bulletin - Allegheny County Medical Society

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○EDITORIALHelmet to HelmetFRANK VERTOSICK, MDThe phrase du jour of this past “ultimate fighting” and other socalledextreme sports? But realism is already be upon us.number unreported, the disaster mayfootball season was helmet tohelmet, symbolizing the increasingly taking its toll on professional players The NFL can do what it wants;violent play that carries a higher risk and, by extension, the amateurs who it’s a free country, but they must beof brain injuries. Comedian Jerry imitate them. Football at all levels aware that the style of play theySeinfeld once joked that the helmet now faces an epidemic of concussions.encourage necessarily trickles down tomay be the stupidest invention of allTo make matters worse, the youngest, most vulnerable andtime because it offers a false sense of emerging evidence suggests that even least skilled players. Every kid whosecurity. Nature gave us a wall of minor concussions can have lasting straps on pads thinks he’s headed forsolid bone around our brains, psychomotor consequences, particularlyNotre Dame and the pros, just asSeinfeld reasoned, and any activityin younger brains. These effects, every person who buys a lotterythat requires added protection should albeit subtle, can be cumulative, ticket thinks he’s a dollar away fromprobably be avoided.debilitating and possibly fatal. The playing golf with Donald Trump. It’sFootball was once a running NFL officially discourages vicious all a big lie, of course; statistically,game played by small men wearing impacts; yet, while the front office few high school players get scholarshipsminimal padding and leather helmets fines James Harrison $75,000 forand virtually none of them willwithout any face guards. The average one such impact, the league’s website be pros. Nevertheless, this fantasyweight of a Pittsburgh Steeler offensivesimultaneously markets a glossy print fuels the need to play the game likelineman in 1950 was less than of it suitable for framing.the pros do: dangerously. Thus, each200 pounds, and even the revered Ironically, the real problem lies fall legions of pencil-necked beginnersJack Lambert weighed barely more neither in the beefy NFL nor in anyanxiously go helmet-to-helmetthan 200 pounds during his career. major college program. In those with each other, egged on by coachesToday the game has become passoriented,arenas, athletes are of consenting age urging them to suck it up and dealthereby encouraging high and their fully myelinated brains are with the pain (i.e., hide it) like men.speed collisions between behemoths at less risk. Furthermore, they are High school teams can be grosslyemboldened by high tech body serviced by competent training staffs mismatched, putting players of vastlyarmor and facial shields. The idea of and receive monetary compensation different sizes and skill levels on the“tackling” an opponent has given way for their risks in the form of scholarshipssame field of battle, somethingto “hitting” him instead. Tacklingor salaries. The real looming schools would never allow in, say,takes skill; hitting requires only blind disaster is at the high school level and wrestling. But schools see gatemomentum, hence the trend to larger younger, where vast numbers of revenue, parents see a paid collegeand faster players.poorly conditioned boys expose education and the boys see glamourAs such, the NFL now finds themselves to long-term cognitive and girls. A recent Toyota televisionitself in a Catch 22. The increasingly problems under the guidance of commercial shows a mother laudingbloodthirsty public demands that the potentially undertrained staff. In fact, the company for sharing its knowledge“simulated warfare” of sport carry the with an estimated 70,000 highof high speed auto crashes withsame hazards as real combat. How school football concussions reported her son’s football program. We areelse to explain the rising popularity of annually, and an equal or greater shown computer images of a brain6:Bulletin January 2011:

EDITORIALsmashing into a windshield while themother coos, “That makes me feel alittle better about my son playingfootball.” In other words, the motherfrankly admits she’s letting her sonelectively play a sport that carries therisks of a car crash. If that womanowned a $1 million Ming vase, Iwonder if she would trust it insidea Toyota-designed football helmetduring a game. But her son’s cerebrum,well, that’s different.I’m not against violent sports.I watch football, professional bullriding and Ultimate Fighting asmuch as the next guy, but highschools don’t have PBR or UFteams—at least not yet—and adultscan assume whatever risks they want.But are children under 18, or theirparents, being told of the risks? Dowe even know all the risks yet? Ofcourse, proponents of youth footballcan point to the fact that hundreds ofthousands of kids participate incontact sports and yet society doesn’tseem to be teeming with braindamagedadults (insert your ownsarcastic comment here). Nevertheless,the damage is there if onebothers to look for it.There are numerous anecdotalcases of high school players experiencingdemonstrable reduction of IQmonths, even years, after concussions.Society doesn’t see the A studentstruggling to get Bs or even Csbecause of a football trauma. In fact,the media has until recently done agood job obscuring the dangers ofhigh school contact sports. Thissummer, to its credit, the Post Gazetteaddressed this issue, highlightinginstances where children had cognitivedamage severe enough to be heldback a calendar year in their studies,and for what? If we tolerate sacrificingour children’s health on the altarof sport, why stop with football?Why not full-contact karate?The attitude of sports medicineto this epidemic is perplexing. Ratherthan taking the correct stance—namely that underage minors withsoft, unmyelinated brains should bestrongly discouraged from engagingin adult recreational contact sportsthat carry a clear risk of concussionand long-term cognitive deficits—themedical community has insteadbecome enablers. Sports medicineoften deals with short-term issues,such as when a player can get backonto the field again; that may overshadowwhat is the best medical carecontinued on page 9Our multi-million-dollar,state-of-the-art healthcare facility.Every day, we provide healthcare to more families in their homes thanjust about anyone. Whether you’re recovering from surgery, disabledor just need a little help to maintain your independence, our trained,experienced caregivers will come to your house and take care of you.On a part-time, full-time or live-in basis. We’re Interim HealthCare®,and we provide healthcare for the people you love. Give us a call.1789 S Braddock Ave.Pittsburgh, PA(412) 436-2200www.interimhealthcare.comJanuary 2011 : Bulletin7

What Does ACMS Membership Do For Me?ACMS members have exclusive access to vendors of physiciansupplies and services at special rates. We screen all vendors forquality and value, so you don’t have to.Membership Group InsuranceProgramsBlue Cross/Blue Shield, Disability,Property and CasualtyUSI AffinityBob Cagna, 724.873.8150Banking, Financial andLeasing ServicesMedical Banking, Office VISA/MCServicePNC BankBrian Wosniak, 412.779.1692Medical Liability InsurancePMSLICMarketing DepartmentLisa Klinger, 717.802.9236Medical SuppliesAllegheny MedcareMichael Gomber, 412.580.7900Medical Waste RemovalMedical Waste Recovery Inc.Mike Musiak, 724.309.9261Printing Services andProfessional AnnouncementsService for New Associates, Officesand Address ChangesAllegheny County MedicalSocietySusan Brown, 412.321.5030Life, HIV CoverageMalachy Whalen & Co.Malachy Whalen, 412.281.4050Records ManagementBusiness Records ManagementInc. (BRM)Autumn McGinnis-Gollob,412.321.0600Auto and Home InsuranceLiberty MutualAngelo DiNardo, 412-859-6605,ext. 51902Member ResourcesBMI Charts, Where-to-Turn cardsAllegheny County MedicalSociety412.321.5030Staffing ServicesLiken Health Care StaffingJudy Thompson, 888.366.45458 Bulletin : January 2011

EDITORIAL (from page 7)in the long-term. Incorporatingshort-term team goals into medicaldecision-making may be (arguably)acceptable for pros but not foramateurs. I’ve witnessed neurosurgeonsdebating whether an amateurwith a fresh Jefferson fracture ofthe cervical spine should be allowedto play in an “important” game thenext day. “Well,” said one, “It is a‘stable’ fracture, generally…” Huh?As John McEnroe would say: YOUCANNOT BE SERIOUS! The samemay be happening with brain injuries.When should a fifteen-year-oldboy who is knocked unconscious forfive minutes return to football? Doesany physician have the courage to say,how about next year? Or when youare eighteen and can appreciate therisks you are taking for yourself?How about never?We, as a medical profession, haveno problem officially discouragingadults from any number of activitiesthey find enjoyable, from smoking toeating red meat. New York City evenwants to take salt shakers off restauranttables because we are obviouslytoo stupid to know what’s good forus. But for organized medicine totake an official stand against a recreationalactivity that renders 140,000of our precious children unconsciousevery year, damaging many of them,even killing a few… why, that wouldbe un-American! No, we’ll formulateguidelines instead, really strict stuff,like, “If your son gets knockedsenseless, he should wait a wholeweek before he slams his head intosomething again!” Don’t you feelbetter knowing the best neuroscientistsare on top of this problem?The argument these scientistsmake is that they are striving to“minimize the risk of concussion” inunderage athletes. A valid point, butJanuary 2011 : Bulletinhere’s a better idea: Don’t play highschool football. Then the risk is zero.In his recent biography, rock starKeith Richards claims he found a wayto “minimize” the risk of heroin use.Perhaps, with his help, we couldmake that a safe sport too. The realissue becomes not minimizing therisk, but asking why any risks arebeing taken in the first place. Who isreally benefiting from this epidemic?Not the children, I fear. Remember,this is your kid’s brain, not his ACL.Aren’t football scholarships theonly way some kids go to college?Studies suggest that only a smallfraction of football recruits graduateand, even when they do, it’s oftenwith a marginally useful degree. Andthere’s the little-mentioned flipside ofathletic free rides: The average footballrecruit at schools like Stanfordrarely meet the academic acceptancecriteria demanded of non-athleteapplicants. Given that most collegesare overflowing, is it fair for a footballplayer to edge out someonebetter qualified academically? Besides,if a boy can only afford college bysubmitting to eight straight years ofhead trauma, God help us. And a lotof college educations have been paidfor by wages earned in the tobaccoindustry, but that wouldn’t stop usfrom shutting that industry down ifwe could.Boys under 18 serious aboutfootball can learn the fundamentalskills of the game without beingconstantly exposed to weekly, fullcontactgames for four or more yearsat their most vulnerable ages. Onlythose men demonstrating solidfundamentals and the necessary sizeand conditioning would be eligible,as adults, to begin full contacttraining and enter a ladder systeminto the pro ranks. This would notharm the NFL, only high school andcollege programs. This system worksfor other high risk ventures like Indycar racing. Somehow, skilled professionalsemerge even when the localhigh school doesn’t have a strongFormula One program.Of course, no one would listen ifthe medical community came outagainst children playing helmetedcontact sports like football andhockey; life will go on as it alwayshas. No one listens to us aboutcigarettes or exercising regularlyeither, and at least we’d be true to ourmission. Taking a stand againstminors playing adult contact sportsdoesn’t mean we would quit workingwith organized sports to study andreduce the problem. Our stanceagainst cigarettes doesn’t require us toquit researching and treating smoking-relatedillnesses.Life is a game of balancingrewards versus informed risk. Myconcern for the average high schoolplayer is that the risks are great, therewards few and the “informed” partalmost non-existent. In the meantime,my recommendation to parentsis simple; follow the advice ofanother comedian, the late GeorgeCarlin: Never participate in any highschool sport in which an ambulancehas to be called to the field beforeplay even starts!George was a wise man, wiserthan many brain surgeons I know.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○Dr. Vertosick is a semi-retired neurosurgeonpracticing in Washington County and associateeditor of the ACMS Bulletin. He can be reachedat vertosick@acms.org.The opinion expressed in this column isthat of the writer and does not necessarilyreflect the opinion of the EditorialBoard, the Bulletin, or the AlleghenyCounty Medical Society.9

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○PRESIDENT’S MESSAGEHealth Care PeregrinationsLEO R. MCCAFFERTY, MDIam honored to be your presidentand grateful for the chance toserve. I joined the Allegheny CountyMedical Society in 1990 when Ireturned to Pittsburgh after trainingand specializing as a plastic surgeon inMiami. ACMS was the first organizationI joined in Pennsylvania uponmy return. I still believe that was oneof the best decisions in my professionalcareer. Becoming a member ofACMS instantly made me feel athome within the medical communityand gave me a voice in AlleghenyCounty and Pennsylvania health care.As president of ACMS I welcomeand encourage you to becomean active member of the society; ifyou’re already a member, pleaseencourage your cohorts to join byvisiting www.acms.org or calling(412) 321-5030.There continue to be manyunresolved issues changing the face ofmedicine nationwide such as medicalliability and Medicare paymentreform, as well as health care reform.Share your opinions. Make yourvoice heard. Organized medicineprovides the ideal platform forphysicians to join forces and worktogether as a profession. ACMS isthere for you and your patients. Thesociety’s mission says it all—Leadershipand Advocacy for Patients andThe concept of reducing costs and improvingefficiency when it comes to patient care issomething most of us would like to achieve,but at what cost?I would like to take this opportunityto address some of the globalconcerns that I have with the healthcare reform law that passed about 10months ago. There is perhaps toomuch focus on cost savings and notenough focus on promoting competition.The combined effect, I suggest,will ultimately take the windout of the sails of what has traditionallybeen recognized as the planet’sbest medical care.A recent article in the New YorkTimes (November 20, 2010) addressedwhat some consumer advocatesfear: that the health care lawcould worsen some of the veryproblems it was meant to solve byreducing competition, driving upcosts and creating incentives forphysicians and hospitals to stint oncare in order to retain their costsavingbonuses.These fears have been spurred bythe growing frenzy of mergersinvolving hospitals, physician groupsand clinics eager to share costs andincentives for controlling costs.The concept of reducing costsand improving efficiency when itcomes to patient care is somethingmost of us would like to achieve, butat what cost? While the new lawencourages doctors, hospitals andother health care providers to cometogether and jointly take responsibilityfor the cost and quality of care ofpatients, I believe it must be donewithout compromising basic tenets,laws and values of American society.Lawyers and lobbyists, in analarmingly unsettling movement, aretrying to persuade officials in Washingtonto relax or waive antitrust lawsthat are intended to prevent healthcare monopolies and to protectagainst careless patient care andfraudulent billing of patients orMedicare. Some believe that thecurrent anti-trust laws are obstaclesthat will make it difficult for hospitalsto reward doctors for cuttingcosts or following best practices.Relaxing anti-trust laws is comparableto relaxing freedom of speech orPhysicians.savings while earning government10 Bulletin : January 2011

PRESIDENT’S MESSAGEother basic values cherished byAmericans. How would this affectthe care of the high risk/high costpatient? Would care be rationed ordenied to keep costs down or to takeadvantage of government-basedincentives?Care delivery markets should beconstructed to be competitive, thusincreasing efficiency, innovation andquality, as well as to reinforce aphysician’s ability to compete.Anything that stifles competitionworks against innovation and advancement.Integrated care can bebeneficial, but it must be done sothat “destructive, exploitative andcostly forms of collusion and monopolisticbehaviors do not emergeand thrive, disguised as cooperation.”This is a controversial topic and is anissue surrounding the health carereform law nationwide. It deservesdebate and I welcome your opinionsand thoughts.Physicians today run the risk ofbecoming trivialized by direct-toconsumeradvertising stemming fromthe pharmaceutical industry, medicaldevice industry, large insurancenetworks and large health caresystems. These entities tend to createa perception that they are moreimportant than the individual physiciansproviding the care.The fact is we need each other.Physicians need to be on the sameplaying field with an equal voice forthe health system to thrive andcontinue as the world’s best. Beingpart of organized medicine is apartnership. Physicians cannot workin a vacuum. Whether you operateyour own practice or are employedby a health system, group practice orother entity, you play a vital andindispensable role in building andleading the best health care deliverysystem our patients need and deserve.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○Dr. McCafferty is a plastic and reconstructivesurgeon and 2011 ACMS president. He can bereached at mccafferty@acms.org.The opinion expressed in this column isthat of the writer and does not necessarilyreflect the opinion of the EditorialBoard, the Bulletin, or the AlleghenyCounty Medical Society.January 2011 : Bulletin11

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○MEDICAL STUDENT MUSINGSProviding a Forum for ExpressionALAN ROSENBAUMThis past summer I found myselfin Tanzania, a nation known forbeing one of the more stable, accessibleand beautiful places on theAfrican continent. Home to thebeaches of exotic Zanzibar, theheights of Mount Kilimanjaro andthe wilds of the Serengeti, it is nosurprise that Tanzania is such apopular destination to those who arewilling to sacrifice some of thecomforts of home.I was drawn to Tanzania by anopportunity to volunteer in a ruralgovernment-run health dispensary inthe small town of Kwala. When Idiscovered that even GoogleEarthcouldn’t pinpoint the location ofKwala, Tanzania, I knew it was timeto purchase the plane ticket. I hadhoped that working in a sub-SaharanAfrican rural setting would be anexciting opportunity to learn adifferent kind of medicine from whatI was accustomed to in westernhospitals, but by the end of thesummer, I had discovered that it wasreally the same.Upon arriving, I toured thevillage to become familiar with mynew surroundings, navigating the dirtpaths that surrounded the only road.I eventually came across the dispensary,a cement and sheet metalbuilding consisting of a large, openwaiting room, a few small closets,one examination room, a basic laband an open-air doctor’s office. Thewindows had horizontal metal barsthat lacked any glass, permitting theoccasional gust of wind to give theworkers a reprieve from the heat,although the bars also allowedinsects, birds or bats to swoop in andout. In fact, a space under the roofwas a favorite haunt of bats; despiteattempts to remove them, theirpresence persisted. The floors werecovered with pervasive dust and dirt,making it appear as though the dull,gray cement was covered by a browncloak. The ceiling was littered withspider-webs, and throughout theday’s work I could turn my eyesupwards and witness the demise ofsome unfortunate creature thanks toa spindly-legged arachnid. It wasevident that the walls were painted atsome point, but over time chunkshad disintegrated away, leaving gapsin the finish. In the sole examinationroom, the walls had been splatteredand stained with various liquids overthe years, as if it were the setting of agory video game. Indeed, the aestheticsof the dispensary were more akinto a haunted house than a health carecenter.Working there certainly met myexpectations and, throughout thecourse of my stay, I saw manyconditions that were relatively aliento me: terrible infections, cripplingtraumatic injuries and debilitatingdevelopmental disorders. While that12 Bulletin : January 2011

MUSINGSarea shares common diseases foundthe world over, those ailmentsseemed all the more intimidatingthere. Often patients lacked access tohealth care, so their illnesses festeredand advanced; they might havedelayed seeking treatment until theirstate was unmanageable, waiting untiltheir condition became incapacitating.To make matters worse, it wasnot uncommon that their ailmentshad been complicated by a prior visitto a tribal healer or witch doctor.Within days, it was clear that alarge proportion of cases seen at thedispensary fell into the category ofsexually transmitted infections (STI).STIs are a familiar foe in Tanzania; anestimated 7 percent of her people areinfected with HIV, and Kwala is noexception, with 0.5 percent of thevillage residents being registered asnew cases of HIV annually. Mostconcerning was that it was often thesecondary school students whosought care at the dispensary for STIsymptoms. As a result, I decided tospend the summer creating andimplementing a sexual educationcourse in order to contribute to theprevention of diseases that werecausing so much suffering in thecommunity.After obtaining the support ofthe school administration and localcommunity, I was ready to begin thelessons. The students were divided bysex and age, and at the differentsessions I was accompanied by aphysician or teacher to serve as atranslator. Their participation wascritical because the material was tooimportant to risk the language barrierbecoming an obstacle. It was imperativeto create a comfortable environmentfor the students, and translatorsgreatly facilitated that goal. I wasentirely satisfied that we had accomplishedthis based upon the amountof questions that our talks produced;every seminar prompted at least 15-20 questions.The inquiries from the studentscovered every topic I had hoped todiscuss and more: Can you get HIVor get pregnant from anal sex? Is itsafer to be abstinent or use condoms?Can you use a plastic bag instead of acondom? Can I play football withsomeone who has HIV? The prevailingtheme was that the students werecurious about the subject and thatthere had never before been a venuein which they could find answers totheir questions.Our discussions displayed whatmakes the doctor-patient relationshipso unique; the patient discusses hiscuriosities, secrets, concerns and fears,no matter how personal or embarrassingthey may be. Despite the vastdifference between the challengesfaced by Tanzanian medicine comparedto our own system, the fundamentalprinciples and essence of theinteraction remained the same. Of allthe roles a physician plays, I’ve foundone to be the most important:providing a forum for patients toexpress issues that they cannotelsewhere.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○Mr. Rosenbaum is a second year medical studentat the University of Pittsburgh. He can bereached at rosenbaum.alan@medstudent.pitt.edu.The opinion expressed in this column isthat of the writer and does not necessarilyreflect the opinion of the EditorialBoard, the Bulletin, or the AlleghenyCounty Medical Society.Got Something to Say?If you’re an ACMSmember and would like towrite a student or residentcolumn, call Linda Smithat (412) 321-5030, x105 ore-mail lsmith@acms.org.Tracy L. Prizant, M.D.announces the opening ofPRIZANT DERMATOLOGY Providing complete general dermatology and dermatologicsurgery services including pediatric, adolescent, adultand geriatric care.January 2011 : Bulletin13

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SOCIETY NEWSOphthalmology (l. to r.): Dr. Norman Edelstein, president of the Pittsburgh OphthalmologySociety, Dr. Frohman, featured speaker, and Dr. John Charley, neuro-ophthalmologist, whoinvited Dr. Frohman to speak to the society members.Ophthalmology, DecemberThe Pittsburgh OphthalmologySociety met on December 2. Dr.Larry Frohman, professor of ophthalmologyand neurosciences, Universityof Medicine and Dentistry of NewJersey (UMDNJ), was the featuredspeaker. Dr. Emily Deschler, aUPMC resident, spoke on a neuroophthalmologicalcase.Dr. Frohman is director of neuroophthalmologyand vice chair,ophthalmology, UMDNJ. He hasbeen president of the North AmericanNeuro-ophthalmology Societysince 2004 and has been active on theexecutive board since the early 1990s.Also active in the American Academyof Ophthalmology, Dr. Frohman hasbeen chair of the Panel on EstablishingCurriculum in Neuro-ophthalmology(knowledge base project)since 2002. Recipient of severalawards from the American Academyof Ophthalmology, Dr. Frohmanalso was winner of the DistinguishedJanuary 2011:Bulletin:Service Award in 2010 presented bythe North American Neuro-ophthalmologySociety. Currently he ispresident of the Faculty Practice ofNew Jersey Medical School.The ophthalmology societyvoted to add Drs. Michael Alunniand Roheena Kamyar as new membersand introduced Drs. MichaelCampbell and Sean Pieramici aspotential new members. The societyannounced the retirement of longtimemember Dr. William FronczekJr. Dr. Fronczek, who has practicedmost recently in the McMurray area,said continued involvement with theTrolley Museum located at theWashington County Fairgrounds willbe one of his retirement activities.Society members were remindedto set aside Friday, March 18, toattend the annual meeting at theOmni William Penn Hotel. Guestspeakers will include Drs. CarmenPuliafito (Thorpe Awardee), StevenNewman and Shahzad Mian. Inaddition to the clinical talks, Mr.Edward Kabala, Esq, senior partnerwith Fox-Rothschild, will speak onthe subject of physician asset protection,including estate and tax planning.continued on page 17Make the load a little lighterfor an area medical studentThe Allegheny County Medical SocietyFoundation offers two annual scholarships of$2,000 to Western Pennsylvania studentsattending medical school in the state.To make your donation, send a check to:ACMS Foundation Scholarship Fund713 Ridge AvenuePittsburgh, PA 15212-6098For more information contact themedical society at 412.321.5030.15

16 Bulletin : January 2011

SOCIETY NEWS (from page 15)Ob/Gyn, DecemberThe Pittsburgh Obstetrical andGynecological Society met onDecember 6. Featured speakerChristina Scifres, MD, (top photo)focused her presentation on diabetesand pregnancy. Dr. Scifres is assistantprofessor, obstetrics, gynecology andreproductive science, University ofPittsburgh School of Medicine. Dr.Eric Miller, society president, notedthat Dr. Scifres has written extensively.She took time to answer manyquestions from the audience.Dr. Miller (bottom left) presenteda plaque to James Garver,MD, the ob/gyn society’s immediatepast president, noting his service tothe society during 2009-2010.On February 7, the ob/gynsociety will present a program ontreatment of varicose veins, featuringguest speaker Mario Plaza-Ponte,MD. To register for the meeting, callDianne Meister at (412) 321-5030.A March meeting will feature Ms.Luciaz DiVenere, ACOG director ofgovernment affairs.Ob/gyn featured speaker: Dr. ChristinaScifres.Ob/gyn: Dr. Eric Miller (left) presented aplaque to Dr. James Garver.ACMS ALLIANCEUPDATEThe ACMSAlliance presentedKathleen Reshmiwith its Thompsonaward at aDecember 15holiday luncheon,held this year atthe Fox Chapel Ms. ReshmiGolf Club. The award is givenannually in recognition of dedicationand service to the community, to thealliance and to family.Ms. Reshmi currently serves aspresident of the alliance.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○The ACMS Alliance is an organization ofspouses and supporters of the Allegheny CountyMedical Society membership. Information isgleaned from the alliance’s newsletter, ACMSANews Update. For information on becoming amember of the ACMS Alliance, contact SandraDa Costa at (412) 343-2914 or Mary KaySchaner at (724) 941-5147 or visitwww.acms.org.January 2011 : Bulletin17

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ACTIVITIES & ACCOLADESIN MEMORIAMDonald A. Fetterolf,MD, MBA, was oneof 14 individualsinducted as fellows atthe College of Physiciansof Philadelphiaat its annual College Dr. FetterolfNight in November. An honorificcollege founded in 1789, it is theoldest professional society in thecountry, having been founded byphysicians from the RevolutionaryWar period, including BenjaminRush. Known widely for an immenseclosed stack library containing some325,000 volumes and the famousMutter Museum, the college selectsfellows for their individual contributionto medicine.Edwin C. Fischl, MD, MS, MBA,was honored by the National HealthCare Anti-Fraud Association with its2010 NHCAA Medical DirectorAward for assisting in more than 450cases, reviewing medical records andclaims, assisting with onsite audits,spearheading revisions to medicalpolicy and providing invaluableinformation and training to lawenforcement. Dr. Fischl is medicaldirector, medical management andpolicy, Highmark Blue Cross BlueShield.Freddie Fu, MD,chair of Pitt’s departmentof orthopaedicsurgery, was recentlynamed DistinguishedService Professor ofOrthopaedic Surgery. Dr. FuDr. Fu is the first from the departmentto receive this designation.Grant J. Shevchik, MD, recentlyappeared on Channel 4 Action Newsdiscussing UPMC’s onlineJanuary 2011:Bulletin:HealthTrak system that allowspatients to connect with a doctorwith a click of their mouse. Dr.Shevchik, who is medical director ofHealthTrak, says, “Using HealthTrakis just as safe and private as usingonline banking,” but cautioned it’sonly designed to treat commonillnesses.Anthony Spinola,MD, was recentlyquoted in a PAMedNews article, “Breathlessin Pennsylvania,”that focused on theproblem of chronic Dr. Spinolaobstructive pulmonary disease(COPD) in the Keystone State. Dr.Spinola, who is an internal medicinephysician, says, “We can’t cureCOPD, but we can help patientsmanage it.”○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○Send your Activities & Accolades items to LindaSmith at ACMS, 713 Ridge Ave., Pittsburgh,PA 15212 or e-mail lsmith@acms.org. We alsoencourage you to send a recent photographindicating whether it needs to be returned.ACMS Medical StudentScholarship...$2,000 will be awarded annuallyto each of two qualified medicalstudents. For information on howto apply for the ACMS StudentScholarship or how to contributeto the scholarship fund, e-mailstudentservicesfoundation@pamedsoc.org or call(717) 558-7854.(Note: The PaMedSocFoundation isadministering thescholarship.)E. David Cherup, MD, age 88,passed away on November 23. Dr.Cherup (family practice) graduatedfrom the University of PittsburghSchool of Medicine in 1951 andcompleted a residency at ShadysideHospital. Prior to attending medicalschool, he served as a naval aviatorofficer in World War II. Dr. Cherupset up his medical practice in BethelPark in 1952 along with his brothersin-law,Drs. James and GlennRankin, where he cared for patientsfor 35 years. He is survived by hiswife Naomi, daughters Lori and Lisa,son David and nine grandchildren.DEAR DOCTORLisa A. Pawelski, MD, dermatology,wrote a Dear Doctor column for thePittsburgh Post-Gazette’s healthsection about psoriasis, a chronic skinrash that is not curable, but controllable.Dr. Pawelski wrote that psoriasisis the result of an immune systemthat revs up the growth rate of skincells. Mild psoriasis may respond totopical steroid treatments, includingprescription creams, ointments,lotions and foams. More severe skinpsoriasis is best treated by a dermatologistwho can determine whichtreatment is best for the patient.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○The Dear Doctor column is published regularlyin the Pittsburgh Post-Gazette’s HealthSection. To contribute a Dear Doctor column,call Christina Morton at (412) 916-2421 ore-mail cmorton@acms.org.19

123We will help you withyour diagnosticequipment needs.3 reasonsto consultMike Gomberfor your office diagnosticequipment needsMike isn’t a “sales rep.” Mike is isa professional consultant with anMBA and 30 years experience inthe medical supplies.Mike will help you make the bestbusiness decisions on theequipment that is right for yourmedical practice.Mike will guide you in choicesthat will reduce your medical andpharmaceutical costs to offsetreductions in reimbursements.Allegheny MedcareSavings, Service and Solutions!endorsed byALLEGHENYCOUNTYMEDICALSOCIETYMichael L. Gomber, MBAMore than 30 years meeting physicians’ needs412.580.7900 Fax: 724.223.0959E-mail: michael.gomber@henryschein.comAllegheny MedcareHenry Schein, a Fortune 500 CompanyTogether to serve to provide a one-stopsolution for all your needsMedical Review Officer Training(Special CME Programs)Come learn the technical, legal and business proceduresand guidance to act as a Medical Review Officer. Thisvaluable certification and occupational medicine credentialis required by some state drug testing laws and theU.S. Department of Transportation.Comprehensive MRO Training Including Hair, Sweat, OralFluid, Alcohol Testing, and AAMRO Certification ExamSteamboat Springs, COJanuary 14–16, 2011Washington, DCFebruary 25–27, 2011NEW!Recertification: Effective October 1, 2010, DOT regulations requireall certified Medical Review Officers to maintaintheir certification and “re-qualify”(i.e., recertify) every 5 years. To re-qualifyafter October 1, 2010, an MRO mustattend a comprehensive MROtraining program and pass therequalification exam.800/489-1839www.aamro.comAdvanced Topics in Thyroidand Parathyroid SurgeryMarch 13-14, 2011 A D V A N C E D T E C H N I Q U E S C OURSE DIRECTORS These activities have been approvedfor AMA PRA Category 1 Credit.Sponsored by:University of PittsburghSchool of MedicineCenter for Continuing Educationin the Health SciencesIn collaboration with:Geisinger Health System andPennsylvania State UniversityFor brochure and online registration:https://ccehs.upmc.com or call 412-648-630420 Bulletin : January 2011

JANUARY/FEBRUARY CALENDARJanuary is the month for the following nationalawareness programs: glaucoma and birth defectsprevention. February 4 is National Wear Red Day andFebruary 14 is National Donor Day. (U.S. Dept. of Healthand Human Services, www.healthfinder.gov/library/nho/).Feb 3, 4:30-8:30 pm ............ Pittsburgh Ophthalmology SocietyFeb 7, 6-9 pm ....................... Pittsburgh Obstetrical/Gynecological SocietyFeb 8, 10 am ......................... ACMS AllianceFeb 10, 8:30 am-3:30 pm ...... PMS VideoconferenceCommission on CMEFeb 15, 6-9 pm ..................... ACMS Board of DirectorsFeb 18, 9 am-1 pm ................ Three Rivers Adoption CouncilFeb 21 .................................. Holiday: ACMS office closedAccuMed Billing Services, Inc.“We are your billing team”>> Increase your Cash Flow with:>> Stay in Control by:With AccuMed you practice medicine andleave the billing headaches to us!Let us make your search easier.Medical AssistantsMedical Records Clerks/Medical BillersMedical Secretaries, Receptionists, etc.RNs, LPNsNurse PractitionersPhysicians AssistantsClinical or Administrative(Our candidates are fully screened, tested andhave had criminal background checks.)Nature’s Frost, a 2010 photo contest entry by Dr. KimberlyHennon, whose specialty is emergency medicine.Call for more information, or visit our Web site:888-366-4545 www.likenservices.comJanuary 2011 : Bulletin21

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○FEATURE2011 ACMS Presidentand OfficersDr. McCaffertyPresidentDr. VarmaPresident-ElectDr. ParéVice PresidentDr.GarrettSecretaryDr. WilliamsTreasurerLeo R. McCafferty, MD2011 ACMS PresidentDr. McCafferty, the medical society’s 146th president, is aplastic surgeon certified by the American Board of PlasticSurgery. He is in private practice and is affiliated withUPMC Shadyside and Children’s Hospital of Pittsburghof UPMC. His office is licensed by the state of Pennsylvaniaas an Ambulatory Surgical Facility. At the Universityof Pittsburgh School of Medicine he is a clinicalassistant professor of plastic surgery.Dr. McCafferty has been a member of ACMS since1990 and, in addition to his service on the board ofdirectors, he serves on the Finance Committee. He servedon the Communications Committee from 1993 to2006, chairing it for five years, and he participated on theACMS Managed Care Survey and Evaluation Team in1996. Dr. McCafferty served on the Bylaws Committeefrom 2008 to 2009, chairing the committee during thattime. He also participated on the Peer Review Board andAwards Committee in 2009 and served on the ACMSFoundation and Gala Committee in 2010. Dr.McCafferty was ACMS treasurer in 2007, secretary in2008, vice-president in 2009 and president-elect in 2010,serving on the Executive Committee during that time. Atthe state level he served as a delegate to the PennsylvaniaMedical Society in 1995 and 1996.Dr. McCafferty is an active member of the AmericanSociety of Plastic Surgeons and a member of the EthicsCommittee. He is a fellow of the American College ofSurgeons and past-president of the D. Ralph Millard Jr.,MD, Plastic Surgery Society.Dr. McCafferty holds several key positions in theAmerican Society for Aesthetic Plastic Surgery, an associationthat unites a select group of plastic surgeons demonstratingexpertise in all areas of cosmetic surgery. Hisparticipation in the society includes member of theProgram Committee and New Member Committee, andchair of the Industrial Relations Task Force and of theAdministrative Commission for which he is regionalspokesperson. He also serves as secretary of the society’sboard of directors and sits on the Executive Committee.Raised in the Pittsburgh area, Dr. McCafferty receivedhis bachelor of science degree from The PennsylvaniaState University and medical doctorate from TempleUniversity; he completed his internship and residency ingeneral surgery at Cedars-Sinai Medical Center in LosAngeles. His training in plastic surgery was at the Universityof Miami, Jackson Memorial Medical Center, underthe world-renowned plastic surgeon, D. Ralph Millard,Jr., MD. Prior to returning to Pittsburgh, Dr.McCafferty was assistant professor of clinical surgery atthe University of Miami and chief of staff services at theJackson Memorial Medical Center.Dr. McCafferty has been the plastic surgeon consultantto the Pittsburgh Steelers since 1993. He and his wifeSusan reside in Mt. Lebanon. They have four children,daughters Kristen, Kimberly and Kelly, and a son Lee.22 Bulletin : January 2011

FEATURERajiv R. Varma, MD2011 ACMS President-ElectDr. Varma is a pediatric neurologist certified in pediatricsand neurology with special qualifications in child neurology.He is clinical director of the pediatric neurologydivision of Children’s Hospital of Pittsburgh of UPMC.A member of ACMS since 1987, Dr. Varma has beenvery active with the medical society, in addition to hisservice on the board of directors from 2003 to 2005 andagain in 2008 to 2010. He was a member of the LegislativeCommittee from 1993 to 2006. He was chair of theMember Benefits Committee in 1999 and participatedon the Membership Committee from 2000 to 2005,serving as vice chair in 2000 and chair from 2001 to2005. Dr. Varma was the Board of Directors PresidentialAppointee from 2000 to 2002. He served on the NominatingCommittee in 2006 and the Finance Committeein 2008 and 2010. He was a member of the AwardsCommittee in 2009. He participated on the Peer ReviewBoard in 2010 and was chair of the Bylaws Committeethat same year. Dr. Varma served as ACMS treasurer in2008, secretary in 2009 and vice president in 2010,serving on the Executive Committee during that time. Atthe state level he served as an alternate delegate to thePennsylvania Medical Society from 1993 to 1995 and in2002. Dr. Varma served as a delegate to the PennsylvaniaMedical Society from 1996 to 2001; 2003 to 2008 andin 2010. Dr. Varma has also served on the PMS StrategicPlanning Committee for several years.Dr. Varma is a member of many professional andscientific societies, including the American Academy ofNeurology and the Child Neurology Society. In addition,Dr. Varma volunteers with the United MitochondrialDisease Foundation.Dr. Varma earned his medical degree from Prince ofWales Medical College in Patna, India, in 1974 and thenserved as senior house officer in Royal Gwent Hospital,England. From there, Dr. Varma moved to Michiganwhere he completed his pediatrics residency at the HurleyMedical Center and Children’s Hospital of Michigan.In 1980, Dr. Varma came to Pittsburgh as a pediatricneurology fellow at UPMC and Children’s Hospital.Prior to joining Children’s, Dr. Varma was chief, divisionof child neurology and vice-chairman of pediatrics atMercy Hospital of Pittsburgh.Dr. Varma and his wife, Dr. Swarna Varma, reside inUpper St. Clair. They have three children, Manu,Sumeeta and Anita.January 2011 : BulletinAmelia A. Paré, MD2011 ACMS Vice PresidentDr. Paré is a plastic surgeon certified by the AmericanBoard of Plastic Surgery. She is in private practice and isaffiliated with Jefferson Medical Center, WashingtonHospital, St. Clair Memorial Hospital and UPMC. Sheis also affiliated with the University of Pittsburgh and is afellow of the American College of Surgeons.Dr. Paré has been a member of ACMS since 2000. Inaddition to serving on the board of directors since 2009,she served on the Nominating Committee from 2003 to2004 and in 2007. She has also served on the CommunicationsCommittee since 2006, becoming its chair in2008. Dr. Paré participated on the Legislative Committeein 2007 and the Awards Committee from 2007 to 2009.Dr. Paré was a member of the Finance Committee in2009 and was the Board of Director’s Presidential Appointeefrom July 2007 to 2008. She served as ACMStreasurer in 2009 and secretary in 2010, serving on theExecutive Committee during that time.At the state level Dr. Paré served as alternate delegatefrom 2000 to 2002 and, since 2003, as delegate to thePennsylvania Medical Society; she has been on the PennsylvaniaMedical Society Political Action Committee(PAMPAC) since 2005. She is also a member of theAmerican Society of Plastic Surgeons, PennsylvaniaMedical Society, Pittsburgh Plastic Surgery Society andthe Harvard Alumni Society. On behalf of physicians inthis area, Dr. Paré has visited local legislative offices, aswell as those in Harrisburg and Washington.Dr. Paré earned a bachelors of science degree inchemistry from Harvard University and studied at OxfordUniversity in England. She received her medicaldegree from Hahnemann University School of Medicinein 1992. She trained in general surgery at St. Luke’s-Roosevelt Hospital Center, University Hospital ofColumbia University College of Physicians in New YorkCity, where she served as chief resident of general surgery.She completed specialized training in aesthetic, plastic andreconstructive surgery at UCLA, where she also served aschief resident. She has worked with Doctors Missions inHonduras.Dr. Paré and her husband Kyung Park, MD, reside inUpper St. Clair with their son Liam.continued on page 2523

Look for details in the February Bulletin, or visitwww.acmsgala.com.Physician AwardsJohn A. Straka, MDRalph C. Wilde AwardJudith S. Black, MD, MHAFrederick M. Jacob AwardChris Allen, MDNathaniel Bedford Award(posthumously)Jan D. Smith, MDPhysician VolunteerAwardCommunity AwardsPride in Pittsburgh AwardsBenjamin RushCommunity OrganizationPublic Health AwardFredric V. Price,MD, FACSAnn McGaffey, MDGreta K. RooneyMark J. LaskowBenjamin RushIndividual Public HealthAwardAwards to be presented at the ACMS Foundation Gala on March 19, 2011. Call 412-321-5030 for tickets.24 Bulletin : January 2011

FEATURE (from page 23)Kevin O. Garrett, MD2011 ACMS SecretaryDr. Garrett is a board certified general surgeon, practicingat UPMC St. Margaret Hospital, where he serves as chiefof surgery. He is a clinical professor of general surgery atthe University of Pittsburgh School of Medicine.Dr. Garrett has been a member of ACMS since 1985,serving on the board of directors since 2006. He was amember of the Nominating Committee in 1999 and theMedical-Legal Committee from 2002 to 2004. Dr.Garrett served on the Membership Committee in 2006,the Awards Committee in 2007 and the Finance Committeefrom 2007 to 2010. Dr. Garrett was ACMStreasurer in 2010 serving on the Executive Committeethat year, too. He also has been a delegate to the PennsylvaniaMedical Society since 1998, serving as vice chair andchair of the ACMS delegation in 2008 and 2009 respectively.Dr. Garrett has served as an alternate delegate to theAMA from the Pennsylvania Caucus since 2007.Dr. Garrett has been a member of the AmericanCollege of Surgeons since 1995 and has served as agovernor since 2007. He has also been active with theSouthwestern Pennsylvania Chapter of the AmericanCollege of Surgeons, serving as treasurer, council memberand program chair.Dr. Garrett received his bachelors of science degree inchemistry from Carnegie Mellon University. He earnedhis medical degree at the University of Pittsburgh Schoolof Medicine and served his surgical internship and residencyin general surgery at the University of PittsburghSchool of Medicine.He and his wife Jennifer reside in Allison Park withtheir three children, Kevin Jr., Kelly and Megan.John P. Williams, MD2011 ACMS TreasurerDr. Williams is chair of the department of anesthesiologyat the University of Pittsburgh where he is the Peter andEva Safar Professor of Anesthesiology. Board certified inanesthesiology and critical care medicine, Dr. Williams isa diplomate of the American Academy of Pain Managementand was a member of the Analgesic GuidelinesCommittee of the American Society of Clinical Pharmacologyand Therapeutics from 1994 to 2004.A member of ACMS since 1998, Dr. Williams was amember of the Communications Committee from 2000to 2001. He was a member of the Legislative Committeefrom 2002 to 2007, serving as its chair in 2007. Dr.January 2011 : BulletinWilliams has served on the Board of Directors since2006. He was a member of the Membership Committeefrom 2008 to 2010 and was chair of the Awards Committeein 2010. He has also served as an alternate delegateto the Pennsylvania Medical Society from 2002 to 2004and as a delegate from 2005 to 2010. He served as analternate delegate to the AMA for the PMS.Dr. Williams received his medical degree from theBaylor College of Medicine. He completed his internshipat St. Joseph Hospital in Houston, Texas, and his residencyin anesthesiology at the University of Texas MedicalSchool in Houston and a fellowship at Guy’s Hospital inLondon, England.Dr. Williams has dedicated his career to education andresearch with a clinical emphasis on cardiac illness andcardiac surgery. He previously served as chief at UMPCPresbyterian Hospital from 1999 to 2001 and as interimchair from 2001 to 2002. He has also served as thedirector of cardiac anesthesiology and co-director ofintensive care at UCLA and prior to that at the Universityof Texas, Houston.Dr. Williams and his wife Valerie reside in Gibsoniawith their children Brynna, Connor and Victoria.The ACMS Board of Directors meetsthroughout the year on Tuesdays at6 p.m. Board meetings are open tomembers. If you wish to attend,contact the medical society at (412)321-5030 to receive a schedule andmeeting agenda. Board meetings in2011 are scheduled for: February15, May 24, September 27 andDecember 6.25

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○FINANCIAL HEALTHLong-Term Care: AnIssue You Can’t Affordto AvoidMALACHY WHALENLong-term care (LTC) is a subject that all Americansshould consider in their overall financialplanning because it is for that period in our lifewhen we can’t take care of ourselves or need assistance toperform the activities of daily living. It includes medicaland non-medical care for people who are critically ill ordisabled from an accident or an illness.Why do we need to be concerned?A critical illness or accident can be financially devastatingregardless of age. While LTC is thought to be forolder people, it is actually applicable to younger people aswell because it applies to anyone who is critically ill ordisabled. A major insurer offers statistics that show 40percent of people who receive LTC are between the agesof 18 and 64.A recent study by the U.S. Department of Health andHuman Services indicates that anyone who reachesage 65 has a 40 percent chance of entering anursing home, with a 20 percent chanceof staying there more than five years.While a very sobering statistic, itdoesn’t include the tremendousamount of pre-nursing home healthcare and assisted living care thatmight be needed.Overwhelming costThe cost for LTC is overwhelming.Nursing home expenses exceed $100,000 a year in mostcities today and is increasing every year. Average costs inthe United States in 2009 included:• $198/day for a semi-private room• $3,131/month for care in an assisted living facility(one-bedroom unit)• $21/hour for a home health aide• $19/hour for homemaker services• $67/day for care in an adult day health care centerThese are the national averages, but a local example ofnursing home charges in the Pittsburgh area shows $224/day for a semi-private room and $340/day for a privateroom. These are realities that must be faced by all of us,so what are possible solutions?Solution #1: Do Nothing. Your assets must besubstantial to afford $100,000 a year or more from yourinterest or investment income and stillhave enough for the rest of the familyto live comfortably. Of course, if yourspouse goes into a LTC situation atthe same time, you are looking at$200,000 or more a year. If youhave to start using the principal ofyour savings, home equity andretirement funds, they will depleterapidly and perhaps be exhaustedcompletely depending on howlong you need LTC.26 Bulletin : January 2011

FINANCIALSolution #2: Move into a retirement community.This entails buying into the concept of living in a communitysetting where essentially all your needs are takencare of. You buy an independent living unit such as anapartment, townhouse or villa. The community willprovide for most of your daily needs, as well as assistedlivingaccommodations or nursing home care if needed.While it sounds good, this solution is expensive, includingthe original buy-in price plus a monthly fee that isadjusted for inflation. In addition, you need to carefullyexamine the business’s financial stability basis. Finally, youmust be in good health to secure full coverage, which isexpensive, but an option that should be considered.Solution #3: Medicaid. There are very restrictiveincome and asset provisions that need to be met. Even ifyou plan ahead, it is not a very satisfactory solution.Solution #4: Life insurance policy accelerated benefits.Most policies will allow you to use a portion of your faceamount to cover expenses if your life expectancy is undertwo years. If you chose this as a solution, you shouldcheck your life policy to make certain it is included andalso read the definitions, as they vary. A competentinsurance broker will assist you in understanding coverageand your options.Solution #5: A combo life insurance policy withbuilt-in LTC. One high quality insurer offers this onpermanent insurance policies of up to $1,000,000 ofcoverage. The policy has an LTC rider that allows you totake a percentage of the face amount per month whenyou qualify for long-term benefits. For example, a$1,000,000 policy provides:1% = $10,000 per month for up to 100 months2% = $20,000 per month for up to 50 months4% = $40,000 per month for up to 25 monthsThere are real advantages to this because it answers thequestion:“What happens to all my premiums if I don’tneed long term care?” It also allows you to take whateveryou need without rate increases. This is a very goodoption for some people.Solution #6: Long-term care insurance. This is thesolution that appeals to many people. It is an insurancepolicy designed to cover the expenses of long-term care,including home health care, assisted living and nursinghome charges. Planning is needed to determine the rightpackage to fit your unique position. Of course, insurabilitybecomes an issue, so you need an expert to assist in theplanning process.January 2011 : BulletinLong-term care insurance policy highlights1. Benefits are payable when the insured becomeschronically ill, satisfies the elimination period, and isreceiving qualified long-term care services pursuant toa written plan of care approved by the insurancecompany. Chronically ill would be defined as lackingthe ability to perform two or more activities of dailyliving without substantial assistance from anotherindividual. Activities of daily living are bathing,dressing, toileting, transferring, continence and eating.2. A severe cognitive mental impairment such asAlzheimer’s is covered when you are a hazard toyourself or others.3. The contract itself is guaranteed renewable, whichmeans the insurance company can’t cancel or changethe policy. Individual policy premiums cannot beincreased; however, a company may file with the StateInsurance Department requesting approval for aunified rate increase on all policyholders in thatparticular state.4. There are two types of LTC coverage.a. Reimbursement plan: Means that you accumulateyour bills, submit them to the insurance companyand receive reimbursement up to the eligible dailyor monthly benefit amount.b. Indemnity plan: Means that, once you qualify forbenefits, the insurance company will send you theeligible daily or monthly benefit and you payyour own bills. The indemnity plan is a littlemore expensive, but it is far easier to administer;plus the benefits will generally be higher, especiallyfor the home health care and assisted livingcoverage. I usually recommend this plan.5. How a claim is established: Once an insured qualifies,the attending physician certifies that the claimant isdisabled; a plan of care is developed by a home healthcare agency in conjunction with your attendingphysician and approved by the insurance company.The plan may be for home health care, assisted livingor nursing home services.Major benefit options• Coverage is available up to $400 a day.• There is always an elimination period, and it can beanywhere from 20 days to 365 days. Normally a 90- or100-day waiting period is used to keep the cost down,plus Medicare benefits may be available up to 100 days.continued on page 2927

Doctors and Patients. Preserve the Relationship. ®Free. Members-Only InformationFrom the Pennsylvania Medical SocietyOf the thousands of calls and e-mails we receive from Members every year, many concern thesame issues and questions. So, we’ve developed a series of brief publications that addressthese common Concerns. They’re free and available only to Members.RegulationsPractice Guidelines for Physician Assistantsand Certified Registered Nurse PractitionersA resource for physician practices to understand licensure,scope of practice, and reimbursement rules andguidelines for these positions.Setting the Record Straight: What You Need to KnowAbout Medical RecordsFrom Ownership rights to copying fees, “Setting theRecord Straight” will help you make sure you’re handlingthese vital documents appropriately and legally.Disease ReportingIncludes lists of reportable diseases, how and where toreport, confidentiality rules and penalties for failing toreport.ReimbursementAct 6: A Crash Course in Auto AccidentReimbursementA concise run-down of the steps you need to take to getappropriately reimbursed for care of patients injured in amotor vehicle accident.Your Right to Timely Payment Under Act 68Provides details of physician’s rights under the Quality andHealth Care Accountability & Protection Act, includingprovisions for prompt payment of clean claims within 45days.Collection Protocols for the Medical PracticeManage your accounts receivable and prevent them frombecoming delinquent. “Collection Protocols” includes tipson managing accounts and also useful collection techniques.Workers’ Compensation:The Application for Fee Review ProcessFAQs and sample forms for when you have trouble gettingpaid for workers’ compensation health care services orwhen an insurer is making you wait for payment.Practice ManagementPolicy and Procedural Manuals/EmployeeHandbooks for Medical PracticesUse this brief publication to find out the basic informationthat should be included in a comprehensiveemployee handbook for your practice.Selecting Computer Hardwareand Software for Your Medical PracticeUse this short paper to help you with the process ofselecting a practice management system for yourmedical practice.Setting Up a Practice—Areas to ConsiderFor physicians who are considering starting a practice.With all there is to consider, you’ll probably misssomething without a checklist like this.Medical LiabilityArbitration of Medical Liability ClaimsFocuses on private arbitration outside the judicialsystem that takes place if the physician and patienthave a voluntary agreement to engage in arbitration.Medical Professional Liability Insurance OptionsBasic information and definitions for physicians consideringnew as well as traditional medical liability insuranceoptions.Lawsuit Protection StrategiesDesigned to be an instructional tool for physicians sothat they can have a more informed discussion withtheir legal and financial advisors.Order any of these publicationsby calling (800) 228-7823or on the Pennsylvania Medical SocietyWeb site store, www.pamedsoc.org/store.28 Bulletin : January 2011

FINANCIAL (from page 27)• The benefit period is the length of time that the insurancecompany will pay. That can be anywhere from twoyears to lifetime. The lifetime benefit is recommended.• Inflation or Cost of Living Benefits (COLA) are essentialin this type of coverage. They may be compound orsimple, and factors up to 6 percent are available.• There is a difference between simple and compoundCOLA. If you have a $200 a day benefit and 5 percentsimple COLA, that means the coverage would increaseby $10 each year, so at the end of 20 years, the benefitwould be $400 a day. Five percent compounded for 20years would increase the benefit to $530. Dependinghow long the coverage is in force prior to the use of thebenefits, the compound inflation rider is generally thebest.• Home health care: Most everyone wants to stay athome as long as they can. Professional home health careis a very valuable benefit and should be included.• Accelerated payment options allow you to pay onesingle premium, 10 annual premiums or payments toage 65 in addition to premiums for life. This option isattractive if the corporation is going to pay the premiumbecause it may be deducted and the benefits arenot taxable to the employee.• Tax consequences: If you are paying thepremium personally, a portion of thepremium may be deductible on your1040. The inflation-adjusted tables for2010 allow the following deduction onyour federal tax returns (see table onright).Age of insuredAdditional options to be considered• Bed reservation pays the charges for the LTC facility ifyou leave on a temporary basis.• Special services designed to allow you to remain athome longer may be included.• Waiver of premium is provided while receiving benefits.• Non-forfeiture benefits are available that provide ashortened benefit period if you stop paying the premiumafter three or more years.• Survivorship rider eliminates the premium for thesurvivor if the policy has been in force for 10 consecutiveyears.• Return of premium at death rider provides a benefitequal to the total premium paid minus any claims paid.SummarySerious planning is needed to establish a plan that willmeet your needs and provide you and your family withfinancial peace of mind.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○Malachy Whalen is the founder of Malachy Whalen & Co, Inc., aninsurance agency serving health care practitioners and facilities nationwide.He can be reached at (412) 281-4050 or help@malachy.com.Eligible LTC insurance premium deductionAge 40 to 50 $620Age 50 to 60 $1,230Age 60 to 70 $3,290Over age 70 $4,110**You should consult with your CPA on all tax matters including this information.**Help your patients talk to you about their BMIAllegheny County Medical Society is offering free posters explaining bodymass index (BMI) and showing a colorful, easy-to-read BMI chart. Theposters can be used in your office to help you talk about weight loss andmanagement with your patients.To order a quantity of posters, call the society office at 412-321-5030.You can view or download a smaller version online at www.acms.org.Allegheny County Medical SocietyJanuary 2011 : Bulletin29

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○FEATURE2010—Year-in-ReviewACMS President John F. Delaney Jr., MD, MPH,DrPH, and the Board of Directors relied on theACMS Strategic Plan to address the challengingissues of national health care reformlegislation, Medicare funding andphysician payment schedules, and thePennsylvania MCare fund in 2010. Theofficers focused on advocacy for physiciansand patients in a very challengingenvironment for physicians and medicine.In Pennsylvania, MCare fundingand the deepening Pennsylvania budget crisis led to theDr. Delaneymisappropriation of MCare funds by the governor and thelegislature to reduce the state’s budget deficit. The PennsylvaniaMedical Society and the Hospital and HealthcareAssociation of Pennsylvania filed litigation challenging theconstitutionality of the use of those funds and won afavorable decision. Theoutgoing Rendell administrationhas appealed thedecision; cases are pendingbefore the Pennsylvania Supreme Court.The national debate over health care policy reform hasbeen at the forefront of activity, and health care reformresulted in a very broad, encompassing act that will haveenormous impact on health care. The bill creates sweepinggoals and structures with specific regulatory definition yetto be defined. The national elections in November reflectedongoing contentious debate concerning the futureof this legislation.One national issue is clear: reform of the Medicareprogram payment methodology. The SGR (SustainableGrowth Rate) formula was statistically flawed at itsinception, and each year proposes significant fee schedulecuts for physician and hospital services. For the past sixyears, Congress has appropriated additional funding toavoid deep cuts in the program. The year saw five shorttermpayment “fixes” that froze physician paymentschedules and caused financial disruptions, if not havoc,in medical offices. The medical society is focused oncorrecting the payment formula to reflect the costs ofpractices and the growing demand for services from anaging population, and it is conducting ongoing legislativecontacts to create a realistic methodology for the Medicarefee schedule.The Allegheny County Medical Society also has beenactive in our community as Dr. Delaney and other boardmembers met with hospital medical staff to discuss localissues. The medical society maintains active liaisons witha wide number of community partners, including theLeadership and Advocacy for Patients and PhysiciansAllegheny County Bar Association, Pittsburgh RegionalHealth Initiative, Consumer Health Coalition, HospitalCouncil of Western Pennsylvania, Community Collegeof Allegheny County and the Allegheny County HealthDepartment.Under the leadership of Co-chairs Lawrence John,MD, and Anthony Spinola, MD, the Primary CareCoalition (PCC) represented family and internal medicinephysicians in discussions with state and federallegislators, insurance companies and community groupsto identify the challenges and issues facing primary care30 Bulletin : January 2011

FEATUREphysicians and to develop policies that will improve theirprofessional lives and attract medical students to thesespecialties. The PCC sponsored a program exploring thepotential impact of the national legislation on primarycare physicians and also examined the Geisinger HealthSystems primary care network.The Primary Care Coalition worked with the Instituteof Politics at the University of Pittsburgh on a whitepaper on primary care. The group has helped createawareness of the shortages of primary care physicians andthe challenges presented to health care systems thatdepend upon them. It has also achieved fee scheduleincreases from carriers for primary care services.Executive Committee and Board of DirectorsThe ACMS Executive Committee and Board ofDirectors direct the medical society’s actions and providea forum for discussion for physicians, hospitals, insurancecompanies, business and legislative representatives. Theyhave worked tirelessly for the society and continue to beinvolved and supportive in community issues and organizations.During the past year, ACMS welcomed to itsboard meetings the following groups and individuals:• Christopher J. Olivia, president andCEO, West Penn Allegheny HealthSystem, presented a historical perspectiveof WPAHS, the health careenvironment in western Pennsylvaniaand his vision for the future of thesystem and associated physicians.• Highmark’s Bonnell G. Irvin, vicepresident of provider contracts &relations, and Carey T. Vinson, MD,January 2011 : BulletinDr. Oliviamedical director, quality improvement, discussed theQuality Blue Incentive Program for participatingphysicians and the impact of change in Medicare policyand payment for consultations upon private insurancebusiness.• Donald R. Fischer, MD, senior vice president, chiefmedical officer; and Atiya Abdelmalik, nurse manager,provided information on national health care reformlegislation and its impact on physicians and Highmark.Dr. Fischer noted that, while the legislation has passed,many of the provision’s details will be addressedthrough the development of regulatory policies, andthat there is a great deal of uncertainty regarding thespecifics of the majority of the issues contained in thelegislation.• Wellspring Worldwide’s RobertLowe, CEO, and Brian Bricker,vice president, provided informationon their company’s SEEDprogram. Wellspring Worldwide, aglobal leader in technology commercializationthat works ontransforming research and creativeideas into successful products, isfunded by Pittsburgh-based foundations to developentrepreneurs in technology in the Greater Pittsburgharea. The SEED Program (Services for Entrepreneurshipand Economic Development) provides individuals andemerging companies with support and resources inbusiness planning, engineering and development,product design and usability testing and infrastructure.One area of expertise is in health care informationtechnology.• A. J. Harper,HospitalCouncil ofWesternPennsylvaniapresident,discussed theMedicare WageIndex and itsimpact onWesternPennsylvaniaand the paymentdisparityamong medicalMr. BrickerA. J. Harper HCWP president (l.) and Dr.John F. Delaney, ACMS presidentassistance payments between hospitals in eastern andwestern Pennsylvania. The hospital council covers 32counties in Western PA. Mr. Frederick Peterson, hospitalcouncil vice president, professional services, disasterpreparedness, discussed West Penn Allegheny HealthSystem’s restructuring of clinical services and its possibleimpact on the community. He also noted the ongoingdisaster preparation and emergency planning beingconducted by the hospitals, as well as work on theMedicare Wage Index project.• Dr. David Perlmutter, chair of the department ofpediatrics at UPMC and a pediatric gastroenterologistat Children’s Hospital of Pittsburgh, outlined what hecalls health care’s biggest challenge, here and in thecontinued on page 3231

FEATURE (from page 31)Ralph Schmeltz, MD, was installed as the Pennsylvania MedicalSociety’s 161st president at October’s House of Delegates. Drs. CarolRose of Pittsburgh and Jonathan Rhoads of York look on.country: an enormous need for pediatric subspecialistsand a very small pool of subspecialists to draw from.This is especially true for certain subspecialties such aspediatric rheumatology and nephrology. In 2001,children’s hospital did not have sufficient staff for thesespecialties. Children’s Hospital of Pittsburgh is uniquebecause there is no other hospital in the western Pennsylvaniaservice area that has pediatric subspecialties.• Jaan E. Siderov, MD, PMSLIC president; Timothy J.Friers, ACAS, MAAA, senior vice president, PMSLICunderwriting & policyholder services; and Lisa Klinger,PMSLIC representative, all met with the ACMS boardin 2010. PMSLIC, a medicalliability insurance company, wasformed by the Pennsylvania MedicalSociety (PAMED) in 1978 andwas acquired by NORCAL MutualInsurance Company in 2002.NORCAL is the fourth largestphysician carrier in the UnitedStates with an “A” rating. PMSLICis an endorsed vendor for ACMS.• ACMS delegates who participatedin board meetings include: Drs. H.Jordan Garber, Dwight F. Heron,Todd M. Hertzberg, Maria J.Sunseri, Robert L. Thompson, KarlE. Bushman, Jennifer L.Middleton, Robert C. Oelhaf Jr.,and David B. Palko.Legislative CommitteeACMS continues to meet with legislators, mostrecently Congressmen Jason Altmire, Tim Murphy andMike Doyle, focusing on the Medicare program andhealth care system reform legislation. The medical societyis working with Pennsylvania House Majority LeaderMike Turzai to evaluate medical policy issues, particularlyadditional professional liability reform.Bruce A. MacLeod, MD, will succeed Dr. Paré asrepresentative to the PAMPAC board. Dr. Paré willcontinue to serve as an at-large member and will chair thePAMPAC board in 2011.DelegationACMS had a full contingent of 29 physicians participatingat the 2010 House of Delegates, including anumber of medical students. The Allegheny CountyMedical Society and the Philadelphia County MedicalSociety again held a joint caucus at the House of Delegates.Several local physicians serve on the PMS Board.Representing ACMS are: Ralph Schmeltz, MD, PAMEDpresident; Bruce A. MacLeod, MD, emergency medicinetrustee; Paul W. Dishart, MD, 13th District trustee; andAdam Z. Tobias, MD, PMS resident and fellows trustee.ACMS meetings and activitiesACMS thanks the many guests who participated inthe medical society’s meetings and activities, including:• Ralph Schmeltz, MD, and Paul W. Dishart, MD;• Zeyad Schwen and Hilary Michel, medical students;More than 200 office staff and technicians participated in the Pittsburgh OphthalmologySociety’s annual meeting’s break-out sessions in March.32 Bulletin : January 2011

FEATURE• Carl A. Sirio, MD, AMA Trustee;• Fateh Entabi, MD, resident;• Guest speakers at the Primary Care Coalition SpringProgram, including Jonathan Darer, MD, medicaldirector, clinical transformation for the Division ofClinical Innovation, Geisinger Health System; andKeith T. Kanel, MD, chief medical and learning officerfor the Jewish Healthcare Foundation;• The medical society provides office and administrativestaff services to specialty societies, including PennsylvaniaGeriatrics Society-Western Division, PittsburghObstetrical/Gynecological Society, Pittsburgh OphthalmologySociety, Pittsburgh Pediatric Society, PittsburghUrological Association, Pittsburgh SurgicalSociety and SWPa Chapter of the American College ofSurgeons (Joint Surgical Association).ACMS AllianceThe ACMS Alliancecontinues to promote itsinternational communityproject, Henry the Hand, ahand-washing techniqueprogram presented toschool age children. Thegroup’s fund-raisingactivities help to benefitthe AMA Foundation andthe Community College ofAllegheny County AlliedHealthcare Scholarships.Other projects providegifts to the Auberle Homein McKeesport and “Socksfor the Homeless.”Occupational Medicine CommitteeApproximately 75 participants attended the OccupationalMedicine Committee’s 2010 Medical OfficeOccupational Health and OSHA Update. Committeechair, Joseph J. Schwerha, MD, MPH, served as moderatorof the seminar, focusing on relevant medical officetopics relating to bloodborne pathogen standards, updateson OSHA regulations for the medical office, emergingfood pathogens and medical office safety.ACMS FoundationCreated, funded and led by physicians since 1960, theJanuary 2011 : BulletinKathleen Reshmi (l.), ACMSpresident and Patty Barnett,immediate past president2010 ACMS Foundation GrantsAnchorpoint Counseling Ministry: Youth Development Summer Tutoring Program ................................. $5,000Angels’ Place: Showcase of Scholars Scholarship Program ..................................................................... $5,000Carnegie Institute SciTech Initiative: Two student awards in the field of Medicine and Biology ................. $700Community College of Allegheny County Educational Foundation: health career scholarships(from proceeds of ACMS Foundation Gala .......................................................................................... $8,500Contact Pittsburgh: Suicide Prevention Program ........................................................................................ $2,500Focus on Renewal Sto-Rox Neighborhood Corporation: Lift-equipped small transitbuses and radio ..................................................................................................................................... $1,720Foundation of the Pennsylvania Medical Society: ACMS Foundation Medical Student ScholarshipFund (Two scholarships given by Allergy & Clinical Immunology Associates, PC, in memory ofDr. Gilbert Friday) .................................................................................................................................. $5,000Foundation of the Pennsylvania Medical Society benefiting ACMS Foundation Medical StudentScholarship Fund (from proceeds of ACMS Foundation Gala) .......................................................... $8,500Foundation of the Pennsylvania Medical Society benefiting ACMS Foundation Medical StudentScholarship Fund ................................................................................................................................. $15,000Medical Student Awards (to three students, one each from Drexel University School of Medicine,Temple University School of Medicine, and University of Pittsburgh School of Medicine) ............... $1,500Pittsburgh Action Against Rape: Emergency On-Call Medical Advocate Program ................................. $5,000Pittsburgh Schweitzer Fellows Program: Support for three medical student fellows for 2010-2011projects addressing unmet needs of children or elderly in an underserved community in SWPennsylvania .......................................................................................................................................... $6,000South Hills YMCA: Camp AIM for special needs youth ages 5-21 ............................................................ $5,000St. Margarets Foundation: Fitwits Zones Evaluation Proposal Pilot Study ............................................... $5,000United Mitochondrial Disease Foundation (2009 Benjamin Rush Community Organization HealthService Award)....................................................................................................................................... $1,000University of Pittsburgh Graduate School of Public Health (2009 Benjamin Rush Individual PublicHealth Service Award) .............................................................................................................................. $500Woodlands Foundation Inc.: Healthcare services for children with disability and chronic illnesswho participate in the year round programs offered at the Woodlands............................................ $10,000TOTAL................................ ................................ ................................ ..................................................$ 85,920Allegheny County Medical Society Foundation has givenmore than $2.2 million to various community programs,including $85,920 in grants in 2010 (see above chart forbreakdown). It also gifted three students $500 each forthe 2010 Medical Student Awards, including SeanTackett, University of Pittsburgh School of Medicine;Peter Maropis, Drexel University College of Medicine(Allegheny General Hospital); and Chinyere Ogbonna,Temple University School of Medicine (West PennHospital).The Allegheny County Medical Society and theACMS Foundation held its Community Awards Gala inJanuary to recognize the achievements of its physicianmembers and community partners and to raise funds forthe foundation’s charitable works. The celebration tookplace for the first time at the Heinz Field East ClubLounge and featured a reception and silent auction,dinner and award presentations.Communications and community relationsIn 2010 ACMS represented physicians as patientadvocates and educators, participating in public healthand community events and voicing physicians’ concernsregarding the practice of medicine.Health care reform dominated the media agenda.continued on page 3433

FEATURE (from page 33)Drs. Maryann Miknevich (l.) and Amelia Paré confer on winningentries at the 71st Pittsburgh Regional Science and Engineering Fairat Heinz Field on March 26.Addressing concerns of physicians and patients, ACMSmembers served as sources for opinion/editorialpieces and news articles for the Almanac, AmericanMedical News, Dynamic Business, Hospital News,Observer-Reporter, Pittsburgh Business Times, PittsburghPost-Gazette, and Pittsburgh Tribune-Review, as well ascoverage on WTAE-TV, KDKA-TV, WQED-TV, andKQV and KDKA radio. Issues covered included challengesfor physicians in primary care, electronic healthrecords, health care programs, healthy living, retail-basedhealth clinics, reconstructive surgery, the malpracticeclimate in Pennsylvania and Medicare funding.The medical society provided physician judges andsponsored two awards in the health and science categoryat the 71 st annual Pittsburgh Regional Science and EngineeringFair at Heinz Field in the spring.Also, ACMS distributed health-related information ata senior health fair sponsored by Pennsylvania staterepresentative Mike Turzai.Membership CommitteeACMS and the PennsylvaniaMedical Society createda collaborative field staffcontact program with staffmembers Nadine Popovichand Debbie Kocak. Thecommittee works throughoutthe year to improvephysician outreach programsand develop new programs tohelp members in both theirprofessional and private lives.Nadine Popovich (l.) andDebbie Kocak initiated thejoint ACMS/PAMEDmembership developmentprogram.Physicians and medical students gathered for Medical Student CareerNight at UPMC Shadyside’s Herberman Conference Center onNovember 16.Red bag waste services, auto/home owner insurancediscounts and banking services were made available tomembers.Two exciting member benefits were made availableonly to members: the Wellspring Seed Program (see page31, Executive Committee and Board of Directors for moreinformation) and the ACMSDocBook iPhone app. TheACMS DocBooks iPhone appprovides searchable directory ofACMS members and pharmacies.The app is currently availableonly for iPhone, iPad, andiTouch, but an Android versionis slated for early 2011.Medical students had opportunities in 2010 to chatinformally with physicians from various specialties, gatherinsight into different practice modalities and discuss theirfuture at a medical student Career Night in November.The ACMS also encouraged students to improve theirknowledge of organized medicine by attending boardmeetings and the annual state meeting.Community outreachACMS collaborates with many groups to providehealth care education and information to physicians,schools, groups, business and the community at large.Towards its goal of community outreach, ACMS has:• …met with representatives from the Pittsburgh Centerfor Deaf and Hard of Hearing to examine the initial34 Bulletin : January 2011

FEATUREresults of the pilot project to provide translation servicesfor primary care offices under a grant from the FISAFoundation.• …provided publicity for the Caregiver Championsprogram underwritten by the Jewish Healthcare Foundation,which provides support groups for thoseproviding care for family members and loved ones.• …provided support for the 2010 Pittsburgh BusinessGroup on Health for its annual educational conference.• … worked with the Allegheny County Bar Associationprogram, How to Document and Implement Client/Patient Health Care Decisions. This ongoing program ispart of the Advanced Directive Living Will project thatprovides both continuing medical education credits andcontinuing legal education credits.• …collaborated with the Consumer Health Coalitionon the Health in Latino Communities grant providedby the Pennsylvania Medical Society.• …participated in the Community Partners Programestablished by the University of Pittsburgh School ofNursing to involve the community on public healthcare issues such as diabetes, health assessments.• …participated in theMedication Clean-UpCampaign, a pilotproject of Drug FreePennsylvania and thePennsylvania MedicalSociety, carried out incooperation withpharmacy students,Allegheny County Policeand the DEA.• …participated in theGateway MedicalSociety’s town hallmeeting and supported its Healthy Lifestyles in EthnicCommunities project.• …endorsed the American Heart Association’s MissionLifeline program, designed to save lives by closing gapsin the system of ST-Elevation Myocardial Infarction(STEMI) care. The program will require the participationof physicians, nurses, emergency medical serviceproviders and hospital teams. The medical society willsupport communications to physicians on the project.Another ongoing objective of the medical society is tobring awareness to the community. ACMS officers metwith groups outside the health care industry to discussJanuary 2011 : BulletinDavid Bluestein, MD, and JohnF. Delaney Jr., MD, participatedin Pittsburgh’s first MedicationClean-up Day on May 8.health care reform, including speaking to Rotary Clubs,the Pittsburgh Business Group on Healthcare and the Tri-State Association of Physicians of Indian Origin (TAPI)on health care reform and the importance of membershipand participation in the ACMS.ACMS Editorial Board and the BulletinThe Editorial Board said goodbye to two associateeditors in 2010: Michael Chapman, MD, began serving aresidency at the Medical College of Georgia after servingnearly four years, and Adam Tobias, MD,completed a maximum allowed three, twoyearterms, expressing the desire to serveagain in the future. The Editorial Boardthanks Drs. Chapman and Tobias for acombined ten years of faithful service. Alsoin 2010, medical student Jacob EsquenaziDr. Tobiasjoined the Editorial Board as contributing editor andassists by recruiting writers for the Bulletin’s studentcolumn.The Bulletin’s 2010 annual photo contest attracted 34entries, from which 12 were selected to grace themagazine’s covers in 2011. This month’s cover featuresthe grand-prize winning photo, Fall in Pennsylvania, byElias Hilal, MD.Bulletin articles in 2010 featured its semi-annuallegislative update, listing responses from candidates toquestions of interest to our readers, as well as articles onlegal concerns facing physicians, pharmacy topics, implementingelectronic health records and advice on practicemanagement and financial health, member profiles andperspectives. A number of special reports providedinformation on community activities and programs.Regular columns also keep readers updated on societybusiness, including specialty societies, information aboutour members’ awards and activities and on the ongoingwork of the ACMS Alliance.The Bulletin invites its readers to submit letters to theeditor for its “Mailbox” column or to pen a “Perspective”column (less than 1,000 words) expressing opinion on atopic of choice; send them to bulletin@acms.org or callmanaging editor Linda Smith with any questions at (412)321-5030. Past issues are available online at www.acms.org; click on Bulletin information/past issues.35

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○PROFILELeo McCafferty, MD: Physician,Advocate, Musician, Family ManCHRISTINA E. MORTONLeo R. McCafferty, MD, is the Allegheny CountyMedical Society’s 146 th president. A board certifiedplastic surgeon, Dr. McCafferty is in privatepractice. A member of ACMS since 1990, he also is amember of several other professional organizations,serving leadership roles in many (see page 22).Dr. McCafferty was born and raised in Pittsburgh,growing up in Mt. Lebanon and graduating from Mt.Lebanon High School. He received a bachelor of sciencedegree from The Pennsylvania State University andmedical doctorate from Temple University; he completedhis internship and residency in general surgery at Cedars-Sinai Medical Center in Los Angeles. Dr. McCaffertycompleted his training in plastic surgery at the Universityof Miami, Jackson Memorial Medical Center, underworld-renowned plastic surgeon, D. Ralph Millard, Jr.,MD.Dr. McCafferty recently talked about being a physician,his mentor Dr. Millard, and his beloved family, aswell as his hobbies andinterests outside of medicine.Dr. McCafferty, whatinspired you to become adoctor?My pediatrician, Dr.Wunderlich, was a very biginfluence. He made housecalls and I remember beingfascinated by all of thethings he carried in hismedical bag. I knew from avery young age that Iwanted to become aphysician.Dr. McCafferty and family at 2009 Super BowlWhy did you choose the specialty of plastic surgery?When I was a third-year student in medical school Iattended a lecture by a plastic surgeon that was about asmall child mulled by a pit bull. I saw that and thought,“Wow, I would like to do that.” When I was completingmy surgery residency in Los Angles, I always foundmyself sneaking into the operating room with a plasticsurgeon to help and watch. Later I went to visit Dr. D.Ralph Millard in Miami and ended up training with him.He was a world famous physician and I was so impressedwith what he did. Training and working with Dr. Millardreally helped to seal the deal in terms of what I wanted tospecialize in.Can you tell me a little bit about your mentor, Dr. Millard?I was very privileged to train with Dr. Millard inMiami. He taught me to think, not only as a doctor orplastic surgeon, but as a human being, too. He encouragedme to never accept the written word or the statedword of so-called expertswithout really questioningand investigating what wasbeing stated. He has been abig mentor in my life. Oneof his favorite sayings was,“Avoid the rut of routine.”He was an amazing individual.You received your medicaltraining outside ofPittsburgh. What made youdecide to come back to thearea?I completed mytraining in plastic surgery at36 Bulletin : January 2011

PROFILEthe University of Miami, Jackson Memorial MedicalCenter. Prior to returning to Pittsburgh, I was assistantprofessor of clinical surgery at the University of Miamiand chief of staff services at the Jackson MemorialMedical Center. I was on the full-time faculty, and mysuperiors were actually in the process of offering me apromotion. Practicing medicine in Miami was great froma medical and university standpoint, but I just didn’t feellike Miami was a good place to raise a family. My wifeand I were both from Pittsburgh and so, with a lot of fearand trepidation, we decided to move back. We movedback on September 17, 1990.You are very active with the American Society for AestheticPlastic Surgery. Does your work with that specialty societycompliment your involvement with ACMS?My involvement with ACMS allows me to bring amore open-minded approach to the specialty society. Inthe specialty society, we are sometimes blindsided byissues that just pertain to plastic surgery, whereas ACMSaddresses issues that encompass the whole spectrum ofmedicine. That perspective is very helpful for me whendealing with the specialty society and vice versa. Myinvolvement with ACMS and that of the specialtysocieties play off of each other. I have been privileged tobe a member of both organizations.Talk about the role you play with the Pittsburgh Steelersorganization.The Pittsburgh Steelers probably has one of the bestmedical staffs in the NFL. I have been a consultant forthem since 1993. I am not on the field every week likeDrs. (Joseph) Maroon or (James) Bradley, but there is anoccasion when my services are needed. The whole Steelerorganization and especially the training staff are superb.They have really put together a superb medical staff thatvirtually covers every specialty for the men, women andchildren within the Steeler organization.Tell our readers a little bit about your family.My beautiful wife Susan is a graphic artist. She hasdone a lot of wonderful things in the art world, inaddition to raising four children. My son Lee, who is 25,graduated from The Pennsylvlania State University (PSU)in 2006 and almost immediately began working for NFLFilms. He has already won three Emmys for his work.My daughters Kristin (22); Kimberly (20), and Kelly (18)are all currently students at PSU, where I first met myJanuary 2011 : Bulletinwife. When our youngest daughter Kelly entered PSU,she became the 48 th member of the family, between myside and my wife’s side, to attend Penn State.What are your interests or hobbies outside of medicine?I’ve always enjoyed music. In 2001 I made a consciousdecision to learn how to play the guitar. My friendFrank Cappelli, who had a children’s show several yearsago, said he would teach me how to play. Now I knowhow to play a little bit of mandolin, bass guitar and banjoas well.I am also part of a group called theMonongahela Duck Club Band. AfterFrank started teaching me how to playthe guitar, we started to play old BobSeger tunes. We found that there wasan audience out there for that type ofmusic. He is a very good entertainerand the group just came together withFrank and some other friends. We play at different eventslike the Saxonburg Summer Arts Festival and the UPMCShadyside talent show, which took place this past fall. It’sbeen fun. I also collect guitars and mandolins.It’s a great outlet. You can’t think about anything elsewhen you play because you are working a different part ofyour mind. I also do some artwork. I draw and that’s thesame thing. You have to shut off one part of your brainand use the other. My wife is a much better artist though.I definitely take a back seat to her when it comes to art,but both music and art are great outlets for me.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○Ms. Morton is a communications consultant. She can be reached atcmorton@acms.org.Dr. McCafferty and the other 2011ACMS officers will be recognized atthe ACMS Foundation Gala andcommunity awards ceremony onSaturday, March 19, 2011, at HeinzField. Look for more details aboutthe annual event in upcomingissues of the Bulletin (see page 24of this issue).37

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○SPECIAL REPORTMedical Records Reproduction FeesUnder 42 Pa.C.S. §§6152 and 6155 (relating tosubpoena of records and rights of patients), theSecretary of Health (secretary) is directed toadjust annually the amounts which may be charged by ahealth care facility or health care provider upon receipt ofa request or subpoena for production of medical charts orrecords. These charges apply to any request for a copy of amedical chart or record except as follows:(1) Flat fees (as listed in this notice) apply toamounts that may be charged by a health care facilityor health care provider when copying medicalcharges or records either for the purpose of supportingany claim or appeal under the Social Security Actor any federal or state financial needs based program,or for a district attorney.(2) An insurer shall not be required to pay forcopies of medical records required to validate medicalservices for which reimbursement is sought underan insurance contract, except as provided in: (a) theWorker’s Compensation Act (77 P.S. §§1—1041.1and 2501—2506) and the regulations promulgatedthereunder; (b) 75 Pa.C.S. Chapter 17 (relating tomotor vehicle financial responsibility law) and theregulations promulgated thereunder; or (c) a contractbetween an insurer and any other party.The charges listed in this notice do not apply to anX-ray film or any other portion of a medical record that isnot susceptible to photostatic reproduction.Under 42 Pa.C.S. §6152.1 (relating to limit oncharges), the secretary is directed to make a similaradjustment to the flat fee which may be charged by ahealth care facility or health care provider for the expenseof reproducing medical charts or records where therequest is: (1) for the purpose of supporting a claim orappeal under the Social Security Act or any federal or statefinancial needs based benefit program; or (2) made by adistrict attorney.The secretary is directed to base these adjustments onthe most recent changes in the Consumer Price Indexreported annually by the Bureau of Labor Statistics of theUnited States Department of Labor. For the annualMedical RecordsReproduction Fee Schedule for 20112001 HIPAARetrieval Fee ... $19.92 .............................. $0Pages 1-20 ......... $1.34/page ....... Cost to copy & mailPages 21-60 ........ $ .99/page ....... Cost to copy & mailPages 61+ .......... $ .33/page ....... Cost to copy & mailMicrofilm copies $ 1.97/page ....... Cost to copy & mail38 Bulletin : January 2011period of October 31, 2009, through October 31, 2010,the Consumer Price Index was 1.2 percent.Accordingly, the secretary provides notice that,effective January 1, 2011, the following fees may becharged by a health care facility or health care provider forproduction of records in response to subpoena or request:The Department of Health and Human Services hasstated that, under HIPAA, medical record copying feesfor patients may not include costs associated with searchingfor and retrieving the medical record. For a subpoena,attorney, or insurance company requests, you may chargethe fees, including the search and retrieval fee. To determineyour cost for copying and mailing medical recordsfor a patient request under HIPAA, you should considerthe following:• Salary and benefits of the person who does the copying.Include all steps of the process, i.e., verifying validity ofauthorization, pulling the chart, reviewing the record,removing the records, copying, preparation for mailing,re-assembling the chart, and re-filing the chart.• Cost of the supplies, i.e., paper, toner, envelopes, etc.• Cost of equipment, i.e., prorated lease or depreciationexpense.In addition to the amounts listed, charges may also beassessed for the actual cost of postage, shipping anddelivery of the requested records.Neither PA Law or HIPAA mandates that charges beassessed for copies of medical records. It merely sets themaximum fees that can be charged.

If a district attorney requests a medical record for anaction or proceeding, a flat fee of $19.92 may be charged.No independent or executive agency of the Commonwealthis required to pay any costs associated to medicalcharts or records unless required by law. At this time,Workers’ Compensation (utilization review) and Auto(peer review) pay $.12 per page, plus actual mailing costs(scope of release is limited to the treatment of the workrelated or auto injury). Attorney requests for Workers’Compensation and Auto treatment records are notsubject to the $.12 limitation.If the medical record is requested for the purpose ofsupporting a claim or appeal under the Social SecurityAct, a flat fee of $25.24 plus postage may be charged (theattorney should be able to supply a copy of the Appointmentof Representative from the Social Security Administration).Note: Some health insurance contracts may requirethe physician to forward patient records to anotherphysician within a network at no charge.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○The Pennsylvania Medical Society provided the information for thisSpecial Report. For more information, call (800) 228-7823.Know a Physician in Need?If you know aphysician who mightneed assistancewith an impairingcondition, pleasecontact thePhysicians’ HealthPrograms at thenumbers below.A Professional CorporationCertified Public Accountants"Specializing in Physician Practices Since 1978"Let us be the key to your future . . .412-281-1901www.3kcpa.comIncreasing Collection Ratiosis as easy as pie…All information isconfidential.Monday - Thursday — 7:30 a.m. to 5 p.m.(866) 747-2255 or (717) 558-7819Friday – emergencies only — 7:30 a.m. to 5 p.m.(717) 558-7817The Kell Group, on average, increases their physician’scollection ratio 10-12%, raising revenues by $10-12,000per every $100,000 of billing—that’s a lot more pie.No matter how you slice it, the Kell Group serves up ahealthy bottom line.Call the Kell Group today for an evaluation of yourmedical billing process, 412-381-5160.777 East Park Drive • P.O. Box 8820 • Harrisburg, PA 17105-8820www.kellgroup.comJanuary 2011 : Bulletin39

ACMS BOARD OF DIRECTORSThe Allegheny County MedicalSociety Board of Directors met onOctober 12, 2010. Board ChairDouglas Clough, MD, called themeeting to order at 6 p.m.Dr. Clough introduced guestsfrom the American HeartAssociation who reviewed theMission Life Line Program toimprove response time to heartattacks in southwestern Pennsylvania.The program’s mission is to save livesby closing gaps in the system of ST-Elevation Myocardial Infarction(STEMI) care, requiring the participationof physicians, nurses, emergencymedical service providers andhospital teams. The ACMS Board ofDirectors voted to endorse theMission Life Line Program and tosupport communications to physiciansconcerning the project.Dr. Cloughintroduced Dr.Carl Sirio, trusteeof the AmericanMedical Association(AMA), whoprovided anupdate on currentissues. Dr. SirioDr. Siriodiscussed the status on the campaignto prevent mandated cuts to theMedicare fee schedule and to revisethe Sustained Growth Rate (SGR)Medicare payment formula. He alsodiscussed the AMA’s participation inthe ongoing regulatory framework ofthe national health care reformlegislation. He thanked the board ofdirectors for supporting his campaignfor the AMA board and pledged toreport to them periodically and torespond to individual questions andcomments sent directly to him.Dr. John Delaney reported onthe Executive Committee’s Septem-ber 8 meeting. The committeerecommended the board approve thenomination of Bruce A. MacLeod,MD, both as PAMPAC districttrustee in 2010 to succeed Dr. AmeliaParé and for vice president of thePAMED in 2011. The board approvedthe nominations.Nadine Popovich and DebbieKocak, who serve as ACMS andPAMED membership field staffrepresentatives, reported on theirinitial meetings with ACMS boardmembers and their first visits toseveral group practices and practiceadministrators. They requested theboard’s assistance in identifyingindividuals and group practices thatshould be contacted concerning thebenefits of society membership.Drs. Lawrence John and AnthonySpinola reported on the activities ofthe Primary Care Coalition (PCC),reviewing minutes from the group’sAugust 4 meeting. They noted thatthe PCC would review a draft of thewhite paper on primary care beingdeveloped by the Institute of Politicsof the University of Pittsburgh andreport back to the board.Dr. Christopher Daly, chair ofthe Nominating Committee, presentedthe 2011 slate of candidatesfor office; nominees have agreed torun for election. He also noted thatthe election would be conducted bymailed ballot at the end of Octoberin accordance with the bylaws. TheBoard of Directors approved the slateof candidates as presented.In the absence of Finance CommitteeChair Alan Yeasted, MD, Dr.Rajiv Varma presented thecommittee’s report containing the2011 proposed budget, noting thatdues would remain at the currentlevel and that a modest year-endsurplus is projected. The Board ofDirectors adopted the proposed 2011budget as presented.Dr. Kevin Garrent, chair, and Dr.Amelia Paré, vice chair, ACMSDelegation to the PAMED House ofDelegates, to be held October 22-24in Hershey, PA, noted the following:• Dr. Ralph Schmeltz will be installedas PAMED president;• Dr. Daniel R. Lattanzi will receivethe PAMED Physician Award forInternational Voluntary Service;• ACMS will receive the R. WilliamAlexander Award for PoliticalAdvocacy from PAMPAC;• ACMS will also be recognized forreceipt of the 2010 PAMED Grantfor Healthy Living in MinorityCommunities for a collaborativewellness program with the GatewayMedical Society targeting theAfrican-American community inAllegheny County.Dr. John Delaney reported on thestatus of planning for the 2011ACMS Foundation Gala to be heldon March 19, 2011, at Heinz Field.He requested the support of boardmembers in securing auction items,attendance at the event, sponsorshipsand ads in the program. He alsonoted that information regarding thegala can be found on the ACMSwebsite: www.acmsgala.com.Dr. Delaney next reported on hisparticipation in the Gateway MedicalSociety annual conference and onGateway’s anticipated collaborationon the PAMED Wellness Grant.Kathleen Reshmi, ACMS Alliancepresident, expressed the alliance’sappreciation to the Board of Directorsfor its support of the group’s85th jubilee.In a written report, Dr. ScottMiller, ACMS Bulletin medicaleditor, asked for board approval ofterms for associate editors :40 Bulletin : January 2011

BOARD OF DIRECTORS• Timothy Lesaca, MD, (1st term),• Frank Vertosick, MD (2nd term),• Melinda Campopiano, MD (3rdterm),• Deval Paranjpe, MD (3rd term),• Stuart Tauberg, MD (3rd term).The board approved the appointments.Zeyad Schwen, medical studentrepresentative, reported on medicalstudent activities, noting that theACMS and the University of PittsburghSchool of Medicine wouldcollaborate on a Medical StudentCareer Night on November 16 at theHerberman Conference Center atUPMC Shadyside. He encouragedACMS board members to participateas faculty members, noting that morethan 40 faculty members had signedon and that student participation isexpected to exceed 100 students.A. J. Harper, Hospital Council ofWestern Pennsylvania president,reported on activity concerning thehealth care reform legislation, notingthe contentiousness of the debate inthe upcoming election. He also notedthe impact of the hospital assessmentsto Pennsylvania resulting inadditional medical assistance payments,Medicare Wage Index andongoing negotiations with respect topayment for observation status withcommercial insurance carriers.The meeting ended at 8:20 p.m.○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○○This is a summary report. A full report isavailable by calling the ACMS office at (412)321-5030. Board meetings are open tomembers. If you wish to attend, contact thesociety to receive a schedule and meeting agenda.The next regular Board of Directors meeting isMonday, February 15, 2011.Member BenefitSavings onAuto RentalsYou’re entitled to receive themedical society’s corporate rateon automobile rentals atEnterprise rent-a-car, foreverything from compact carsto luxury cars, trucks andpassenger vans.Simply call any Enterprise rent-acaroffice and ask for details. UseAllegheny County MedicalSociety Customer I.D. #40A7256.ALLEGHENY COUNTYMEDICAL SOCIETYLeadership and Advocacyfor Patients and PhysiciansACMS MembersNew Partner?January 2011 : BulletinNew Address?Retiring?Congratulatory Message?Announce it here...Professional announcement advertisements inthe Bulletin are available to ACMS members atour lowest prices.Contact Linda Smith at 412-321-5030for more information.Please visit our website(www.acms.org/express) toshare your thoughts in anumber of ways:√Article Ideas√Favorite Websites√Letter to EditorPlease let us hear from you!41

CLASSIFIEDSFOR RENTMEDICAL OFFICE, prime location,Moon Township, 960 BeaverGrade Road. Approximately2,000 sq. ft., private street levelparking, two entrances. Includesthree exam rooms, waiting room,reception room, physician’s office,laboratory, kitchen, and tworestrooms; all furnished, ready tomove in. Some utilities included.Call 412-922-3333.FOR SUBLEASEOFFICE SPACE in ShadysideMedical Building for sublet. 1-3days per week. Three exam rooms+ front office. Telephone: 412-681-8720.HELP WANTEDPHYSICIAN with active/or canactivate PA license, any specialty.Work 4-16 hours/monthly. Malpracticeinsurance provided. Idealfor retired physician. PITTS-BURGH FAMILY PRACTICE.412-734-1100.PHYSICIAN with active license,any specialty, for two to three halfdaysper month, malpractice insuranceprovided. 412-855-9032.NURSE/PA WANTED. PittsburghCardiovascular Institute ishiring a full-time CRNP and/orPhysician Assistant to provide patientcare services to cardiology andinternal medicine patients includingassessing and managing patientsin the outpatient and/or inpatientenvironment, by followingestablished standards and practices.Located in the Monroeville area ofPittsburgh, Pittsburgh CardiovascularInstitute is considered one ofthe foremost outpatient focusedfacilities. Responsibilities: -Assesspatient health status. -Determineappropriate diagnostic and therapeuticprocedures and developstreatment options. -Provide acuteand chronic patient care includingtaking histories, doing physicals,monitoring therapies, giving injectionsand medications. -Triage patientcalls and evaluates patientproblems. Basic Qualifications:PA: -A graduate of a Physician Assistantprogram accredited by theAccreditation Review Commissionon Education for the PhysicianAssistant (ARC-PA) is required.-BS or MS candidate is preferred.-Experience as a physician assistantand/or experience in a clinical settingis preferred. -Cardiology and/or Internal Medicine experiencepreferred. CRNP: -The successfulcompletion of an approved NursePractitioner program is required.-BSN, MSN is preferred. -Professionalnursing experience and/ornurse practitioner experience ispreferred. -Cardiology and/or InternalMedicine experience preferred.Licensure/Certifications:PA: -A current state PA license, certifiedby the National Commissionon Certification of Physician Assistants(NCCPA) is required. -Acurrent CPR certification is required.CRNP: -A current stateRN license and CRNP certificationis required. -A current CPR certificationis required Submit resumesand three references online to:josephineoria@mhs-pci.com or faxto (412) 373-6861.Looking for one place to getanswers to your questions aboutgovernment benefits and services?USA.gov has you covered. It’s yourofficial source for governmentinformation.The medical society appreciatesand depends on its advertisers.Please remember to tell themyou saw their ad in the Bulletin.Free classified ad on the world wide web!www.acms.orgPlace a classified advertisement in the BULLETINand your ad will also appear on the AlleghenyCounty Medical Society’s website for the durationof the advertisement at NO ADDITIONAL COST. Checkout your ad at http://www.acms.org. For moreinformation, call Linda Smith at (412) 321-5030.42 Bulletin : January 2011

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