I recently attended the UPMC-sponsored first annual all-day Physician Wellness Seminar, and I wanted to share the information the conference provided, along with how it has impacted my individual approach to my own well-being as well as that of my colleagues and other friends and family I interact with on a daily basis.
Over the past 10 years, there has been a continuous rise in the utilization and cost of echocardiograms, the most widely used diagnostic imaging test for heart disease. Since 2009, utilization has doubled. As a result, concerns were raised about overutilization or misuse of this procedure, and Appropriate Use criteria were subsequently developed by leading cardiologists. Utilization of echocardiography is especially high in the Pittsburgh region, according to Highmark, and not all physicians are complying with the Appropriate Use guidelines. On Jan. 1, 2019, Highmark announced the Advanced Imaging and Cardiology Services Program, which requires prior authorization for specific outpatient, non-emergent, elective cardiology services, including transthoracic echocardiograms and nuclear imaging. Providers will be required to obtain prior authorization in order to reduce the overutilization taking place in this market. Insurers want to be certain that echocardiograms are medically necessary, and prior authorization validates this.
Quality of care and efficiency are elusive concepts that third-party payors have been struggling to measure as they attempt to transition away from traditional fee-for-service reimbursement models. One recent local approach may impact both primary care physicians (PCPs) and specialists depending on how the payor uses the data it has gathered.
Sirens, unpredictably wailing at all hours, are part of living near a busy hospital. Undergraduate students residing in Oakland complain of this noise from ambulances racing down Fifth Avenue. Few know of the confluence of sociopolitical events and individuals driven to make a change in the 1960s to create what would become the modern-day ambulance service, placing Pittsburgh at the forefront of emergency medicine. Recently, this legacy was tested during the shooting at the Tree of Life Synagogue, where the emergency medical system, partially pioneered in Pittsburgh, was credited with saving lives.
Age-related macular degeneration (AMD) is a very common condition that can result in profound central vision loss. As the name implies, AMD affects older individuals typically over the age of 50 and is a leading cause of central vision loss in the elderly. AMD is divided into two major categories: non-neovascular (dry) and neovascular (wet). Approximately 80 percent of total AMD cases are dry; however, wet disease accounts for roughly 90 percent of severe central vision loss in patients with AMD. Therefore, it is essential to promptly diagnose and treat wet AMD before scar tissue forms to avoid permanent vision loss. I am often asked by patients, “Which form of AMD is worse, wet or dry?” To answer this question, it is more appropriate to think about AMD in terms of stages: early, intermediate and late (advanced), as opposed to simply dry or wet. The disease starts in the dry form, and remains dry through the early and intermediate stages. Late stages can be either advanced dry or wet, both of which can cause significant vision loss. However, progression of dry AMD is often insidious, whereas wet AMD can present with sudden central vision loss.
Hepatitis C at 30: Targeted efforts to increase awareness and facilitate treatment of those most impacted
Hepatitis C has reached a high level of awareness among the public in the past several years. It is hard to imagine that only 30 years ago this year, the virus was first identified and the name “non-A, non-B hepatitis” was replaced with “hepatitis C.”
I’m sitting alone at a gate at the Detroit airport as I write this, on the way to Shanghai for an educational adventure. I’ve been flying internationally since before I could remember flying at all. My first flight was at the tender age of 3 months, and I started flying alone overseas (shepherded by flight attendants as an unaccompanied minor) around the age of 5 or 6. This raises a few eyebrows when told today, but you have to take into account that it was a different era. Pan Am still ruled the skies; pilots and flight attendants lead glamorous lives, and the Internet had not yet corralled the wild unknown romance of the far-flung corners of the Earth into the tidy little package that we know today. As a 6-year-old child, life was already a grand adventure. To travel alone as a 6-year-old child made that adventure the stuff of legend.
The space between
Deval (Reshma) Paranjpe, MD, FACS
Kiss me and make me better
John Kokales, MD
Perspective ........................... 70
What’s in a name and other first
Andrea G. Witlin, DO, PhD
Perspective ........................... 72
Age-related macular degeneration in 2019
Jared Knickelbein, MD, PhD
As part of the 2019 Medicare annual inpatient prospective payment system (PPS) fee schedule update, CMS has added a “rule” requiring hospitals to publish a list of standard charges beginning January 2019. CMS announced this initiative as follows:
Dr. Towers was introduced to the medical profession at a young age. Her father passed away when she was 14 years old, and the physicians and nurses that took care of him when he was ill had a lasting impact on her.
After completing an engineering degree at Cornell University, Dr. Towers entered the University of Connecticut, where she earned her medical degree. Her interest in internal medicine and geriatrics stemmed from her childhood, growing up around a lot of older adults as a result of her grandmother, aunt and uncle each having personal care facilities in their own homes. “I enjoyed hearing their stories and was interested in their medical issues,” Dr. Towers said. “It made sense to pursue internal medicine and transition into geriatrics.” She also was influenced by several professors of geriatrics during her medical training. They became more like mentors and helped to steer Dr. Towers toward the specialty of geriatric medicine.
As a medical student, Dr. Towers had the opportunity to travel to Sri Lanka for six weeks, which was a memorable and eye-opening experience. Describing it as very primitive and observing undesirable care of the elderly, Dr. Towers recalls seeing patients with rabies, tuberculosis and other diseases that were not prominent in the states. The experience was life-changing, and she would encourage all medical students to participate in an overseas mission trip if the opportunity presents itself.
Dr. Towers has been on the faculty at the University of Pittsburgh since 1992 and is currently an associate professor of Medicine and Psychiatry in the Division of Geriatric Medicine. Her prior roles include medical director, Primary Care, at Western Psychiatric Institute and Clinic; vice chair of Quality Improvement and Patient Safety for the Department of Medicine; medical director of UPMC Health Information Management; and medical director of UPMC Home Health. She also served as president, Medical Staff, UPMC Presbyterian.
As medical director of UPMC Health Information Management for nearly seven years, Dr. Towers oversaw medical records at every UPMC hospital. The position required her to attend all the hospitals’ medical staff meetings, which enabled her to meet physicians throughout the health system and learn about the issues at each hospital. “Fulfilling that position made me aware of the need for physicians to communicate with each other and to be connected. We shared a lot of the same issues, and a lot of the same solutions could be applied at each hospital.”
During her tenure, the department developed two computer-assisted coding (CAC) tools that became quite successful. In 2013, Dr. Towers was invited to join the staff at UPMC Enterprises, which is dedicated to technology development for medical providers and insurance companies. She currently serves as senior clinical advisor and director of Risk Adjustment.
“I have been very fortunate to work with several of the start-up companies that UPMC has supported or initiated,” Dr. Towers said. “My primary focus is with a company called Health Fidelity. It is dedicated to helping providers and health plans succeed in utilizing new value-based models of care.” Dr. Towers welcomes individuals who have innovative ideas to improve healthcare to reach out to her.
In addition to her position at UPMC Enterprises and traveling throughout the country to educate providers about value-based models of care, Dr. Towers still sees patients at Benedum Geriatric Center at Montefiore Hospital. “I told them [UPMC Enterprises] that I could not talk the talk if I could not walk the walk,” describing her desire and need to stay connected to patient care.
Staying connected to patient care is one reason why Dr. Towers thinks active membership within the medical society is so important for physicians. “Right now, physicians feel like their authority has been removed in terms of provision of care or oversight of care for their patients,” she said. “Therefore, we need to be united in our efforts to retain that role as the leader in our patients’ care. It is important for us to keep our position at the table as the patient advocate.”
As ACMS president, Dr. Towers’ vision is one of unity, inclusion and support. This year is the first year where more than 50 percent of medical school enrollees are women, and Dr. Towers believes more work still needs to be done to support women who want to pursue medicine as a career, balanced with having a family.
Physician wellness and support of those experiencing burnout also are issues that she would like to address during her presidency. “Due to EMR, many things have been placed in the physician’s lap. We need to become more efficient with our healthcare teams, which means working with nurse practitioners and physician assistants collaboratively and not separately.”
Dr. Towers believes the medical society needs to continue to attract and retain members, which means finding out what issues affect physician well-being and figure out what resources it can provide to help the physician community to make them stronger and more unified.
In her spare time, Dr. Towers enjoys dancing, especially Argentine tango and ballroom. “I strongly encourage physicians to take up dancing as a hobby because it exercises both the body and mind.”
Dr. Towers also is an avid beekeeper, a hobby that she picked up five years ago as a result of her pumpkin plants not producing any pumpkins. Taking the advice of a wise onlooker, Dr. Towers obtained bees to help pollinate her plants. A year later, her plants produced 96 pumpkins, which she shared with everyone. Dr. Towers’ beekeeping hobby even helped her neighbors harvest plentiful pear trees and bountiful raspberry bushes.
Dr. Towers is the mother of three and resides in Wilkinsburg.