutation
Adam Patrick, PharmD candidate

Legal Report ……………………428
Regulatory sprint to coordinated care: New Stark and Anti-Kickback rules
Michael A.

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Regulatory sprint to coordinated care: New Stark and Anti-Kickback rules
Michael A. Cassidy, Esq.

On Oct. 22, 2019, the Centers for Medicare & Medicaid Services (CMS) and OIG (Office of Inspector General) released new proposed rules regarding Stark Law Exceptions and Anti-Kickback Safe Harbors in response to what has universally been christened as the “Regulatory Sprint to Coordinated Care,” first announced by the U.S. Department of Health and Human Services (HHS) in June 2018.
As background, please remember that, although the Anti-Kickback Safe Harbors and the Stark Law Exceptions are confusingly similar with respect to their intended purpose, they serve the following different functions:
1.

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In our hospice inpatient unit, we have taken care of the following patients:

  • An elderly patient with metastatic cancer who fell while walking and suffered a traumatic lower extremity fracture, requiring inpatient hospice care to manage fairly severe pain and agitation. She was not a surgical candidate. Her medication regimen included a continuous infusion of morphine at 10 mg intravenously per hour, along with a scheduled dose of lorazepam at 2 mg every six hours. She could have as-needed doses of both medications for breakthrough pain and agitation (10 mg of intravenous morphine hourly is the approximate equivalent of 30 mg of oral morphine tablets taken every hour).
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How often have we heard friends and neighbors tell us that they were not going to vote because they thought their vote would not make a difference? This is especially true in today’s polarized political climate where there are well-documented instances of foreign (attempts of) intervention and massive campaign financing by political action committees (PACS). So, I ask, can a voice of one make a difference? Is every vote important? I say yes and have experienced it first-hand.

In 1998, I was a councilor for Pennsylvania to the American College of Radiology (ACR). While most radiology societies have predominantly academic membership, the ACR represents all of radiology – academics and private practice, and functions to establish practice standards, provide education, manage economic issues, and serves as the political arm for the profession.

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As suspicion – or acknowledgement – that many cases of opioid use disorder (OUD) were iatrogenic and the opioid crisis grew, both federal and state governmental health agencies sought to develop and issue guidance for physicians. Having been fed misinformation by pharmaceutical companies for years, physicians needed evidence-based guidelines to appropriately treat their non-cancer chronic pain patients. The Centers for Disease Control and Prevention (CDC) responded definitively by issuing guidelines after seeking input from experts and stakeholders and combing through the evidence and responses. In addition, legislatures put strict limitations on prescribing in certain situations. It is clear that compliance with opioid prescribing legislation is mandatory, but what about compliance with guidelines?

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Our country is undeniably becoming the home to an ever-increasing number of individuals from distinct racial and ethnic backgrounds. According to the U.S. Census Bureau, Statistical Abstract of the United States 2001, between 1980 and 2000, while the country’s white population grew by 9%, the African American population increased by 28%, the Native American population increased by 55%, the Hispanic population by 122% and the Asian population grew by more than 190%. The abstract goes on to state that Asians and Native Americans already account for more than half of California’s population. Forty-five percent of Texans self-identify as members of minority groups, as do one in three residents of New York, New Jersey and Florida.

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Opinion

Editorial …………………………..362
Pocket MBA
Deval (Reshma) Paranjpe, MD, FACS

Editorial …………………………..364
A voice of one
Richard H. Daffner, MD, FACR

Editorial …………………………..366
When the music stops
Andrea G. Witlin, DO, PhD

Editorial …………………………..368
‘Generation A’ comes of age
Anthony L. Kovatch, MD

Miller Time ………………………372
High-dose opiates and benzodiazepines in end-of-life care
Scott Miller, MD, MA, FAAHPM

Perspective………………………374
An ode to Planet Nine Pluto: A human hospice physician sharing a pet hospice experience
Keith R. Lagnese, MD, FAAHPM, HMDC

Perspective………………………380
A case for diversity in the Pittsburgh workforce
William Simmons, MD

Departments

Membership Benefits………..378
Society News …………………..383
• Pittsburgh Ophthalmology Society
• Pennsylvania Geriatrics Society – Western Division
Activities & Accolades………384

Articles

Feature……………………………..386

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October 2019 Bulletin“History does not repeat itself, but it rhymes,” according to a popular proverb misattributed to Mark Twain. Healthcare trends tend to be cyclical, and the 1990s trend of publicly traded physician practice management (PPM) companies infusing investor capital into medical practices has returned from oblivion in the form of private equity (PE) transactions. Like the ill-fated PPMs, PE deals offer physicians cash up front and ownership in management companies that are designed to be sold in the future at a profit, and like PPMs, PE deals claim to be in a position to consolidate physician groups to achieve greater profitability. The results may not be in for a few years, but PE firms hope to avoid falling prey to the mistakes which led to the meteoric rise and fall of the PPM industry.

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