THE essage · Washington State Department of Health Its database provides a complete immunization...

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A M O N T H L Y N E W S M A G A Z I N E O F S C M S – F E B R U A R Y 2 0 1 1

SPOKANE COUNTYMEDICAL SOCIETY

By Brad Pope, MDSCMS President

Inland Northwest and Care CoordinationThe Beacon Community of the

Let's use our data toolsto practice coordinated care

“Raising the Bar” for Pediatric Care in the Inland Northwest

February SCMS Message Open2

February SCMS Message Open3

T a b l e O F C O n T e n T S

President’s Message: let's use our data tools to practice coordinated care 1

Top 5 Physician Challenges in 2011 2

beacon Community of the Inland northwest Selects Orion Health Technology 5

Growing Medical education in Spokane 6

Funding Received from empire Health Foundation 6

Deaconess Offers a Wide Range of Services for Children 8

aCO-bound? Consider the Financials First 9

Giving Wings to Pediatric Critical Care 10

Cecilia Fry, MD 10

Spokane Prescription Opioid Task Force 11

CMe 12

FYI 13

Membership Recognition For February 2011 13

“Raising the bar” for Pediatric Care in the Inland northwest 14

new Physicians 15

eHR incentive program timeline 16

In the news 17

Typical Fractures Seen in Children 17

2011 legislators 18

The Future of Pediatrics: advancing to the Medical Home 19

Pediatrician Deb Harper, MD, talks about new concerns for kids’ health 20

Physician Opportunities 23

“You are the same todaY that You are going to be in five Years from now except for two things: the people with whom You associate and the books You read.”

charles Jones

Spokane County Medical Society Message

Terry Oskin, MD, Editora monthly newsletter published by

the Spokane County Medical Society The annual subscription rate is $21 74

(this includes the 8 7% tax rate)

advertising Correspondence Quisenberry Marketing & Design attn: Jeff akiyama 518 S Maple Spokane, Wa 99204 509-325-0701 Fax 509-325-3889 jeff@quisenberry net

all rights reserved This publication, or any part thereof, may not be

reproduced without the express written permission of the Spokane County Medical Society authors’

opinions do not necessarily reflect the official policies of SCMS nor the editor

or publisher The editor reserves the right to edit all contributions for clarity and length, as well as

the right not to publish submitted articles and advertisements,

for any reason acceptance of advertising for this publication in

no way constitutes Society approval or endorsement of products or

services advertised herein

2011 Board of Trusteesbrad Pope, MDPresidentTerri Oskin, MDPresident-electanne Oakley, MD Vice PresidentDavid bare, MDSecretary-TreasurerGary Knox, MDImmediate Past President

Trustees:Keith Kadel, MDMichael Cunningham, MDPaul lin, MDRandi Hart, MDGary newkirk, MDCarla Smith, MDRob benedetti, MDaudrey brantz, MD

February SCMS Message 1

Brad Pope, MD

Did you take steps in 2010 to create and use patient care registries for your practice? If not, may I suggest that you make a new Year’s resolution for improving your medical care and practice in 2011 by beginning the journey?

With the growing focus on pay-for-performance, doctors have real opportunities to improve their patient care while also increasing their practice reimbursements Through the use of data management systems, we can show payers and federal agencies that we are managing our patient populations to create better health outcomes

Since this month’s the Message covers developments in Pediatrics, I’ll use a pediatric example The Child Profile Immunization Registry is a data system operated by the Washington State Department of Health Its database provides a complete immunization history for children in Washington that can be viewed, updated and printed for parent, school or camp requests The registry also helps physicians manage patient care and immunization reporting, and can generate clinic-specific recall lists of children past due for vaccines, in addition to vaccine accountability and benchmarking reports

Through the Child Profile registry, doctors can reach out proactively to patients who are overdue for their immunizations It’s no longer sufficient for medical practices to wait for a

parent to phone in requesting the immunization and then act to see them quickly Using Child Profile one can send reminders systematically Families also get direct reminders mailed from the state, but there is nothing like hearing directly from the doctor Patients are more impressed and take it more seriously when they are contacted by their doctor’s office They will feel more bonded to their provider

What’s also terrific about Child Profile is that it is accessible to any practicing physician, including specialists It’s a shared platform at

this time, some physicians are entering information directly into Child Profile for immunizations; others use their own eMRs and then synchronize them with the state database monthly If we all did this—both primary and specialty providers—we could really

provide coordinated care because specialists can also access information about their patients

So, for example, when a pediatric allergist sees a child, his team can also verify if the child needs a vaccine and encourage the parent to pursue it by having more members of the healthcare system remind patients of their medical needs, we are creating integrated care

Pediatricians were the original physicians who championed the Medical Home model to assure that primary care for kids was coordinated, especially those with special needs They deserve a lot of credit for articulating the need for a medical home and designing a system like Child Profile to help make it a reality because of their interest in immunization, we now have this excellent tool—developed and expanded over 20 years—where many different physicians can coordinate care around childhood immunization

There are many ways for adult care physicians to use data management tools as well Many physicians have electronic medical records, but they still aren’t using their full potential to create registries and to areach out to their patients proactively for specific needs

For primary care physicians, one step is to create workflows for clinic support staff to fill out the fields in the eMR care tracking tool for preventive care Today many physicians get preventive screening results—such as colorectal cancer screening—through the mail at the office a staff member scans the file and adds it to the eMR, however this doesn’t populate the data flow chart tool in the eMR a doctor still needs to search through the record to find the results

Why not have the person who is scanning the results be responsible for inputting the data into the eMR? Then, when you are ready, you can generate reports

I also encourage adult care specialists to think about their eMRs and how to use the flow chart functionality within their medical group For example, someone on your team can keep the immunization information up to date, (pneumococcal, flu, hepatitis a & b) In the future this information might be shared between systems facilitating coordination of care across the community as is happening with Child Profile now

Medicare is thinking about increasing its reimbursements to practices with eMRs with “meaningful use ” Getting your data tools to be more functional and being ready to feed them into a centralized data system helps position your practice for meaningful use

If you have expanded your data tools or integrated them in some way to provide better care, I would like to hear about them We can learn a great deal from each other Please drop me an email at pope b@ghc org or give me a call at 509-241-7370

President’s Message:Let's use our datatools to practicecoordinated care

It’s no longer sufficient

for medical practices

to wait for a parent to

phone in requesting the

immunization and then

act to see them quickly.

Using Child Profile one

can send reminders

systematically.


Top 5 Physician Challenges in 2011Joe Cantlupe, for HealthLeaders Media

There are many things to look forward to in the new Year: possibly a fresh start for those physicians changing their day-to-day lives, maybe moving from a single practice to a group practice, or for baby boomers, a chance to finally curtail their hours as they promised themselves all those years ago

but this column isn't about fresh starts, exactly

This is about the carry-overs, issues that unfolded in 2010, and will continue to be especially important for physicians in 2011, whether physicians are changing their practices or cutting back on their hours These are certainly hot-button issues that we will be keeping an eye on in the coming year

1.The 'Doc Fix'. Seriously, aren't we all sick of it? at the end of the year, Congress again dealt with the doc fix by putting it back another year, instead of only a few months It seems the doc fix is the ultimate in procrastination and definitely a driver for much unpleasantness especially among physicians President Obama, in signing a one-year delay in implementation of the Sustainable Growth Rate Formula, said, "It's time for a permanent solution that seniors and their doctors can depend on

There is keen frustration among many that a permanent solution to the SGR formula for Medicare funding hasn't been found The formula has called for cuts over the past decade, which includes a 25% reduction in Medicare reimbursements that would have taken effect January 1, 2011 Congress delayed five times in dealing with the doc fix, as elliot reported, and the longer it stalls, the longer the toll on the federal budget and reimbursements look for more delays until Congress gets its act together

2.EHRS. Meaningful use tops the list of healthcare industry challenges in 2011, according to a recent PricewaterhouseCoopers report How are physicians going to fare with electronic medical records? are they -- or enough of them -- going to join the ranks of the modern era and get moving digitally, or will they fall behind?

Instead of going forward with electronic health records, some will get out of the business altogether but many physicians on the fence should follow the example of anne brooks, DO, a 72-old physician in rural Mississippi told me she would do "whatever it takes to improve the quality of life for my community," even

if it means embracing electronic records as I write this, let me remind you that CMS and the Office of the national Coordinator for Health Information Technology announced that registration

will begin January 3 for eligible providers hoping to participate in the Medicare electronic health record incentive program

3.Impact of Primary Care Shortages. against the backdrop of the primary care shortage, the soothsayers, pundits, and other prognosticators are saying definitely there will be an increase in mergers among physicians and medical group practices; it's starting already In the meantime, the shortage of primary care physicians is threatening prospects for new healthcare models To wit: the Medical Home Model

as my colleague, John Commins, wrote in november, " Shifting specialists' routine followup care to primary care physicians in a medical home model under the new federal healthcare reforms could save time, money and free specialists for more complex patient care However, the lack of primary care physicians could make such a policy difficult to implement, Commins writes, describing a new study by the University of Michigan Health System " The reason? Redistributing half of the routine follow-up care for patients with common chronic conditions "would require either thousands of new primary car doctors or an extra three weeks of work a year form the primary care physicians in the current work force either way, good luck

4.Accountable Care Organizations. Talking about the new Year and not mentioning aCOs, is like whistling auld ang Syne, and not saying Happy new Year in the next breath So many in healthcare are soooooooooooooooo excited about the prospects of aCOs, and for the most part, rightfully so anything involving large organizations however, needs some caveats to keep us all grounded

as PricewaterhouseCoopers reported in its predictions for 2011, "while aCOs hold great promise for reduced costs and improved quality, the challenge will be keeping people in the aCO and engaging them to stay healthy, which could be the difference between profit and losses "

In any event, for physicians, aCOs are a point of concern Despite all the excitement and hype for pilot aCOs that begin in 2011, at least 42% of respondents in a September Healthleaders Media report, Physician alignment in an era of Change, say there will be strained relations between hospitals and physicians with the advent of accountable care organizations

The aCO movement, however, is likely to make its presence known in the years to come In its wake, there will be "creative destruction" of the fragmented fee for service system, and "consequently the actions of physicians and hospitals during this period will determine the structure of the delivery system for many years," write Robert Kocher, MD and nikhil R Sahni, bS, in november 10 issue of the new england Journal of Medicine

Continued on page 3

she would do

"whatever it takes to

improve the quality of

life for my community,"

even if it means

embracing electronic

records.


• View"TheMessage"Online-Fullcurrentandpastissuesavailable

• Membershipinformation-Informationaboutcredentialing,committees,bylaws,etc.

• CMEinformation-TopicanddatesforupcomingCMEcourses

• Legislativeupdates-ConnectwithSCMSonFacebookandstayinformed

• ConnecttoMedicor-TheonlinemedicallibraryisaSCMSmembershipbenefit.

Continued from page 2

5.The American Board of Internal Medicine. Through much of 2010, the abIM was dealing with the fallout of its proposed sanctions of 139 physicians for passing along and receiving exam questions from a test preparation company, which could result in dismissal of certificates for the accused physicians at the outset, I got the impression from abIM that it would resolve the issue expeditiously not the case appeals and settlement processes have begun, but months after the initial announcements of the alleged cheating, no formal declaration of what will eventually happen to the 139 physicians is really in sight Hopefully, the situation is resolved in 2011, with equanimity and justice for all involved

Yes, from the uncertainty surrounding the american board of Internal investigation to the uncertainty surrounding the Doc Fix, the diagnosis for physicians in 2011 is, well, we'll have to wait and see…

Joe Cantlupe is a senior editor with HealthLeaders Media Online.

He can be reached at

jcantlupe@healthleadersmedia com

Used with permission of Joe Cantlupe, Healthleaders Media Copyright 2010

In Memoriam John “Jack” Francis Driscoll, M.D.

John “Jack” Francis Driscoll passed away on January 7, 2011 He was born on april 13, 1929 to John and Patricia (Geraghty) Driscoll in boise, Idaho Jack attended Seminary at St Joseph's in California and then enrolled at the University of Montana While in college, he was drafted into the Korean War after serving two years in Germany he returned to the University of Montana and finished his degree in Pre-Medicine Jack attended loyola University Stritch School of Medicine, earning his Doctor of Medicine degree in 1959 While in Chicago Jack married Margaret Maher in 1956 and began their family at the completion of his training Jack fulfilled his goal of returning to Spokane with his family to begin his professional career

In 1964, Jack established his Internal Medicine practice, which eventually became the Physicians Clinic of Spokane During his career he served as President of the Spokane Internal Medicine Society, officer of the Spokane County Medical Society, President of the staff at Sacred Heart Medical Center and offered his time as a volunteer

after retirement, Jack continued to live an active, vibrant life in his community He continued his passion for medicine as a volunteer physician at the House of Charity Jack is remembered for his love of family, golf, gardening, cards and lake time

He was preceded in death by his wife Margaret, daughter-in-law Joan Kelly Driscoll, brothers-in-law Curran Higgins MD and James Maher MD, niece Michelle Higgins and cousin Forest "Jay" Trembley Jack is survived by his son John, daughters anne and Mary, sons-in-law edward lapinski and William Uppinghouse, sister Mary Higgins, brother Thomas Driscoll, MD and wife Karen, sister anne Driscoll-Carr and husband bill; eight grandchildren and three great-grandchildren all who knew and loved him will miss him

Visitourupdatedwebsite


Beacon Community of the Inland Northwest Selects Orion Health Technology Solution to Support Regional Program Diane Lenier BCIN

beacon Community of the Inland northwest (bCIn), a regional collaboration led by Inland northwest Health Services (InHS), has chosen an Orion Health solution to provide the technology framework for the project The Orion solution includes care coordination and disease management tools and a clinical data repository, all integrated with a health information exchange bCIn is focused on helping the regional healthcare community establish and adhere to common care coordination programs for improved diabetes management and tracking Orion Health technology was selected to further enable health information exchange across the 14-county bCIn region, support the delivery of best practice care plans, and facilitate quality measurement and reporting back to providers and special interest groups The product’s comprehensive disease management capabilities allow care team members to better track compliance with diabetes management protocols and benchmark progress against individual, regional and national standards

Health Information exchange (HIe) is a critical foundation for the overall bCIn project HIe is defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system HIe provides the capability to electronically move clinical information among

disparate health care information systems while maintaining the meaning of the information being exchanged The goal of HIe is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care

HIe systems facilitate physicians and clinicians meeting high

standards of patient care through electronic participation in a

patient's continuity of care with multiple providers Secondary

health care provider benefits include reduced expenses

associated with: duplicate tests, time involved in recovering

missing patient information, paper, ink and associated office

machinery, manual printing, scanning and faxing of documents,

the physical mailing of entire patient charts, and manual phone

communication to verify delivery of traditional communications,

referrals and test results

Over the past decade, InHS and health care providers across the region have developed a nationally recognized health information technology network benefitting providers and patients throughout the region Tom Fritz, CeO of Inland northwest Health Services, says "In collaboration with bCIn key partners and providers, working with Orion Health will expand our existing technology capabilities and help us connect additional care providers across a much larger geographic area This clearly is an opportunity for a regional effort to improve patient care "

bCIn has a long-term goal of reducing unnecessary hospital admissions and lowering the cost of health care delivery across the region while improving health outcomes for a number of chronic conditions One of 17 beacon Communities identified by the Office of the national Coordinator for Health Information Technology (OnC), bCIn is receiving funds to help update the current regional IT infrastructures to better share information related to the care of chronically ill patients


Growing Medical Education in SpokaneDerek Weyhrauch UWSOM M1, E10

Why did you choose medicine? It’s a question we’ve all answered many times, but as a first-year medical student, I’ve probably answered it more recently than most even so, after a week consisting of 40 hours of lecture, it’s easy to forget that I chose this career primarily for the opportunity to work with patients It’s not until Monday afternoons when I shadow a local neurologist, or Saturday mornings when I work with volunteer physicians at the House of Charity, that my answer is validated These are the experiences that put my first year of medical school in perspective and their availability is what makes medical education in Spokane special

There are very few cities where a first year medical class of 20 students has access to all the healthcare resources that Spokane has to offer It’s one of the reasons I chose to spend my first year here instead of in Seattle and it’s perhaps an even better reason to return for my third and fourth years of school because of the exceptional student-physician ratio I’ve already had

the opportunity to work with several physicians in outpatient, in-patient and community health settings In the time I plan to spend in Spokane during my third and fourth years, I know I can look forward to more one-on-one time with attendings and more subspecialty exposure than would be available elsewhere

Yet, despite these advantages afforded to current students, Spokane still has more to offer I’m confident that this community can support more than our current 20 first-year students, approximately 30 third and fourth year students and 81 residents I care about expanding medical education in Spokane because someday I’d like to return here to establish my practice When I do, I hope for the opportunity to mentor students and residents, have access to the resources to conduct research, and perhaps teach at a four-year medical school

For now, my classmates and I would like to think that medical students are simply good for the community We’re already volunteering in elementary schools and community health centers, and would love to join you in other service-learning projects Consider it an opportunity to mold your potential future partners! Many of us would be honored to someday practice with our attendings and preceptors In the meantime, we would be happy just to shadow you all-day, every-day and ask lots of trivial questions I think you’ll find we’re not much of a burden and for us, clinic sure beats sitting in lecture!

Funding Received from Empire Health Foundation for Faculty Development for Medical Education John McCarthy, MDAssistant Dean for Regional AffairsUWSOM

as many of you are aware, the empire Health Foundation (eHF) has been working to improve the health of residents in the seven-county region Their mission is to fund initiatives that will result in measurable improvements in the health of people living within this region at the same time, WWaMI Spokane has been working to further develop a culture of medical education in our community that will expand and improve our ability to educate the next generation of health care providers Those two missions will join thanks to support from the eHF for a program to further faculty development for our community’s medical educators Ken Roberts, PhD, Director of the WSU-Spokane WWaMI Program and 1st year assistant Dean at the University of Washington School of Medicine, has been awarded a grant from the eHF for use to create a series of faculty development workshops Those workshops will be designed to develop and improve the skills required for teaching students in pre-clinical, clinical and graduate settings Current WWaMI faculty, and those interested in teaching health profession students, will be encouraged to take advantage of the workshops

The WWaMI Spokane leadership looks forward to creating opportunities for you to develop and hone your teaching abilities It is the SCMS members who will lead us toward a healthier community and train the providers who will care for us, and our families in the future Please watch for announcements and consider joining us in faculty development opportunities as they are rolled out

There are very few

cities where a first

year medical class of

20 students has access

to all the healthcare

resources that Spokane

has to offer.


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Deaconess Offers a Wide Range of Services for ChildrenJulie Holland, Communications & Marketing Supervisor

Deaconess Medical Center has a long and rich history of providing quality care to mothers, babies and children in the Inland northwest We’re proud of our proven commitment to caring for high-risk pregnant mothers and their newborn babies, as well as our latest initiative to open an 8-bed general pediatric unit that will offer high quality noncritical inpatient care to children although Deaconess has been without a designated pediatric unit for five years, we’ve always provided quality women’s and children’s services through our perinatal, labor and delivery, mother/baby and level III neonatal intensive care units additionally, Deaconess has continued treating children in the emergency department and through scheduled outpatient surgeries

as we continue to develop an Integrated Delivery System with our partners – Valley Hospital, Rockwood Clinic and Inland Cardiology associates of Spokane – we are also re-evaluating our service line coverage With 12 Rockwood pediatricians, more than 70 Rockwood providers who treat children and many local community physicians who already come to Deaconess to care for newborns, it makes sense for us to offer general pediatrics We’re delighted to fill this gap in

services and give families more options and choices for care

Our comprehensive women’s and children’s program provides a wide-range of services, including the following:

Perinatal Services

Our Deaconess perinatal services team provides care and support for all aspects of high-risk pregnancies We have full time Maternal-Fetal Medicine physician coverage and the only american Registry for Diagnostic Medical Sonography (aRDMS) fetal echocardiography ultrasound technologists in our community Our treatment specialties include: prenatal diagnosis, genetic evaluation, fetal surveillance (doppler, biophysical profiles and non-stress testing), amniocentesis, evaluation of recurrent pregnancy loss, co-management of medical problems in pregnancy (diabetes, HTn, etc ) and management of RbC isoimmunization to include middle cerebral artery dopplar studies and following titers closely throughout the pregnancy

Services provided by our perinatal services team include high quality ultrasound capability, Doppler studies (color and pulsed-wave), detailed fetal cardiac imaging, fetal MRI, detailed organogenesis surveys, genetic counseling, hospital-to-hospital transfer and care for patients with intrapartum complications and palliative care

In addition, the Deaconess perinatal services program is Fetal Medicine Foundation certified in first trimester nT (nuchal translucency) measurement/Down syndrome screening and american Institute of Ultrasound in Medicine (aIUM) accredited for targeted obstetrical ultrasound exams

Neonatal Intensive Care Unit

Deaconess operates a 38-bed, level III nICU staffed 24-hours-a-day with experienced and highly trained clinical staff neonatologists and pediatric surgeons/specialists are also available 24/7 Our nICU nursing staff averages approximately 17 years of experience in neonatal care

The Deaconess nICU team specializes in treating micro-preemies (under 3 lbs ), newborns needing intensive care, drug-exposed infants, multiple births and birth defects (gastroschisis, etc ) Director Patrice Sweeny has worked in the nICU at Deaconess for 27 years She says, “in many categories of the Vermont Oxford network, a database that rates nICU care around the world, we are consistently rated ‘best in Practice ’ Our experience, skill and compassion for families and our fragile patients is exemplary We have a fantastic nICU team of nurses, 20 of which have worked together for 25-35 years ”

In October, 100 percent of the follow-up calls to families discharged from our nICU resulted in the highest ranking for our services every family was “very satisfied” with the care they and their children received from the Deaconess nICU staff

Pediatric Surgery Coverage

as part of the comprehensive level of service provided to all our patients – no matter how small – Deaconess offers 24-hour pediatric surgery coverage With many years of experience in pediatric hospitals around the world, Jim Fisher, MD, anchors our pediatric surgery team Dr Fisher has been providing surgical care for children in the Spokane area since 2002 “Deaconess has one of the premiere nICUs I’ve ever worked in,” says Dr Fisher, “and I’m excited to continue providing surgical coverage for neonates and pediatric patients The nursing care here is outstanding ”

In addition to 24-hour pediatric surgery coverage, we also have fellowship trained pediatric anesthesiologists available For pediatric surgery referrals, please call (509) 473-3630 for more information

Continued on page 9

With 12 Rockwood

pediatricians, more than

70 Rockwood providers

who treat children and

many local community

physicians who already

come to Deaconess to

care for newborns, it

makes sense for us to

offer general pediatrics.



General Pediatrics

Deaconess plans to open a general pediatrics unit soon This 8-bed unit will provide families in our community with the option of choosing Deaconess for their child’s noncritical inpatient care Our goal is to provide general pediatric services to complete the scope of care we provide for babies and children, while continuing to support existing critical children’s services in the community

Our pediatric unit will be relocated on 8-Tower – the home of pediatrics at Deaconess before we closed the service line five years ago We have hired a Pediatric assistant Unit Manager, Robbie landry, a veteran pediatric nurse who previously worked at Holy Family Hospital for 30 years In addition, we’ve hired several other experienced pediatric nurses Full-time pediatric hospitalists will round out our pediatric patient care team Women’s and Children’s Services Senior Director ann Seaburg is proud of our integrated approach to patient care, which includes an expert team of physicians, nurses and other sub-specialists “Reopening our general pediatrics unit is just one more way we are increasing our service line coverage and demonstrating our commitment to providing skilled and compassionate care for children of all ages,” says Seaburg

ACO-Bound? Consider the Financials FirstDavid A. Lips, for HealthLeaders Media

Section 3022 of the Patient Protection and affordable Care act is has the innocuous name, "Medicare Shared Savings Program " accountable care organizations are at the heart of this program, which is intended to coordinate healthcare providers serving patient populations of at least 5,000 Unlike many other parts of PPaCa, this section does not establish a pilot program Instead, it creates a fully active program with its own reimbursement structure

The opening sentence of new Section 1899 of the Social Security act indicates that there are significant financial dimensions to creating and running aCOs To wit:

Not later than Jan. 1, 2012, the Secretary [of the Department of Health and Human Services (HHS)] shall establish a shared savings program … that promotes accountability for a patient population and coordinates items and services under [Medicare] parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery (emphasis added). Indeed, the incentive for establishing an ACO is financial. If an ACO provider network manages costs and meets quality targets on patient care, Medicare will pay it a portion of its savings to the Medicare program.

aCOs may be modeled in various ways Section 1899(b)(1)

lists several possible configurations: professionals (physicians, physician assistants, nurse practitioners, and clinical nurse specialists) in group practices, networks of individual practitioners, joint ventures between hospitals and professionals, and hospitals employing professionals aCOs do not have to include hospitals, although hospitals would be helpful partners because they would probably already have good infrastructure for reporting the information that HHS will require

Once established, an aCO enters into a contract with HHS that lasts at least three years to provide a continuum of care to patients that HHS assigns to it (not necessarily with the patients' knowledge or consent) To participate in the program, aCOs must have the following:

• a formal legal structure that would allow the organization

to receive and distribute payments for shared savings … to

participating providers of services and suppliers

• enough primary-care providers to handle at least 5,000

patients

• a way of implementing "quality and other reporting

requirements"Continued on page 21


Giving Wings to Pediatric Critical CareCecilia Fry, MD

all patients need quality care but critically ill patients, especially the smallest – seriously ill infants and children – need specialized care Their airways are smaller Their veins are more difficult to access They can have illnesses that are unique to their age group requiring specialized expertise to diagnose and treat

With the availability of multiple pediatric subspecialists at Sacred Heart Children’s Hospital, we are seeing increasing complexity of critically ill infants and children referred from physicians and hospitals across the region These are very sick patients with complex medical conditions, making the perinatal team at northwest MedStar more important than ever

Since its inception, nW MedStar has staffed a highly qualified perinatal team to transport pediatric patients by air and ground This is an extraordinary benefit to the pediatric patients in our region essentially a specialized critical care team is delivered to the referring hospital and can aid in stabilization of the patient and then continue to provide critical care throughout the transport to the receiving hospital They have the ability to transport patients on CPaP, on biPap, on conventional mechanical ventilation and on nitric Oxide

as a pediatric intensivist at Sacred Heart Children’s Hospital, I have worked with nW MedStar’s perinatal team for many years They are a highly qualified, skilled team – some of the best in the industry The nurses that are chosen to join the perinatal team already have years of experience caring for critically ill infants and children in a hospital setting Once selected for the perinatal team, they go through additional rigorous training both in the hospital and in the transport environment The perinatal team also includes respiratory therapists trained in the care of infants and children and together the Rn and RT provide highly effective care during transport

These Rns and RRTs are experts, skilled at managing small airways, obtaining IV access in tiny veins, and diagnosing and managing critical illnesses for our smallest patients Due to their specialized training they are able to quickly assess the severity of illness of the patient and respond appropriately It’s a difference that can be is life saving

additionally, nW MedStar has specialized onboard medical equipment including a neonatal isolette and ventilator as well as

medications that bring the neonatal and pediatric ICU care to the patient’s bedside providing a continuity of care through transport until arrival at their destination

because of the long-standing relationship and constant close communication between nW MedStar’s perinatal team and the pediatric intensivists at Sacred Heart Children’s Hospital, they have become our eyes and ears We rely on them to accurately communicate their assessment of the patient This allows us to give tailored input into the patient’s care during transport – rather than a team just following a protocol This communication also provides us with valuable information in preparing for the patient’s arrival at the hospital so that not one minute is lost

as a community we cannot take this team for granted Many large cities with air ambulance service do not have a dedicated

perinatal flight team While it is costly to provide this level of care, the acutely ill or injured infants and children in our region benefit immensely Over the years I have seen funding for specialized units threatened many times Fortunately for these small patients, nW MedStar has been committed to maintaining the perinatal team thus

increasing the odds of survival and a positive outcome for our sickest little patients

Dr. Fry is a pediatric intensivist at Sacred Heart Children’s Hospital

where she works in the pediatric ICU. She has served as the

pediatric medical advisor to Northwest MedStar for fourteen years.

These RNs and RRTs

are experts, skilled at

managing small airways,

obtaining IV access in tiny

veins, and diagnosing and

managing critical illnesses

for our smallest patients.

As a community we

cannot take this team

for granted. Many

large cities with air

ambulance service do

not have a dedicated

perinatal flight team.


Spokane Prescription Opioid Task ForceJ. Courtney Clyde, MD

Intro

Prescription opioid abuse is a major problem in our community Deaths from overdoses are increasing at an alarming rate Chronic pain patients and their difficulty accessing primary care has been identified as a major priority by SCMS members in their annual priority survey The executive Committee of the SCMS brought interested people from the medical community (eR doctors, psychiatrists, addiction specialists), law enforcement (City and County), judiciary (Judge Harold Clarke of the Drug Court and representative from the attorney General’s office), Spokane Medical examiner, WSU College of Pharmacy, social workers, and others together to discuss the problem and develop a plan to address it This meeting occurred on november 17, 2010 and was very well attended Coincidentally, The new england Journal of Medicine published a “Perspective” on the problem along with a specific article about the problem in Washington State, the following day

The number of deaths from prescription drug overdoses is approaching the number of fatalities from auto accidents in the State of Washington It is mostly a rural problem The death rate is highest in Stevens, Clallam, Spokane, Grant, and Snohomish Counties eR Staffs, already burdened with its added role of providing a lot of primary care, is also trying to sort out

the needs of many chronic pain patients They also deal with a lot of dental pain patients These patients are particularly difficult because the hospitals cannot provide what they really need - urgent dental care Social workers report that narcotic patients neglect their parental responsibilities adding extra burdens to the Courts and CPS because of the magnitude of the narcotic problem the DOH is working with MQaC, bOMS, PMb, Dental QaC, and nursing Care QaC to develop new rules on chronic, non-cancer pain management These new rules will affect the way each one of us prescribes narcotics has developed are we creating in our patients an expectation of no pain and trying to achieve it by giving too much medication thereby creating a new problem? Certainly, most patients treated with high doses of narcotics for acute pain will stop using the medications when the problem gets better but some problems don’t get better and some patients continue to be dependent despite the resolution of the acute problem

There was a consensus among the people at this meeting that the fundamental problem was physicians overprescribing narcotics and a lack of communication between physicians, and between physicians and dispensing pharmacists

In 2007 the Washington State legislature gave the Dept of Health the authority to created a Prescription Monitoring Program that would collect all the records for schedule II, III, IV, and V Drugs This information would be made available to medical providers and pharmacists to help keep track of patients and their narcotic use Idaho has a program that works quite well Unfortunately the legislature didn’t fund the program now the attorney General has fund to start it up, but there is no consistent funding source a successful monitoring program like this would be a valuable tool in tracking usage and reduce patients’ use of multiple clinics and eRs to get their medications

Dr Darin nevin of the SHMC eR presented the Consistent Care Program It is surprising how often some of these patients visit the eD Patients who over utilize the eD are difficult to treat in a consistent fashion during every visit Consistent Care reduces over utilization of the eD by employing individualized case management services and facilitating consistent treatment on every eD visit The program is better explained on the web site: www consistentcare com

The CHaS Clinic has developed a multidisciplinary approach to chronic pain in response to the large numbers of patients that come to them after being dismissed from other primary care practices They have developed an excellent service and have hired a pain specialist Unfortunately they cannot accept more patients and their funding is being cut

This Task Force will be meeting again in the spring to pursue more solutions to this problem Hopefully the Prescription Monitoring Program will become functional soon education for physicians appears to be an important part of reducing this problem

• education about narcotic dosage and use

• Utilization of pain agreements

• Collaboration between physicians and pharmacists

Some models will reimburse pharmacists to provide pain

agreement supervision, counseling, and education for

the patient

• Develop educational materials for patients to set up

appropriate expectations for pain control

• The SCMS will be holding a Primary Care Update

Conference on Pain Management on april 28, 2011

Most of these topics will be addressed and I encourage

you to attend

Consistent Care

reduces over utilization

of the ED by employing

individualized case

management services

and facilitating

consistent treatment on

every ED visit.


Continuing Medical Education

Neurology Update 2011: This three-hour seminar is sponsored by the Spokane County Medical Society Conference held on February 9, 2011 at the Sacred Heart Medical Center in the Mother Joseph room (near the cafeteria) Contact Jennifer anderson at (509) 325-5010 or email jennifer@spcms org for more information

Update in Internal Medicine 2011: This 12-credit Category I CMe seminar is sponsored by the Spokane Society of Internal Medicine With a beginning date of February 25, 2011, Update in Internal Medicine 2011, has been reviewed and is acceptable for up to 12 50 Prescribed credits by the american academy of Family Physicians Conference will be held on February 25-26, 2011 at the Spokane Convention Center Contact Merry Maccini at (509) 468-0236 or email spokanesim@gmail com for more information

Rural Physician Training Opportunity: Substance abuse: Rural health care providers are invited to attend training on reducing opiate addiction in Spokane on March 29, 2011 The training is hosted by the Rural Opiate addiction Management (ROaM) project attendees will learn about the use of buprenorphine, a medication that removes the craving for opiates The training includes a certified eight hours of category I CMe credits in addition to access to a variety of additional resources For more information and registration contact Roger Rosenblatt at rosenb@u washington edu or (206) 685-1361 or visit the University of Washington website at http://depts washington edu/fammed/roam

2011 Yakima Valley Medical Conference: This seminar is to be held on March 4 and 5 at the Howard Johnson in Yakima The conference has been approved for 15 aMa Category 1 credits with sixteen regional specialists speaking For more information visit www russocme com or email russocme@gmail com

Other Meetings and Conferences

Institutional Review Board (IRB) – Meets the second Thursday of every month at noon at the Heart Institute, classroom b Should you have any questions regarding this process, please contact the IRb office at (509) 358-7631

Caduceus Recovery Group Meeting for Healthcare Professionals – Meets every Thursday evening, 6:15 p m – 7:15 p m , at 626 n Mullan Rd, Spokane Contact (509) 928-4102 for more information non-smoking meeting for Healthcare Providers in recovery

Physician Family Fitness Meeting – Physician Family Fitness is a recently created meeting for physicians, physician spouses, and their adult family members to share their common problems and solutions experienced in the course of a physician’s practice and family life The meetings are on Tuesdays from 6:30 p m – 8 p m at the Sacred Heart Providence Center for Faith and Healing building, due east of the traffic circle near the main entrance of

SHMC enter, turn right, go down the stairs, Room 14 is on your right Format: 12-Step principles, confidential and anonymous personal sharing; no dues or fees Guided by Drs bob and Carol Sexton The contact phone number is (509) 624-7320

Preparing Your Practice For ICD-10-CM: Transition & Implementation - This seminar will provide a limited introduction to ICD-10 code sets as well as a detailed review of the operational and financial impacts that physician organizations should consider in preparation for the transition to ICD-10-CM Upcoming seminars will offer in-depth skills training on using ICD-10 codes, in preparation for the October 1, 2013 effective date Register on line at http://www wsma org/memresources/seminars html Questions? Contact Jenelle Dalit by phone at 1-800-552-0612 or email jcd@wsma org for more information, visit the WSMa Practice Resource Center online at www wsma org Yakima: Wednesday, February 16 12:30 – 4:30pm WSMa and WSMGMa members can attend for $189 per person

SPOKANE COUNTY MEDICAL SOCIETYCONTINUING MEDICAL EDUCATION

2011 Program Schedule

FEBRUARYneurology Update 2011

Wednesday, February 9, 5:30 - 9:15 pmSacred Heart Medical Center (Mother Joseph Room)

(Three one-hour topics will be preseented)

APRILUpdate in Pain management

Thursday, april 28, 5:30 - 9:15 pmevening Seminar for the Primary Care Update Conference

Red lion Inn at the Park(Two one and one-half hour topics will be presented)

JUNEendocrinology Update 2011

Wednesday, June 8, 5:30 - 9:15 pmDeaconess Health and education Center(Three one-hour topics will be presented)

OCTOBERModerate (Conscious) Sedation and analgesia

Wednesday, October 5, 5:30 - 9:15 pmDeaconess health and education Center

(SCMS' annual program to satisfy JCaHO requirements and provide a refresher course to members of the medical

community in order to increase patient safety)

NOVEMBERTopic TbD

Tuesday, november 8, 5:30 - 9:15 pmDeaconess Health and education Center(Three one-hour topics will be presented)

To sign up for a Continuing Medical Education class, please contact Jennifer Anderson, CME Coordinator

(509) 325-5010 ext. 28 or [email protected]


FYI

New WPHP Officers Appointed

The Washington Physicians Health Program enters 2011 with new board officers: Chairman, John D Wynn, MD (Clinical Professor, Department of Psychiatry and behavioral Sciences, University of Washington School of Medicine and Medical Director for PsychoOncology, Swedish Cancer Institute); Vice Chair, eugene “Tad” Patterson, MD (Clinical assistant Professor, Department of Psychiatry and behavioral Sciences, University of Washington School of Medicine, Consultation Psychiatry, behavioral Medicine Services, Deaconess Medical Center, Spokane); Secretary, Mary-lou Misrahy (President and Chief executive Officer Physicians Insurance, a Mutual Company); and Treasurer, Dennis Stillman (Senior lecturer, Department of Health Services, University of Washington)

The WPHP board and its officers support a program that is nationally recognized, pioneering, and extremely supportive of helping physicians The program’s mission is: “To facilitate the rehabilitation of healthcare practitioners who have physical or mental conditions that could compromise public safety and to monitor their recovery ”

It was founded in 1986 by a group of concerned members of the Washington State Medical association who represented the Committee on Personal Problems of Physicians The WSMa retains the authority to approve the program’s bylaws and elect its board of Directors

Online death filing starts in early 2011!

The Washington State Department of Health is releasing a new online electronic Death Registration System (eDRS) to Pierce, Thurston, Mason, benton, Franklin and Spokane counties in early 2011, with a statewide release to follow Those who file death records in Washington State are encouraged to enroll in the new system eDRS will streamline the death registration process, improve the quality of the death data collected, improve communication among those who file and use the Internet to make filing faster

CMS Posts Q&As on Home Health Face-to-Face Encounter

The Centers for Medicare & Medicaid Services (CMS) has published questions and answers (Q&as) on its provider website regarding the new face-to-face encounters that go into effect for all patients with a start of care date of Jan 1, 2011 or later for coverage of patients' Medicare home health services The questions and answers can be found on the Spokane County Medical Society website at www spcms org additional information about face-to-face encounter requirements can be found on the naHC website under the heading "HH PPS 2011 Final Regulation" at www nahc org/regulatory/home html

MEMBERSHIP RECOGNITION FOR FEBRUARY 2011

Thank you to the members listed below Their contribution of

time and talent has helped to make the Spokane County Medical

Society the strong organization it is today

50 Years

norman e Staley, MD 2/9/1961

40 Years

Ronald l Vincent, MD 2/8/1971

30 Years

Richard b byrd, MD 2/24/1981

Colleen R Carey, MD 2/24/1981

arnold Cohen, MD 2/24/1981

David M Cryan, MD 2/24/1981

Mark a Johnson, MD 2/24/1981

Mary M noble, MD 2/24/1981

Jeffrey R O'Connor, MD 2/24/1981

Craig b Stucky, MD 2/24/1981

10 Years

edward Parker, Jr , MD 2/22/2001


“Raising the Bar” for Pediatric Care in the Inland NorthwestPeggy Mangiaracina, Executive Director, Sacred Heart Children’s

Hospital VP, Providence Sacred Heart Medical Center

Because the kids deserve it! That was the mantra of the pediatric professionals who approached Sacred Heart Medical Center more than ten years ago with the vision to build a children’s hospital in Spokane across the country, children’s hospitals were being developed to meet the unique medical needs of children that are not easy to address in an adult facility Today, about 250 children’s hospitals serve a fast-growing segment of the more than 3 million children who are hospitalized annually, plus provide for rapidly-growing outpatient procedures as referring physicians and parents recognize the advanced level of care and wrap around support services offered within a children’s hospital, the expansion is expected to continue its sharp upward climb far into the future

The Spokane area pediatricians who believed that children should be cared for by specially trained doctors, nurses and staff who understand the important differences between the needs of children and adults cited the fundamental benefits of a dedicated children’s facility:

• Children go through many phases of development in which

illness can affect them very differently from adults, and vary

through childhood

• One in ten children have a chronic illness that requires

coordinated long-term care Children need hospitals that are

experienced in treating complicated childhood illnesses

• Children come in all sizes, from infants to teens, requiring

services and equipment that appropriately fits their size This

requires a large investment on the part of a children’s hospital

to maintain this wide range of supplies

• Children need care providers skilled at communicating with

kids who cannot express their concerns, distress or pain and,

the providers need to be adept at working with the families

who are an integral part of the child’s care and recovery

• Children benefit from a focused pediatric medical hub that

provides education, research and the latest care techniques to

providers throughout the region

10 years and major investments have created a children’s hospital providing exceptional care for your pediatric patients right here in Spokane We are able to offer exceptional care without uprooting a family and sending them hundreds of miles from home to seek medical services for their child

Drawing children from the Inland northwest region, Sacred Heart Children’s Hospital is dedicated to ensuring that every child has access to high quality, cost-effective, primary and specialty care services tailored to fit their needs … close to home

lead by the pediatric physicians, Sacred Heart invested in building the facility and programs to establish the Children’s Hospital in 2003 along with the physical expansion, recruitment of physicians and staff trained in pediatric care was a constant focus and, with new physicians came new services – like 24-hour pediatric emergency and a dedicated pediatric surgery center

Where are we today? We launch into 2011 with a total of 177 pediatric beds, a full complement of pediatric specialists (nearly 125!), and plans for some exciting new services to round out our continuum of care Front and center are our highly skilled pediatric surgical, cardiology, neonatology, emergency and critical

care teams We have endocrinology, gastroenterology, neurology, neurosurgery, psychiatry, nephrology, ophthalmology, orthopedic, psychology, pulmonary, urology, adolescent and developmental medicine --but just as important are the “behind the scenes” specialists that round out the teams

For example, eight pediatric anesthesiologists help provide care for our vulnerable infant and child patients Pediatric radiologists and infectious disease specialists are on-board to assess the sometimes minor nuances in childhood diagnostics Pediatric-trained pharmacy and laboratory staff ensure optimal safety, while the specially trained nursing staff, techs, child life specialists and others demonstrate their passion for children We‘ve come a long way from a simple pediatric unit in a hospital!

as we look to 2011, expanded services will round out the breadth of service the Children’s Hospital offers for your patients neonatal and pediatric eCMO will be offered by the end of first quarter, providing potential life-saving care to some of the most vulnerable patients In addition, it is with great pride that we announce the beginning of our pediatric kidney transplant program in 2011

access to research protocols, connections to other children’s hospitals through the national association of Children’s Hospitals, and recruitment of nationally-recognized pediatric specialists to Spokane has “raised the bar” by advancing the standard of care and quality of pediatric services in our region Ten years after the pediatric community told us “If you build it, they will come,” the momentum is still going and the impact on the health of our children is dramatic all that is due to that passionate group of pediatricians who believed that kids deserve the very best care we can offer I am always interested in your comments and ideas How can we better help you and the children in your practice? Please feel free to share your thoughts!

Continued on page 15

Pediatric-trained

pharmacy and laboratory

staff ensure optimal

safety, while the specially

trained nursing staff,

techs, child life specialists

and others demonstrate

their passion for children.


The following physicians/physician assistants have applied for membership, and notice of application is presented any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St , Orange Flag bldg #114, Spokane, Washington, 99202

PHYSICIANS

Christ, Constance B., MDInternal Medicine/Nephrology

Med School: U of Illinois (1996)Internship/Residency: U of north Carolina (1999)Fellowship: U of Virginia (2001)Joining Rockwood Clinic, PS beginning 4/2011

Cole, Debra A., MDInternal Medicine

Med School: U of arkansas for Medical Sciences (1982)Internship/Residency: City of Faith Hospital (1984)Residency: loma linda U Medical Center (1985)To begin practicing with Rockwood Clinic, PS

Damsker, Keith E., MDInternal Medicine

Med School: Hahnemann U (1997)Internship/Residency: The George Washington U Medical Center (2000)Practicing with Rockwood Clinic, PS since 1/2011

Ionescu, Raluca M., MDInternal Medicine

Med School: Carol Davila U, Romania (1991)Internship/Residency: The brooklyn Hospital Center (1999)Practicing with Rockwood Main Clinic since 1/2011

Ionescu, Serban I., MDInternal Medicine

Med School: Carol Davila U, Romania (1991)Internship: The brooklyn Hospital Center (1998)Fellowship: beth Israel Hospital (1999)Practicing with Rockwood Medical lake Clinic since 1/2011

Kalisvaart, Jonathan F., MDPediatrics

Med School: baylor college of Medicine (2004)Internship/Residency: U of California, Irvine (2009)Fellowship: Georgia Urology (2011)Practicing with Providence Physician Services Co dba Pediatric Urology beginning 8/2011

PHYSICIANS PRESENTED A SECOND TIME

Borden, Rodney B., MDAnesthesiology

Med School: U of Texas Medical branch (1994)Practicing with anesthesiology associates, PS since 1/2011

Dajnowicz, Anthony M., MDPediatrics/Neonata-Perinatal Medicine

Med School: Wayne State U (1985)Practicing with Pediatrix Medical Group beginning 2/2011

Freter, Mark A., MDFamily Medicine

Med School: U of Missouri (1991)Practicing with northwest Pacific emergency Physicians since 1/2011

Quisano, Melissa A., MDFamily Medicine

Med School: loma linda U (2006)Practicing with Columbia Medial associates since 3/2010

Ruiz, Veronica G., MDFamily Medicine

Med School: U of Texas Medical branch (2000)Practicing with Rockwood Quail Run Clinic in the near future

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME

Weidner, Philip L, PA-CPhysician Assistant

Med School: U of Washington, Medex northwest (2010)Practicing with Rockwood Clinic beginning 1/2011

adolescent Medicine

allergy & asthma

anesthesiology

audiology

Cardiology

Cardio/thoracic Surgery

Child abuse

Dermatology

Dental

Developmental

ear, nose, Throat

Children’s emergency

endocrinology

Gastroenterology

Genetics

Hematology

Pediatric Hospitalists

Infectious Disease

Maxillofacial

neonatology

nephrology

Child neurology

neurosurgery

Oncology

Ophthalmology

Orthopedics

Critical Care Intensivists

Rehabilitation

Rheumatology

Pediatricians

Plastic Surgery

Child Psychiatry

Psychology

Pulmonary / Cystic Fibrosis

Radiology

Sports Medicine

Surgery

Transplant

Urology

SPOKANE PEDIATRIC SPECIALISTS



EHR incentive program timelineCMS announced several important dates in 2011 for participating providers, including the following:

January 3, 2011 – Registration began for the Medicare eHR incentive program and for the Medicaid program in certain states (Some states may begin to issue Medicaid incentive payments in January, as well )

April 2011 – attestation begins for the Medicare eHR incentive program

May 2011 – First Medicare eHR incentive payments expected

July 3, 2011 – Deadline for eligible hospitals to start the 90-day reporting period to demonstrate meaningful use for the Medicare program in fiscal year (FY) 2011

October 3, 2011 – Deadline for eligible professionals under the Medicare incentive program to begin their 90-day reporting period for calendar year (CY) 2011

November 30, 2011 – Deadline for hospitals to register and attest to receive an FY 2011 payments under the Medicare incentive program

December 31, 2011 – Payment ends for eligible professionals for CY 2011

Physicians are only eligible for one eHR incentive program at a time—either Medicare or Medicaid—although each physician in a group can register for one or the other, and they may change once during the incentive program

For a list of certified eHR systems or modules on the OnC’s certified health IT product list, visit http://onc-chpl force com/ehrcert

�e medical profession and healthcare community should foster physician well-being

A sense of community with one’s peers is vital to personal well-being

Changes in the healthcare environment and contributing to personal and professional challenges and new stressors for physicians

Physicians should have resources available to them to anticipate and manage episodic personal issues

Physician Health is Important.Eastern Washington Physician Health Committee

We are available to assistyou in the following areas:• Marital and Family Issues• Death of Spouse or Family Member• Drug/Alcohol Misuse• Lawsuit Education and Support• MQAC/OSTEO Board Issues• Boundary Issues• Disruptive Behavior • Elder Care• Practice Management

This committee, a fusion of the former SCMS committee and one including members of medical staffs of Community Health Services and Providence Health Care Hospitals, meets quarterly to educate ourselves about physician health issues, review utilization and satisfaction with the Wellspring Early Assistance Program (EAP), and plan activities, programs and resources to address needs in these areas. Some of the guiding principles of this committee are:

Steve Brisbois 927-2272Michael Metcalf 928-4102

Paul Russell 928-8585Phil Delich 624-1563

Michael Moore 747-5141

Robert Sexton 624-7320Jim Frazier 880-0025

Mira Narkiewicz 889-5599Patrick Shannon 509-684-7717

Deb Harper 443-9420

Sam Palpant 467-4258Alexandra Wardzala 448-9555Mike Henneberry 448-2258

Tad Patterson 939-7563Hershel Zellman 747-2234

COMMITTEE MEMBERSJim Shaw, MD, Chair 474-3097


In the NewsSCMS Leadership advocates for members

The Spokane County Medical Society leadership was recently mentioned in Senator lisa brown’s e-newsletter Various members of the SCMS met with Senators brown and baumgartner along with Representatives Parker, Ormsby and billig to discuss healthcare and other issues affecting

Spokane County Please see the contact information regarding our local, state and federal legislators on page 18

Congratulations to our Circle of Friends member Travis Prewitt from UBS – The Prewitt Group

“Medical economics’ recognition of our team as one of the country’s best financial advisors for doctors highlights our commitment to provide the same kind of specialized expertise and dedication to physician wealth care that physicians provide to community health care ”

- Travis Prewitt

Recognized among 2010’s list of “best Financial advisers for Doctors” by Medical economics magazine, The Prewitt Group works with physician clients in several states Team leader Travis Prewitt has more than 30 years of experience providing wealth management to the medical community Travis notes that, “Physicians are high achievers and should have high expectations for those who serve them The financial rewards of their careers are delayed by many years of expensive medical training, so it is vital that they make the most of their window for building wealth ” Team financial advisors Travis Prewitt and brad Desormeau bring in specialists as needed from one of the world’s largest wealth management organizations, and collaborate with the physician’s other professional advisors They also understand the time constraints that physicians operate under, so the team works to be efficient and are “on call” to fit the schedules of their medical clients

“… one area where you can take control of your future is with your approach to financial planning and investing The best financial advisors can provide the expertise you need to navigate the complex world of financial planning, as well as to meet your long-term and short-term goals…”

– Medical Economics, November 2010

Typical Fractures Seen in ChildrenMedscape

The ribs of children are very flexible and difficult to break For comparison, the force applied during cardiopulmonary resuscitation is typically not enough to break a child's ribs The most common site of traumatic rib fracture is in the lateral or posterior ribs Fractures may be difficult to detect on standard posterior-anterior and lateral views of the chest, and additional oblique views may be necessary Given the difficulty in causing a rib fracture in children, child abuse must be suspected The image shown demonstrates multiple healing fractures with significant callus formation Treatment is typically conservative

The epidemiology of pediatric fractures is different from adults or seniors The risk for fracture increases with age, and boys are much more likely to sustain a fracture than girls Trauma from either playing events or sports injuries accounts for the majority of fractures The most common locations of fractures for children are in the upper extremities There is a growing body of evidence regarding the increasing incidence of obesity in children and increased fracture risk [+]

The bones of pediatric patients are more porous than mature bone, placing them at greater risk for compression fractures, termed buckle fractures The tendons and ligaments in pediatric patients are proportionally much stronger than the bones, leading to an increased incidence of avulsion type fractures The increased flexibility of pediatric bones makes them more likely to bend rather than break, termed plastic deformation Greenstick fractures occur when the bone bends and partially breaks but do not extend through the width of the bone, giving it a tented appearance Mid-shaft fractures should always raise concern for child abuse and may present as spiral fractures if rotation force is applied to a limb



2011 LEGISLATORSFederal - Spokane County - Mayors

FEDERAL GOVERNMENT

Senator Maria CantwellUnited States Senate (D)Spokane: 509-353-2507Washington DC: 202-224-3441maria_cantwell@cantwell senate gov

Senator Patty MurrayUnited States Senate (D)Spokane: 509-624-9515Washington DC: 202-224-2621senator_murray@murray senate gov

Representative Cathy McMorris RodgersUnited States House of Representatives (R)Spokane: 509-353-2374Washington DC: 202-225-2006www mcmorrisrodgers house gov

SPOKANE COUNTY

Office of the Spokane County Boardof Commissioners1116 West broadway avenueSpokane, Wa 99260509-477-2265

Al FrenchDistrict 3 Commissionerafrench@spokanecounty org

Todd MielkeDistrict 1 Commissionertmielke@spokanecounty org

Mark RichardDistrict 2 Commissionermrichard@spokanecounty org

MAYORS

Patrick RushingCity of airway Heights1208 South lundstrom, PO box 969airway Heights, Wa 99001-0969509-244-3413www cawh org

Tom TruloveCity of Cheney609 Second StreetCheney, Wa 99004509-498-9200www cityofcheney org

Wendy Van OrmanCity of liberty lake22710 east Country Vista Driveliberty lake, Wa 99019509-755-6701www libertylakewa gov

John HigginsCity of Medical lakePO box 369Medical lake, Wa 99022509-565-5000www medical-lake org

Mary VernerCity of Spokane808 West Spokane Falls boulevardSpokane, Wa 99201509-625-6250www spokanecity org

Tom ToweyCity of Spokane Valley11707 east Sprague avenue, Suite 106Spokane Valley, Wa 99206509-688-0180www spokanevalley org

Daniel MorkCity of Millwood9103 east Frederick avenueSpokane, Wa 99206509-924-0960www cityofmillwood org

STATE GOVERNMENT

Christine GregoireWashington State Governor (D)PO box 40002Olympia, Wa 98504-0002360-902-4111

Lisa Brown, Ph.D.3rd District Senator (D)360-786-7604brown lisa@leg wa gov

Timm Ormsby3rd District Representative (D)360-786-7946ormsby timm@leg wa gov

Andy Billig3rd District Representative (D)360-786-7888billig andy@leg wa gov

Bob McCaslin4th District Senator (R)360-786-7606mccaslin bob@leg wa govLarry Crouse4th District Representative (R)360-786-7820crouse larry@leg wa gov

Matt Shea4th District Representative (R)360-786-7984shea matt@leg wa gov

Michael Baumgartner6th District Senator (R)360-786-7610baumgartner michael@leg wa gov

John Ahern6th District Representative (R)360-786-7962ahern john@leg wa gov

Kevin Parker6th District Representative (R)360-786-7922parker kevin@leg wa gov

Bob Morton7th District Senator (R)360-786-7612morton bob@leg wa gov

Joel Kretz7th District Representative (R)360-786-7988kretz joel@leg wa gov

Shelly Short7th District Representative (R)360-786-7908short shelly@leg wa gov

Mark Schoesler9th District Senator (R)360-786-7620schoesler mark@leg wa gov

Susan Fagan9th District Representative (R)360-786-7942fagan susan@leg wa gov

Joe Schmick9th District Representative (R)360-786-7844schmick joe@leg wa gov



Growth plate fractures are unique to pediatric patients They are caused by disruption in the cartilaginous physis of the long bones, typically due to compression loads or shear s applied to areas of provisional calcification Overall, physeal fractures are estimated to be responsible for about 30% of all long bone fractures The distal radius and then the distal humerus are the most common fracture areas Fractures are most likely to occur during periods of growth spurts when the physes are weakest The most commonly used classification system for physeal fractures is the Salter-Harris system, which divides fractures based on the presence of metaphyseal, physeal, and epiphyseal fracture patterns and helps determine treatment options

References [+]landlin la epidemiology of children's fractures J Pediatr Orthop b 1997;6:79-83

The Future of Pediatrics: Advancing to the Medical Home Madeleine McDowell, MD, Clinical Advisor, Sg2

Pediatrics has made great strides in improving health care outcomes for children, with the opportunity to do even more in the years to come However, improved outcomes will mean less future need for some services and, at the same time, health care reform will demand that care becomes more standardized and cost-efficient, focusing on prevention and outcomes data

Pediatric Specialties in Demand

While overall pediatric admissions have declined below population-based growth levels in the past few years, children’s hospitals have consistently increased their inpatient admissions, with a 21 4% climb in medical/surgical discharge rates (excluding normal newborns) from 2000 to 2006 a rise in the incidence of common chronic diseases like asthma and obesity in the 1980s and 1990s has driven demand for pediatric specialty care, primarily provided by children’s hospitals Dramatic improvements in survival rates during this same time period for many traditionally fatal conditions has further fueled demand for specialty services For example, survival rates for leukemia improved from 50% in the 1980s to 85% early in this decade and the survival rate for preterm infants at 22 to 24 weeks gestation has gone from 0% in the 1980s to 46% in this decade

This trend has allowed children to live longer with complex medical conditions that require ongoing tertiary care These advances, combined with a pediatric specialist shortage and heightened customer expectations, have translated into a shift in consumer demand from community hospitals to children’s hospitals However, even though children’s hospital discharge volumes will grow by 9% in the next 10 years, this is a significant slowing of the growth experienced in the past decade, and Sg2 expects overall pediatric inpatient utilization to decline nationally by 1% by 2020

Innovations and Future Outlook

Many pediatric diseases and conditions occur less frequently today, contributing to better children’s health, but subsequently diminishing service needs at the same time, the growth in many pediatric chronic diseases has begun to level off, signifying that these conditions will no longer be a main driver of growth for children’s hospitals

For example:

• Pediatric asthma increased dramatically from 1980 to the late 1990s, but prevalence rates have since leveled off In addition, although asthma prevalence has stayed consistent overall, inpatient discharges have declined Improved disease management and more therapeutic options for controlling asthma have led to an increase in ambulatory care since 2000, reducing the demand for inpatient care

• Childhood obesity has also been a driver of recent inpatient growth Obese children require more than twice the rate of hospitalization and emergency department visits than children of normal body weight Obesity often complicates preexisting chronic diseases like asthma, as well as increasing the risk of developing new diseases However, childhood obesity rates may be leveling off, according to the Centers for Disease Control and Prevention, with the prevalence of a high body mass index remaining stable overall for children from 1999 to 2008 and even declining from 2005 to 2008 for children ages 2 to 5 years Still nearly 17% of children today are obese



Pediatrician Deb Harper, MD, talks about new concerns for kids’ healthRhonda Aronwald

What worries you most about kids’ health today?

There are a growing number of kids who are overweight and inactive I have begun seeing kids under age 10 with high blood pressure and type 2 diabetes I have no idea how long these kids will live I’m not sure if they’ll see age 40 I took this work to help people be as healthy as possible, but it sometimes feels like I’m standing in

front of a freight train trying to stop it by holding my hand out

What can parents do to help?

be healthy themselves and show kids by example Do jumping jacks in the living room be seen reading, or eating an apple Keep healthy snacks available and eat meals together when you can Involve your children in decision making from a young age, like picking out healthy foods Have your kids garden with you If you live in an apartment, you and your child can even grow radishes in a pie pan a great way to get kids to eat fruits and vegetables is to help them make a connection between what they grow and what they eat Kids learn by what they see us do, rather than what we say

What’s the biggest challenge you face in your practice?

Working with parents who don’t look critically at information I think of a parent who was afraid to give their baby vitamin K, which prevents deadly bleeding in the brain, because they read one negative thing on the Internet I’m challenged by parents who don’t believe in giving their children immunizations, even as we learn of more unimmunized children getting sick or dying of preventable illnesses

How do you combat that kind of misinformation?

I try to point people in the direction of health resources that are based on proven science evidence shows that immunization protects our children but not everyone values science, and it’s hard to get this message across when that’s the case

A lot of parents are concerned about how much time their kids spend watching TV or screen time in general. What do you think of that?

People can learn from TV I find that the Simpsons can be role models; they have their bad moments, but they’re wonderfully supportive, loving parents most of the time but all things in moderation limit screen time Make the inside of your house boring and encourage outside active time

What kind of positive things do you see going on in medicine?

at Group Health, I love secure e-mail so that I can answer my patients’ questions even when I’m not in the office Parents can sign up for this service even if their child is covered under Group Health but they aren’t Group Health does a tremendous job with chronic disease management and care plans, which we’ve adapted for our young patients Working at Group Health makes it easy for me to practice medicine every day

You had to juggle a lot of balls as a pediatrician who also raised a family (Harper has one grown stepdaughter and three boys in college). Any advice for parents who are doing the same thing today?

It’s hard to keep all the balls in the air, all the time Sometimes, you have to decide which ones are most important to your family, and let the other ones drop until you can pick them up later Don’t be afraid to accept help if it’s offered, or hire help if you’re able to We were fortunate that my parents moved close by after my second son was born I worked part time and made an effort to balance my time when my kids were young I cooked a lot of meals and froze them The Crock-Pot was my friend!

Other than helping their children stay healthy, what do you see as a parent’s most important job?

Help your children learn to see themselves as useful people We gave our kids jobs that were important things they could do for our whole family, like laundering their own clothes and doing the dishes Kids need to know they are competent; they learn this when they’ve done something well themselves It takes an investment of time early on to teach them, but it's good for them, for their families, and for their communities

You just finished your term as president of the Washington State Medical Association (WSMA). Tell me about that.

The WSMa brings doctors together from different organizations, specialties, and geographic areas to collaborate and work to effect positive changes in the way health care is delivered in our state by working with peers, I’ve been able to help improve patient safety, bring a medical home to people who don’t have health care, and share information in ways that make us all better as doctors That collaboration is very powerful

With your term finished, do you plan to spend more time on the advocacy work you’ve been involved with?

I work half a day a week performing exams for victims of abuse I will continue to advocate for children in our community and with our legislators and I look forward to a time when the need for this work isn’t so great

Deb Harper, MD is a Pediatrician at Group Health Riverfront

Medical Center. She attended the University of Illinois College of

Medicine, 1980. Her special interest is preventing child abuse.

Used with permission of Group Health Cooperative. © 2011.

Reprinted from Northwest Health magazine.



• a leadership and management structure that includes clinical

and administrative systems

• Processes to promote evidence-based medicine and patient

engagement, report on quality and cost measures, and

coordinate care, such as through the use of telehealth, remote

patient monitoring, and other such enabling technologies

all of these elements but the second will potentially require a substantial investment

The goal of aCOs is to improve quality of care and drive down costs by providing an incentive (through shared savings) for better patient outcomes and lower expenditures (for example, by lessening the need for intensive care) Rather than being paid on the number of medical services provided, physicians, hospitals, and practitioners in aCOs have the opportunity to be paid, in part, at the end of each aCO contract year for keeping patients healthy, based on comparing current costs with per-beneficiary Medicare expenditures over the past three years but the feasibility of creating or entering into an aCO depends on regulations that are

due to be released this January, covering the following points:

• What are the required performance standards?

• What is their benchmark and how will they be measured?

• What configurations of aCOs are permissible other than those

described in Section 1899?

• What are the reporting requirements?

• What is the basis of comparison used to determine cost

savings?

• How much savings are required before savings are shared?

aCOs will require up-front costs among the most obvious is intellectual technology that will report and store data Since all providers in an aCO will be jointly accountable for quality and cost measures, IT will have to be compatible for multiple providers in order to allow them to share information The IT costs may be high enough to weed out small physician groups and solo practitioners from considering joining an aCO and the up-front costs may be bigger than expected Most early clinically integrated networks, which are precursors to aCOs, took longer than was anticipated to put in place and had greater than expected start-up cost and staff requirements Recently organized physician groups may also lack the history needed for benchmarking costs that would be required for an aCO

In addition to up-front costs, aCOs will require continuing expenses relating to reporting These expenses will involve personnel, IT maintenance, and continual coordination among the different members in an aCO

aCOs also involve financial and legal risk because so much rests on the forthcoming regulations and on inevitable fine-tuning that will occur in the future Right now, it is unclear how aCOs will

be reconciled with the requirements of HIPaa, which restricts sharing patient information among independent providers; the Stark law, which prohibits Medicare claims for physician services due to referrals to entities with which the physicians have a financial relationship; and antitrust, which has hitherto frowned on physician-hospital joint ventures and independent healthcare providers acting in concert

While Section 1899 gives the Secretary authority to waive aCO participants from federal fraud and abuse regulations, those waivers – if they are even granted – may come with their own strings

In 2005, the Centers for Medicare & Medicaid Services sponsored a Medicare Physician Group Practice demonstration involving 10 big integrated delivery systems over five years The participants in this demonstration project, which ended in spring 2010, were the forerunners to aCOs Participating physician practices were given awards based on both cost savings and qualityimprovements (unlike aCOs, which would be eligible for awards measured only by cost savings as long as quality targets are met) In the second year, while all participating practices were paid for quality improvements, only four were paid for cost improvements, based on exceeding target expenditures by at least 2% The awards to the practices equaled 80% of the cost savings above the 2% threshold

The Dartmouth-Hitchcock Clinic received the most: $6 69 million Marshfield Clinic got $5 78 million, and the University of Michigan Faculty Group Practice received $1 24 million everett Clinic, a group practice of more than 300 physicians in the state of Washington, received the smallest payment for cost savings: $129,268 (Payments for all five years have yet to be calculated ) everett Clinic paid more than $1 million in up-front infrastructure costs The average up-front payment was $489,000 plus $1 26 million in operating costs in the first year These costs are low estimates considering that the provider systems in the demonstration project had already absorbed other integration costs before the project got under way

as commentator Trent Haywood tellingly observed, "given that eight out of 10 participants did not receive any shared savings from Medicare in the first year, these investment costs were significant and not offset by any savings Thus, healthcare executives should anticipate losses prior to gains in the implementation of the aCO model "

Reflecting on his experience in the demonstration project, the president of everett said that the 5,000 minimum number of patients for an aCO is most likely too small

The current fee-for-services model may encourage physicians and hospitals not to enter into arrangements like aCOs that will cut their volume of services and, hence, their revenue, at least if the potential shared savings are not great On the other hand, Medicare and private payers may give preference over time



Continued from 21

to aCOs Providers that are not associated with an aCO may find themselves either left out of potential payer networks or otherwise penalized for not having joined an aCO The exercise of creating an aCO and being accountable for quality and cost improvements may spawn efficiencies and better patient care that will outlast any contract with HHS

as with much of healthcare reform, uncertainty rules the day at present The chief medical officer of one organization involved in a pilot aCO, organized in 2009 under the auspices of the Dartmouth Institute for Health Policy and Clinical Practice and the brookings Institution's engelberg Center for Health Care Reform, explained that even estimating the shared savings that would financially justify participating in an aCO is hard to calculate

Continued from 19

• Preterm births have increased 36% since the1980s, driving demand for neonatal intensive care unit services and downstream services for former premature infants with complex medical conditions. A reversal of this trend occurred for the first time with 2 consecutive years of preterm birth rate declines in 2007 and 2008. Sg2 anticipates that future care delivery practices and innovation (ie, molecular diagnostics, high-risk perinatal prevention programs, advanced assisted reproduction technologies) will continue to modestly decrease the number of preterm births in the next 5 to 10 years.

•Vaccines have been responsible for significant declines in infectious disease admissions for children. For example, rotavirus hospitalizations declined 84% from January 2006 to June 2008 after the 2006 licensure of a vaccine for the disease.

Health Care Reform

Health care reform has already made changes in children’s health care coverage From now through 2012, for example, children may retain coverage under their parents insurance until age 26 and the government guarantees 100% well child care coverage, as well as guaranteed issue and renewal of insurance

as coverage expands from 2013 to 2015, Medicaid reimbursement will be increased to 100% of Medicare for pediatric care Then, in 2017, disproportionate share hospital (DSH) payment discounts will top out at $5 6 billion (a 30% reduction from 2009 total payments) These reforms will shape payment incentives In the short term, improvements in children’s

access to primary care services may stress capacity, particularly for states with high numbers of uninsured and underinsured children In addition, the shift in payer mix will pose operational and profitability challenges for hospitals In the long-term, DSH payment cuts will challenge children’s hospitals ability to provide unprofitable services additionally, shifts in payment structure will incentivize prevention and reduce inpatient utilization

The Quality Incentive

Under the current fee-for-service system, success (for example in asthma prevention programs), often translates into empty hospital beds, resulting in lost revenue and creating a lack of incentive for prevention as children’s hospitals are expected to do more with less, a focus on prevention will be required and payment models that align incentives will emerge Delivering the highest quality care is paramount for pediatric providers and, with a culture of continuous performance improvement, the standard of care is rising, which will ultimately reduce utilization through reducing average length of stay and avoidable admissions Comparative effectiveness research (CeR) will support the quality movement and reshape pediatric care delivery CeR is the direct comparison of existing interventions to determine which treatment works best, for whom and under what circumstances The Institute of Medicine has created 100 initial priorities for CeR, 50% of which will impact pediatric care and 25% of which pertain to pediatric-specific research examples of these priorities include:

• Comprehensive care coordination programs (ie, a medical home) for children with severe chronic diseases

• Screening, prophylaxis and treatment interventions for eradicating methicillin-resistent Staphylococcus aureus

• School-based interventions for preventing and treating overweight/obese children and adolescents

• Comprehensive support services models for infants and families following neonatal intensive care unit discharge

• Pediatric quality improvement strategies in disease prevention, acute care, chronic disease care and rehabilitation services

• Therapy management in children with cerebral palsy

With the advances that pediatrics may offer in the years ahead, providers and children’s health care leaders need to shift their perspective from a facility focus to an integrated network focus, piloting their System of CaRe (Clinical alignment and Resource effectiveness) from children’s entry into pediatric care, through disease surveillance and hospital admission, to their return home Future care delivery will be driven by payment models that shift risk to the provider, while a focus on safety and quality will require children’s hospitals to do more with less anticipate these changes in demand and a shift to the outpatient setting for many conditions as technology advances, quality research and payment incentives combine to reduce costly inpatient stays, while prevention and disease management help children achieve optimal health

CER is the direct

comparison of existing

interventions to determine

which treatment works best,

for whom and under what

circumstances.


PHYSICIAN OPPORTUNITIESPOSITIONS AVAILABLE

EASTERN STATE HOSPITAL PSYCHIATRIST – eSH is recruiting for a psychiatrist Joint Commission accredited, CMS certified, state psychiatric hospital 287 beds Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants Contact Shirley Maike, 509 565 4352, email maikeshi@dshs wa gov PO box 800, Medical lake, Wa 99022-0800

EMERGENCY ROOM PHYSICIAN POSITION OPENING –

northeast Washington Medical Group is currently recruiting

for a full-time eR physician to join us in beautiful Colville, a rural

northeast Washington community located 75 miles north of

Spokane northeast Washington Medical Group consists of 27

providers that serve a surrounding area of approximately 30,000

in the very rural tri-county area We offer flexible hours for an eR

physician or FP physician with emergency Room experience Our

eR physicians enjoy working in the new emergency department at

Mount Carmel Hospital, a 25-bed, full service critical access facility

with 24/7 eR and ancillary service coverage This is an outstanding

practice community located in the middle of a wonderful recreation

area with limitless opportunities for outdoor activities Qualified

individuals should contact ed Johnson, MD, eR Medical Director,

via phone at 509-685-7831 or e-mail at edjohnsonmd@hotmail com

or Ron Rehn, DHa, Chief executive Officer, via phone at 509-684-

7723 or e-mail at rrehn@newmg org Mailing address is northeast

Washington Medical Group, 1200 e Columbia, Colville, Wa 99114

Visit our website at www newmg org for more information

INTERNAL MEDICINE POSITION OPENING – northeast Washington Medical Group is currently recruiting for a full-time (Monday through Thursday) Internal Medicine physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane northeast Washington Medical Group serves a surrounding area of approximately 30,000 in the very rural tri-county area This is an outpatient based Internal Medicine position with call There is supporting physician call in Family Practice, Ob, surgery, and orthopedics Our clinic physicians have privileges at Providence Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 eR and ancillary service coverage This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities Qualified individuals should contact Ramon Canto, MD, Internal Medicine Medical Director, by phone at 509-684-7706 or Ron Rehn, D H a , Chief executive Officer at 509-684-7723 or e-mail at rrehn@newmg org The mailing address is northeast Washington Medical Group, 1200 e Columbia, Colville Wa 99114 Visit our website at www newmg org for more information about Colville Medical Center P S

PHYSICIANS – are you looking to expand your clinical horizons? Here’s an opportunity to serve your community and our nation’s veterans We are looking for physicians to provide night coverage, weekends and holidays to do admissions and hospital coverage 12 to 16 hours shifts are available For additional information, please contact Va Medical Center, Jim erickson, administrative assistant to the Chief of Staff, 4815 n assembly, Spokane, Wa 99205 509-434-7211 an equal employment Opportunity

PEDIATRIC HOSPITALISTS OPPORTUNITIES: We need four to five Pediatric Hospitalists to care for our general pediatric patients at either Deaconess or Valley Medical Centers You will be working with nurses with many years of pediatric expertise and be part of a team of hospitalists providing 24-hour coverage/365 days per year Please contact evelyn Torkelson Director, Physician Recruitment, at torkele@empirehealth org for more details

SPOKANE REGIONAL OCCUPATIONAL MEDICINE (SROM) –has made a commitment to help improve or restore the health of workers who incur occupationally related illnesses or injuries Our treatment approach takes a comprehensive view that encompasses the medical, psychosocial and functional outcomes and follows best practices as defined by Washington State l&I’s Center of Occupational Health and education (COHe) SROM is affiliated with Valley Hospital and Medical Center, Deaconess Medical Center and Rockwood Clinic This affiliation provides exceptional administrative support, offers state of the art diagnostic services’ improving our ability to diagnose and treat, and a referral system that is unmatched Please contact evelyn Torkleson, physician recruiter at (509)473-7374 or email at torkele@empirehealth org for more information

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations We are contracted through the Department of Veterans affairs to manage their compensation and pension programs We are expanding our network of Family practice, Internal medicine and General medicine providers for our Washington Clinics We offer excellent hours and work with your availability Our clinics are fully staffed and equipped with all the diagnostic equipment needed to complete our exams We pay on a per exam basis and you can be covered on our malpractice insurance policy The exams require nO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration Please contact Katrina nudo at 1-800-260-1515 x2226 or email knudo@qtcm com or visit our website www qtcm com for more information

PHYSICIAN OPPORTUNITIES AT CHAS – at Community Health association of Spokane (CHaS), we believe doctors should practice what they are passionate about: serving patients and the community We are looking for physicians to join our great team! enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CMe reimbursement, 401(k), full medical and dental, nHSC loan repayment and more experience pure patient care at CHaS To learn more about physician employment opportunities, contact Kelly McDonald at (509)444-8888 or kmcdonald@chas org


P e r s o n a l i z e d OB C a r e . R i g h t H e r e .

12606 East Mission • Spokane Valley

We believe new moms and babies should be surrounded with comfort and care. That’s why we bring you:

• Suites designed so mom and baby can remain in the same room throughout their stay • Spacious suites with cozy amenities, a private bath and accommodations for an overnight guest • Trained OB nurses plus a Special Care Nursery for infants with more complex medical needs • Support for all types of birth plans, from natural to planned C-sections • A waiting room exclusively for families of OB patients

To schedule a tour of The Birthing Center and Special Care Nursery at Valley Hospital, call (509) 473-5475. To find an OB physician based in the Valley, visit www.spokanevalleyhospital.com/physicians.

When it comes to your special delivery, we’ve got you covered.

53203_VHMC_OB_7_5x10c.indd 1 1/14/11 5:01 PM


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