“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).

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So far, more than 20 million Americans have been infected with COVID-19 with greater than 350,000 deaths. Here in Allegheny County, we have had approximately 60,000 confirmed cases and greater than 1,000 deaths. Nearly 3,000 healthcare workers have died from COVID-19 in the United States. In addition to the illness caused by confirmed cases, there have been many more infected individuals who had no testing performed. A recently identified novel COVID-19 strain appears to be much more contagious than previous strains and has been found to be present across the globe, including here in the United States. Proven effective measures to stem the tide of COVID-19, including face masks, social distancing and restricting public gatherings, have been unable so far to contain the pandemic.

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Patricia L. Bononi, MD, FACP
2021 ACMS president

Dr. Bononi received her bachelor of science degree from Georgetown University. She earned her medical degree from the University of Pittsburgh and completed her internship and residency in Internal Medicine and fellowship in Endocrinology at the University of Pittsburgh Medical Center. She is board certified by the American Board of Internal Medicine and the American Board of Endocrinology, Metabolism and Diabetes Mellitus.

Dr. Bononi is the medical director of the Allegheny Health Network (AHN) Center for Diabetes since 2013. She has been site Principal Investigator for more than 20 clinical trials testing medications for diabetes mellitus.

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Opinion

Executive Committee …………..5
COVID-19 vaccines: Protect yourself, protect your loved ones and help return our world to a better place
Raymond E. Pontzer, MD, FACP

Editorial ………………………………6
Lessons for ‘the After’
Deval (Reshma) Paranjpe, MD, MBA, FACS

Editorial ……………………………..7
Finding my niche – training to be a physician scientist
Andrea G. Witlin, DO, PhD

Editorial ……………………………..9
Disruptive technology
Richard H. Daffner, MD, FACR

Perspective ………………………12
‘The Few’
Timothy Lesaca, MD

Perspective ………………………14
Symbolism in American political parties:
How a donkey and an elephant came to represent Democrats and Republicans
Kris Gopal, MD

Departments

Membership Benefits …………16
Society News …………………….18
• Pittsburgh Ophthalmology Society
• Pennsylvania Geriatrics Society – Western Division
Activities & Accolades ……….20
Classifieds ………………………..20

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Acetaminophen, better known by its brand name Tylenol®, is widely used in the inpatient and outpatient settings for pain management and fever relief. It is favorable in many populations because of its opioid sparing properties and relatively favorable side effect profile. Acetaminophen is most commonly used in oral formulations including tablets, capsules and oral solutions, and also is available as a suppository. In 2010, intravenous acetaminophen, also known as Ofirmev®, was approved by the FDA. However, the place in therapy of intravenous acetaminophen has not yet been well established.

The FDA-approved uses of intravenous acetaminophen include management of mild to moderate pain, management of moderate to severe pain with adjunctive opioid analgesics, and reduction of fever, which are identical to that of oral acetaminophen.

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Many of the men and women of science and medicine have been honored by having their names associated with the fruits of their labors. We have Paget disease of bone and breast (Sir James Paget 1814 – 1899), Pasteurization (Louis Pasteur 1822 – 1895), Koch’s postulates (Robert Koch 1843 – 1910), and the Curie, a unit of radiation (Marie Curie 1867 – 1934). And then we have Phillipp Lenard, Hans Reiter, Eduard Pernkopf and Hans Asperger, all of whom made significant contributions to science and/or medicine, but whose names are all but forgotten. Lenard was awarded the Nobel Prize; Reiter and Asperger had syndromes named for them; and Pernkopf produced the most realistic anatomy atlas.

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As I write this, COVID-19 cases in our area are soaring; as you read this, they will undoubtedly have reached record-setting peaks. Vaccines loom on the horizon, but approval, rollout and distribution are still challenges which remain to be overcome.

In this cocktail called December 2020, we have equal parts terror and hope, dread and resolve, resignation and revelation. Add a sugar cube of faith and the bitters of loss, and muddle together.

Allow me to suggest a garnish which might make this cocktail slightly more palatable: gratitude.

Let us be grateful for our lives and the lives of our loved ones and friends.

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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

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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.

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When I was on a toxicology elective as a resident, the fellow and I disagreed over the topic of the presentation I had to give. I wanted to cover a drug commonly prescribed to complex care patients, she wanted something “more interesting,” like an exotic compound that she would only see once in her career if she were lucky (and the patient very unlucky). We compromised on a historical topic of local relevance, the Donora Smog of 1948.

Donora, Pa., named for William Donner and Nora Mellon – lies in a bend of the Monongahela River on the eastern edge of Washington County, 25 miles south of Pittsburgh.

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