Annual Sports Screening for Middle & High School Students

Tuesday, June 11,  2013

Celebrating 36 years of Partnership with the Yakima School District!

Dr. Ray Snyder, Program Chairman

Franklin Middle School Gymnasium

Middle School students 6 – 7 PM

High School students 7 – 8 PM

FREE Game Passes to ALL DAVIS & IKE Games

FREE Pizza & Pop for Screeners!

MDs   DOs   PAs   Nurses   Residents   PTs   MAs   PNWU Students

Volunteers Needed!

Call 575-5550 or email char@ycms.org

Check-in at 5:30

RHEUMATOLOGY FOR PRIMARY CARE

Sponsored by

Yakima County Medical Society

Wednesday, March 20, 2013
1:00 – 5:15PM
Cadwell Student Center, Pacific Northwest University

Dr. Carlin’s Presentation PowerPoints:
Rheumatoid Arthritis Yakima
2013 Early Arthritis ppt
Lupus 2013

Speaker: Jeffrey S. Carlin, MD                  

RHEUMATOLOGY UPDATE – MAKING THE DIAGNOSIS  -  RHEUMATOID ARTHRITIS . . . WHAT NOW?  - LUPUS

Faculty, Planning or Approval Committee Member Disclosure:

Dr. Jeffrey S. Carlin, MD is the Virginia Mason Rheumatology Section Head Clinical Associate Professor in the Division of Rheumatology at the University of Washington.   Dr. Carlin has indicated no relevant commercial affiliations and will not discuss off-label use of a product or any investigational products (non-FDA approved).

Speaker: Galen W. Goertzen, PharmD, BCACP

Faculty, Planning or Approval Committee Member Disclosure:

Mr. Goertzen is the Specialty Pharmacy Coordinator for Network Services Division-Group Health Cooperative.  Mr. Goertzen has indicated no relevant commercial affiliations and will not discuss off-label use of a product or any investigational products (non-FDA approved).

PLANNING COMMITTEE

James P. Zingerman, MD is a Family Physician practicing at Selah Family Medicine Clinic.  Dr. Zingerman has indicated no relevant commercial affiliations with proprietary entities producing health care goods or services.

Katina R. Rue, DO is a Family Physician practicing at Family Medicine of Yakima.  Dr. Rue has indicated no relevant commercial affiliations with proprietary entities producing health care goods or services.

Jeffrey S. Kaplan, MD is a Family Physician practicing at Family Medicine of Yakima.  Dr. Kaplan has indicated no relevant commercial affiliations with proprietary entities producing health care goods or services.

Charlene Upton, Executive Director, Continuing Medical Education Administrator, Yakima County Medical Society.  Ms. Upton has indicated no commercial affiliations with proprietary entities producing health care goods or services.

                                                       Accreditation Statement:
The Yakima County Medical Society is accredited by the Washington State Medical Association CME
Accreditation Committee to sponsor continuing medical education for physicians.

The Yakima County Medical Society designates this live activity for a maximum for a maximum of 4.00 hours in Category 1 to satisfy the re-licensure requirements of the Washington State Medical Quality Assurance Commission.

The Yakima County Medical Society designates this live activity for a maximum of 4 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Yakima County Medical Society

BRINGING PHYSICIANS TOGETHER

“Physicians Supporting Physicians – One Voice for All Physicians”

Our Mission

Support You, Your Practice and the Quality of Care You Provide to Your Patients

ADVOCACY ~  LEADERSHIP ~  MEMBER PROGRAMS ~ EDUCATIONAL PROGRAM

•  YCMS members hold positions of leadership on the WSMA Board of Trustees and Committees 

• (YCMS nominates members to serve on the  WSMA Board of Trustees and Committees)

•  Provide Advertising opportunities for Members on YCMS Website and Quarterly Newsletter, Meeting Sponsorships

• Advocate locally, regionally and nationally on various issues to support physicians including SGR, Medical Interpreter
  Services, Candidate Interviews, Medical Staff By-Laws

• Partner in the county-wide CR Blitz Program providing Financial Management

• Founding partner of the Regional Continuing Medical Education Coalition: Central WA Family
  Medicine, Pacific Northwest University of Health Sciences, Yakima County Health District, Yakima
  Regional Medical and Cardiac Center, Yakima Valley Memorial Hospital

• Provide recommendations of local physicians for scholarships to the WSMA Annual Leadership
  Development Conference

• YCMS members hold positions on the WSMA Judicial Council through recommendations by the YCMS Board of Trustees

• Offer discounted Category I, Continuing Medical Education Programs to Members

•  Engage professional speakers as well as WSMA Legal Council, Elected Officials, Washington Policy Center, and others to educate on issues vital to your profession

The WSMA/UW Physician Leadership Course March 8 – May 10, 2013

The 40-hour course that employs a hybrid distance-learning model combining online and face-to-face sessions. It is a cornerstone for developing physician leadership – whether you’re about to move into a formal leadership track at your clinic or hospital, want to prepare yourself for the possibility, or simply want to understand the techniques and principles being employed in your practice setting.

The spring 2013 course schedule includes only three in-person class days: Friday, March 8, Saturday, March 9, and Friday, May 10. All three will be held at the Riverpoint Campus in Spokane. Between those dates the course will be conducted online.

The deadline for physicians to apply is January 1, 2013. We’ve had physicians from out-of-state take the course, but we would like to hold the maximum number of the 30 available slots for Washington physicians. Non-WSMA members pay a higher tuition rate.

Click on http://www.wsma.org/leadership-course for more information or contact Jennifer Hanscom, our Executive Director/COO, at jen@wsma.org.

2012 CARDIAC ISSUES CONFERENCE

Wednesday, October 17, 2012

Registration Opens at 7:30

Sessions Begin at 8:15 am – 5:00 pm

Red Lion Hotel, Yakima Center (607 E. Yakima Avenue)

FACULTY

Christopher L. Fellows, MD, FACC, FHRS
     Cardiologist, Clinic Cardiac Electrophysiology, Virginia Mason Hospital
James N. Nania, MD
     EMS Medical Director, Spokane County
Neil L. Barg, MD
     Infectious Diseases, Yakima Chest Clinic
Adrienne Bennett, MD
     Hospitalist, Yakima Valley Memorial Hospital
Bharat Keshavaprasad, MD
     Cardiologist, Yakima Heart Center, Inc.
R. Thomas McLaughlin, Jr., MD, FACC
     Cardiologist, Yakima Heart Center, Inc.
Douglass A. Morrison, MD, PhD, FACC
     Interventional Cardiologist, Yakima Heart Center, Inc.
Robert A. Ortiz, MD, FACC
     Cardiovascular Disease Specialist, Yakima Heart Center, Inc.
Laurie Oswalt, Chaplin
     Yakima Valley Memorial Hospital
Dao Gia Pham, MD
     Cardiac Electrophysiology, Yakima Heart Center, Inc.
Victor V. Sharpe, III, MD
     Internal Medicine, Yakima Heart Center, Inc.
Mark Silverstein, MD
     Hospitalist, Yakima Regional Medical and Cardiac Center
Angela S. Stewart, PharmD, BCPS
     Pharmacist, Yakima Valley Memorial Hospital

2012 Cardiac Issues Brochure 

Click here for Online Registration 

Thank You to Our Gold Level Partner

For more information contact YCMS at 575-5550 or email char@ycms.org

MONEY, METALS, MINING & THE ECONOMY

Tuesday, March 20th Membership Meeting

Clarion Hotel & Conference Center – 1507 N 1st Street

6PM Social and No-Host Bar

7PM Dinner & Program

Enter  the Drawing for a

Pan American 1 Troy ounce Silver Round Minted from .999 fine silver!

RSVP by the Deadline – March 16th –

AND must be present to be eligible for the Drawing!

Special Guest Speaker

David Morgan

Big Picture Macroeconomist

David is a dynamic, much-in-demand speaker all over the globe.

David’s educational mission also makes him a prolific author having penned

“Get the Skinny on Silver Investing”. 

David has appeared on CNBC, Fox Business, and BNN in Canada.  He has been

interviewed by The Wall Street Journal, Futures Magazine, The Gold Report

and numerous other publications.  Educating people about honest money

and the benefits of a sound financial system.

YCMS Members and their Guests $30  ~  Non-Members $50

 Please Make checks to YCMS

“Physicians Supporting Physicians ~ One Voice for All Physicians”

New WPC Report Looks at Looming Doctor Shortage

The Looming Doctor Shortage, authored by WPC health care policy analyst Dr. Roger Stark, looks at how the U.S. in general and Washington state in particular are facing a severe doctor shortage in the next 10 to 15 years. Population growth combined with the retiring baby boomer generation and 30 million newly insured people via federal health care reform will further strain our already stretched provider network. Central planning via government price controls, a third-party payment system, and regulations on the number of medical schools and number of graduates has caused this problem. Read our solutions in The Looming Doctor Shortage here

Article submitted by Kay Funk, MD

For student athletes who participate in high school and middle school sports, the Washington Interscholastic Activities Association requires a preparticipation physical evaluation. This standardized exam requires a good cardiopulmonary examination, a good musculoskeletal examination, and an accurate history certified by the responsible parent. Members of Yakima County Medical Society have volunteered to provide low cost examinations for many years. 

Dr. Ray Snyder, grew up in Yakima, and has been in the organizer of the YCMS/Yakima School District sports physicals since 1996.”I started as a volunteer when I came back to town in 1994; that’s when the screening exams were done at Davis. We used a  multi-station format and we had many more student athletes at that time. I think that the maximum was around 1200; it was crazy in those days.”

“The Davis facility was challenging, particularly because it had no air conditioning and the exams were usually done during the summer.  So when Franklin (Middle School) had a nice new facility, we inquired about the possibility of using that, taking advantage of the air conditioning, and the fact that it was all on one floor. Franklin became our facility in 2001.”

“There were some changes besides the facility.  We didn’t have enough manpower for all of the previous stations and still get out of there before 11 o’clock. So, when I took over, I tried to make the stations a more efficient use of provider time. And I remember, to everyone’s joy, we cancelled the hernia/GU check.”

“It wasn’t really a necessity in a sports physical. We did pick up a few varicoceles and undescended testicles, but those do not preclude sports participation. An undescended testicle or other unilateral organ indicates extra protection, but does not preclude participation.”

The number of student athletes decreased when the WIAA requirement was changed to every other year instead of every year. Students entering grades 7 through 12 participate. Dr. Snyder says, “We work with the Yakima School District and include Union Gap Middle School. The middle school students are asked to come earlier, and we do this to make the experience more family friendly.”  In recent years more parents accompany their students, which is always welcome.

“The most important function of the preparticipation sports physical is detecting those orthopedic and medical conditions that may preclude safe participation, practice, or competition. There might also be conditions that need further evaluation, or result in modification of the sport, or modification of the equipment, or use of more protective equipment. ”

“And in our community, one of the most important services that we provide is that many of the students would not be able to participate in after school athletic activities without this inexpensive, but quality, sports physical that meets the WIAA criteria.  If we did not have this event, they might be doing much less healthy things after school.  And I feel that’s the best service that we provide.  Many of those children are underserved, don’t have primary care doctors, and can’t afford to go to a medical clinic.” 

According to the Preparticipation Physical Evaluation Consensus Statement Monograph, “the cornerstone of the preparticipation evaluation is a medical history.  A complete history will identify 75% of problems affecting athletes… to increase the information obtained, the athlete and parent should complete the history form together before the examination. The parents should sign the history form. Ideally, the physician reviews it with the athlete before the physical exam.”

Dr. Snyder has closely followed recent controversy in the management of concussion in student athletes. “The culture of recognition and management of concussion is slowly changing.  It is no longer a coach’s decision or a parent’s decision; it has become a medical decision, demanded by the Zackery Lystedt Law.  An athlete suspected of having a concussion must be evaluated not just by a health care provider; it is recommended that the health care provider be trained in the evaluation and management of concussion. And the student must be released by that provider before he or she can return to athletic participation.  That has taken the pressure off of the coaches and parents.”

The understanding of cardiac anomalies associated with increased risk of cardiac sudden death with physical exertion has also evolved in recent years. However, these congenital anomalies are still very difficult to detect.  In office-based exams, screening electrocardiograms are more frequently recommended. At the YCMS sports physicals, stethoscope exam is used for detection of abnormal heart sounds, which may lead to diagnosis of hypertrophic cardiomyopathy, which is the most common cause of sudden death in athletes.

But Dr. Snyder relates, “The best tool to screen for athletes at risk for cardiac sudden death is the history; the personal and family history.  History of dizziness or syncope, or palpitations with exercise.” For the athlete’s safety and for medical-legal reasons, it is imperative that a parent validates the history and make sure that it’s accurate; that is why we do not accept a questionnaire that is not signed by the parent(s). 

Overuse injuries are the most common injury in sports, and can be prevented with preseason exercise conditioning program, which is recommended for 6-8 weeks prior to the first practice.  Even some of the devastating injuries, such as ACL tear, may be prevented with some preseason conditioning training.  Inadequately rehabilitated injuries can also be picked up on the preparticipation screening exam. 

Asthma, including exercise asthma, requires special management in the athlete.  Dr. Snyder says, “It is so unfortunate that, in this day and age when we have such great asthma treatment, someone would have to limit, or not enjoy their sport because of uncontrolled asthma.  The pulmonary exam may detect asthma and really help that athlete.  I am still angry that I wasn’t treated adequately [during my high school sports]; once I had my Proventil inhaler I was a new person.”

“Hypertension is pretty common in this stimulating environment, and requires further evaluation.  The screening blood pressure check is a sitting unilateral blood pressure measurement.  If the result is outside the standard parameters, the athlete is kept supine for 10 minutes and rechecked.” 

“We have wonderful volunteers from nursing, physical therapy, primary care doctors and several specialists, such as cardiology. We have Physician Assistants, Nurse Practitioners, certified Athletic Trainers (ATLs) from the schools, and student Athletic Trainers who help with the height and weight measurements. The Family Medicine residents have participated, and that is a great avenue for students who did not have primary care doctors to be introduced to primary care.  The Osteopathic medical students help with the blood pressure stations, and observe and learn, because they do not yet have the credentials required by WIAA.”

The 2011 Sports Screening on June 6^th, 6PM at Franklin Middle School provided screening for over 175 students. Our website now allows volunteers to sign up by email. Contact Charlene Upton at char@ycms.org to register. Please sign up early. Your participation is critical!

References for Physicians and Volunteers:

Preparticipation Physical Evaluation, 4th Edition

 Consensus statement of the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine

List Price: $46.95; $41.82 at Amazon

The Preparticipation Sports Examination In Children And Adolescents 
http://www.uptodate.com/contents/the-preparticipation-sports-examination-in-children-and-adolescents

Sudden Death in Athletes
http://www.suddendeathathletes.org/about_sdia.asp

Sports Concussion – Protecting Youth Athletes From Concussions
http://www.sportsconcussions.org

The Sports Trauma and Overuse Prevention (STOP)
www.stopsportsinjuries.org

June 11, 2011
8AM to 5PM
Red Lion Hotel Yakima Center, 607 E. Yakima Avenue

Managing Pain in Compliance with Bill 2876:
Protecting Your Patients and Your Practice

On March 25, 2010, Governor signed into law, WA State Bill 2876, requiring healthcare boards/commissions who oversee WA prescribers to develop and adopt rules regarding pain management by June 20, 2011.  These rules pertain to physicians, physician assistants, osteopaths, dentists, podiatrists and nurse practitioners.  The rules address assessment, therapy and monitoring of patients with chronic non-cancer pain and particularly emphasize when a primary caregiver should seek consultation from a pain specialist and the definition of such a specialists.  Inasmuch as pain is the most common presenting symptom for patients seeking medical care it is not surprising that both the law and the subsequent rules have elicited widespread interest and controversy.  This conference will present the “whys, whats and wherefores” of Bill 2876.

This conference is planned for WA state healthcare providers, physicians, dentists, podiatrists, osteopaths, nurse practitioners, and physician assistants.

Conference Brochure -  2011 Brochure Pain Management   

For information contact YCMS at (509) 575-5550 or email char@ycms.org.

Now, for a short time only, get patches and nicotine gum FREE while supplies last.  Call the WA Tobacco Quitline today at 1-800-QUIT-NOW or 1-877-2NO-FUME. Quitline coaches are waiting for their call.  Or visit http://www.quitline.com/ 

Rays of Hope

Accountable Care Organizations – Highlights of Pierce County’s 525 doctor ACO (the 16-year-old physician-centered Northwest Physicians Network) were spelled out at YCMS’s March 15, 2011 dinner meeting by NWPN’s CEO, Rick MacCornack.  A PhD medical epidemiologist with over 30 years of experience, including working for a large hospital and for Group Health, MacCornack first explained NWPN’s long history of serving 146 independent small primary care groups (average size 2.5 docs), and adequate specialists for managed care contracts.  Now the last two years have been their “virtual ACO” focusing on “shared patient centerd culture”.  When they report specific performance measures for Medicare Advantage and manage Medicaid patient panels, NWPN beats the vertically integrated systems in the Puget Sound.

Dr. MacCornack praised Yakima-grown ChartConnect, and his network uses it for their web-based coordination of referrals and care.  Over and over he stressed how “culture” of communication, cooperation, and caring was key to a successful ACO like theirs.  “Use technology to support culture, not the other way around”, to improve patient care across the full spectrum of clinical treatment.  An EMR is not enough.  A culture of competitive service, not technology, motivates improvement.  In comparison, as a Group Health patient for over 25 years he states Group Health is “a very broken system”.

Currently “payment incentives are upside down” for where ACOs need to go.  He predicts Stark laws will have to be changed also to allow ACOs to exist.  In the future, overuse of tests and procedures will neither benefit doctors or hospitals.  Active physician leadership has been crucial ingredient for NWPN, driving chronic disease registries and care teams, along with low cost interfacing of all these small independent practices.  MacCornack ball parked a per-physician yearly cost of only $600 for running the entire NWPN network.  The bigger cost is time and commitment by the physicians.

Currently their tangible accountability to each other includes “appropriate clinical info” with each referral, acknowledging referrals online within 2 hours, scheduling is finalized within 48 hours, all consults or diagnostic reports are returned within 3 days of a visit, and they all actively pursued “dropped balls” (example, finding out why a patient didn’t go to a consultant).  The result: high satisfaction for both patients and caregivers.

This Pierce County network is currently working on a Premera performance contact and will start expanding to Spokane docs later this year to be part of the network.  MacCornack gave an enthusiastic yes to whether the NWPN “virtual ACO” will become statewide, including our valley.  He was very optimistic for physician-led patient-centered coordination to be extremely competitive in any environment.

YCMS Works Closely With Local Hospitals and Medical Staff Officers to Update New Medical Staff Bylaws to Comply With Joint Commission Standard MS.01.01.01

YCMS leadership was at the forefront working to ensure physicians’ rights were fairly represented as we move forward in the development of the new Medical Staff Bylaws. YCMS leadership held several meetings over the past two years with known experts, WSMA legal professionals, local hospital administrators, and medical staff officers, discussing the changes needed to current medical staff bylaws to conform to the new Joint Commission Standards; and to ensure the physicians’ relationship with the governing body of hospitals has a fair and positive outcome.

Medical Staff Bylaws – Source of Friction? Common Ground?

Too often, proposed medical staff bylaws are viewed with suspicion and consternation. Too often, the views appear warranted. It doesn’t have to be that way.  We can help with our updated Model Medical Staff Bylaws which include all new Joint Commission MS 01.01.01 Standards. The update includes language that will assist medical staffs as they work to comply with the new Joint Commission Standard MS.01.01.01 (previously known as MS 1.20).  The primary focus: to better define the relationship between the medical staff and governing body of hospitals. The principle: making the medical staff/hospital governing body relationship better functioning and positive.

The Joint Commission rules strike a new balance between the medical staff and governing body with a new delineation of what detail must be included in the Medical Staff Bylaws and what may be relegated to rules, regulations, and other policy documents. For example, the new rules state that twenty-five of the Joint Commission’s Elements of Performance must be in the bylaws.  The rule then goes on to state that the “associated details” for those Elements of Performance may reside in the medical staff bylaws, rules and regulations, or polices. The medical staff is charged with determining what is meant by “associated details.”

The WSMA Model Medical Staff Bylaws can assist medical staffs as they work through these decision points. For more information on the model bylaws and how the WSMA can help, contact:

Tim Layton, WSMA Director of Legal Affairs at tim@wsma.org
or Denny Maher, WSMA Associate Director at dpm@wsma.org