Saturday, December 16, 2017

OCMA Blog

OCMA Specialty Spotlight: Should Tissue from Mammoplasty be Examined by the Pathologist?

According to The American Society of Plastic Surgeons, 296,203 breast augmentations and 21,714 breast implant   replacements were performed in 2010. In 2011, after 60 cases of breast implant-associated anaplastic large cell lymphoma  (ALCL) became known to FDA, that agency issued a warning to patients who already had or were considering breast implants.1,2 Breast implant-associated ALCL is a rare type of lymphoma of T-cell lineage with clinical signs and symptoms of swelling, pain, pruritis and/or effusion around the implant.3According to a recent study in M.D. Anderson Cancer Center, patients who present with effusion without a distinct mass have an excellent nprognosis if the breast implant and fibrous capsule are removed. In contrast, patients who present with a distinct mass in the vicinity of the implant may have advanced stage or possibly systemic disease and poorer prognosis.4

One of 500,000 women receiving breast implants is estimated to develop implant-associated ALCL.5However, this frequency may be underestimated for the following reasons. Firstly, there are no standardized recommendations for pathologic examination of tissue excised during cosmetic surgery. The routine submission of tissue from that type of procedure is not typically considered the standard of care and is dictated by the individual and/or institutional policies. Secondly, there are no consensus recommendations for examination of the fibrous capsule surrounding the implant, where the lymphoma would be most commonly detected. According to a survey of 413 institutions in 1999, mostly in the United States, 10.7% had policies that exempted the submission of mammary   implants for pathology examination, and 63% had policies that recommended mammary implants for gross examination only, without distinguishing implants from capsulectomy specimens.6 Being more cognizant of the disease, one can surmise that the detection rate of ALCL will increase as more surgeons send the capsule and breast tissue surrounding the implant to pathology, and as pathologists submit more tissue for microscopic  evaluation.

In view of the above discussion, the following questions merit consideration. Should patients with breast implants have them removed for the fear of a malignancy? A negative response to this question would be appropriate; there is no ground for panic unless the patient experiences pain, swelling, retraction, or effusion around the implant. Should the implant, the surrounding capsule and breast tissue be submitted to pathology for both gross and microscopic examination, even though the likelihood of detecting a malignancy in this type of specimen is quite low? An affirmative response would be appropriate in this situation considering that in addition to ALCL, a very small    number of patients could harbor a clinically undetectable mammary carcinoma. 

Newport Coast Pathology (NCP), Inc. is committed to providing high quality care and exceptional anatomic pathology    services for the patient and the referring physician, respectively. Our pathologists treat every specimen as if it were their own or that of their family member. We strongly believe that the pathologist is an integral member of the team of physicians involved in the patient's care, and that communication between the pathologist and the clinician is essential to serving the needs of the patient. Our pathologists are available for consultation with referring physicians and their staff, any time. 

NCP offers a comprehensive menu of diagnostic tests, including: Histopathology, Histochemistry, Immunohistochemistry, Non-GYN Cytology, Cancer prognostic marker tests by various methods  

Newport Coast Pathology, Inc., was founded in 2010 by Mani Ehteshami, MD, a pathologist who recognized a need for a local laboratory that would provide personalized service. Dr. Ehteshami is certified in anatomic and clinical pathology by the American Board of Pathology, and has 17 years of post-fellowship experience and expertise in surgical pathology and cytopathology, specifically in gastrointestinal, liver, genitourinary and breast pathology. He earned a medical degree from Rosalind Franklin University of Medicine and Sciences in Chicago. Following the completion of his residency in anatomic and clinical pathology at the University of New Mexico School of Medicine in Albuquerque, Dr. Ehteshami was a fellow in oncologic surgical pathology at the University of Texas, M.D. Anderson Cancer Center in Houston, where he was trained by many internationally known academic pathologists including Drs. Kathy Foucar, Elvio Silva, Nelson Ordonez, and Ruth Katz. 

http://newportcoastpath.com/  T: (888) 463-3606 


Prior to relocating to Orange County, Dr. Ehteshami was the Medical Director and co-owner of a highly successful private anatomic pathology laboratory in northern California for 13 years. In addition, he held several key leadership positions including Medical Director of Clinical Laboratories, chair of the Pathology Department and chair of the Cancer Care committee at Shasta Regional Medical Center. He was interviewed by and published in Make [Me] Heal publication:"Checking for Breast Cancer when you Have Breast Implants", April 28, 2011 issue. He has affiliation with the following professional organizations: Fellow of the College of American Pathologists, Fellow of the American Society of Clinical Pathology, Member of the California Society of Pathologists, Member of the California Medical Association, Member of the Orange County Medical Association.

Before earning his medical degree, Dr. Ehteshami volunteered his services to educate and counsel patients with multiple sclerosis, and helped to establish housing for those patients. As the Chairman of the Patient Services Committee, a member of the Medical Advisory Committee, and a member of the Board of Trustees of National Multiple Sclerosis Society in Orange County, he was recognized for his outstanding volunteer service. Dr. Ehteshami is an avid runner who has raced in dozens of full and half marathons in the US and abroad. 


References

1. US Food and Drug Administration. Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. 2011. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm. Accessed June 22, 2011.

2. US Food and Drug Administration. FDA medical device communication: reports of anaplastic large cell lymphoma (ALCL) in women with breast implants. 2011. Available at:  http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm240000.htm. Accessed January 26, 2011.

3. Keech JA Jr, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100:554-555.

4. Anaplastic Large Cell Lymphoma Associated With Breast Implants: A Report of 13 Cases.  Aladily, Tariq N.; Medeiros, L. Jeffrey; Amin, Mitual B.; Haideri, Nisreen; Ye, Dongjiu; Azevedo, Sergio J.; Jorgensen, Jeffrey L.; de Peralta-Venturina, Mariza; Mustafa, Eid B.; Young, Ken H.; You, M. James; Fayad, Luis E.;  Blenc, Ann Marie; Miranda, Roberto N. American Journal of Surgical Pathology. 36(7):1000-1008, July 2012.

5. Kenkel JM. Discussion: anaplastic large cell lymphoma and breast implants: a systematic review. Plast Reconstr Surg. 2011;127:2151-2153.

6. Zarbo RJ, Nakhleh RE. Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions. Arch Pathol Lab Med. 1999;123:133-139.


Introducing: WorldPay

Irvine, Calif. - The Orange County Medical Association is pleased to announce another benefit of membership. The OCMA has designated financial processing partner WorldPay as its Business Partner for physicians seeking credit card processing solutions, check verification services, Cash Advance services and other processing technologies for the medical field.

OCMA members may receive complimentary consultations and discounted rates on a wide range of processing needs, including stand-alone terminals, integrating into current POS/Software systems, check verification services, wireless methods of payment, cash advance products and the latest in HIPAA and PCI Security. They process all card types such as VISA, MasterCard, Discover, AMEX, and JCB.

"Our Medical Professional Plan is designed to specifically help busy physicians protect their professional practices against fraud," said Andy Varble, Regional Sales Manager at WorldPay. "We offer quality credit card processing at an attractive rate while keeping each doctor PCI-DSS compliant which in turn keeps them HIPAA compliant. We look forward to offering our many services through this special arrangement to the OCMA membership."

The following services are included within WorldPay's healthcare practice: current credit card processing reviews at no cost, fraud protection reviews, PCI-DSS training to keep each doctor HIPAA compliant. WorldPay can offer integration with many of the physician-specific POS systems and software that is available on the market today along with check verification services and cash advance programs.

Carla Mullet, who has 19 years industry experience, has been chosen as the point of contact for the relationship between the OCMA and WorldPay. With her tenure she is experienced in every facet of credit card processing and the fraud prevention features that are unique to WorldPay. She uses a consultative approach with each doctor to ensure she understands completely their business model, current needs, and also keeps in mind the future growth strategies for each office with which she consults. Located in the heart of Orange County, Carla Mullet is local to meet face-to-face with each doctor and staff to ensure she is providing the best service, technology and pricing to their practice.

The strategic business partnership with WorldPay reinforces OCMA's commitment to bring added value to its members by aligning with companies that offer business practice expertise, state-of-the-art technology at a competitive price point, and allowing physicians to focus their attention on what matters most, patient care. 

For assistance please contact Carla Mullet at 714-878-2031 or Carla.mullet@worldpay.us 

Or contact Andy Varble at 714-380-1491 or andy.varble@worldpay.us 


Blue Shield Recontracting Effort Expanding to Orange County

Earlier this year, Blue Shield began recontracting with physicians across the state. The California Medical Association (CMA) has learned that physicians in Orange County will be next to see the new contracts.

Blue Shield has assured CMA that if a physician chooses not to sign the new agreement, his or her participation status with Blue Shield will not be affected.

The reason for the recontracting initiative, according to Blue Shield, is twofold: 1) Blue Shield has not done a large scale recontracting with physicians in over a decade, so the new contracts will allow Blue Shield to ensure consistency and compliance with new laws and regulations; and 2) Blue Shield is offering various tiered networks based on price point in anticipation of possible participation in California's Health Benefit Exchange.    

CMA continues to work with exchange stakeholders to address significant concerns regarding the exchange grace period, monitoring of network adequacy and clinician-level performance measurement in qualified health plans offered in the exchange.

Exhibit A of the new Blue Shield contract allows physicians to designate which products they are willing to participate in by product type.

While Blue Shield did update its fee schedule statewide on July 1, there is no fee schedule change associated with this recontracting initiative, with the exception of the Direct Contract HMO Medicare Advantage product.

Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any new contract and new product types. To assist physicians, CMA has completed an  analysis of the new Blue Shield contract, which is available to members in CMA's online resource library at  http://www.cmanet.org/resource-library.

For additional information on evaluating and negotiating complex managed care contracts, see CMA's contracting toolkit, "Taking Charge: A step by step guide to evaluate and prepare for negotiations with managed care payors."The toolkit is also available free to members in CMA's resource library.

The notice  directs physicians with questions about the new contract terms to contact Blue Shield Provider Services at (800) 258-3091.

Questions: CMA at (888) 401-5911 or economicservices@cmanet.org.


OCMA Specialty Spotlight: The Gavin Herbert Eye Institute

The Gavin Herbert Eye Institute at the University of California, Irvine, refers to both an academic specialty eye care practice and research group already in existence and to a high-technology patient care facility under construction on the UC Irvine main campus on Bison, just off the 73. 

The institute itself comprises 17 full-time clinician faculty, covering all subspecialties, with offices at both UC Irvine Medical Center in Orange and at Gottschalk Medical Plaza on the Irvine campus; 9 basic science faculty researchers located at the UC Irvine School of Medicine in Irvine; 9 residents and 9 post-residency subspecialty fellows; plus volunteer faculty and post-doctoral researchers. The Gavin Herbert Eye Institute provides the only full-service academic specialty care between San Diego and Los Angeles, with a full range of advanced diagnostic imaging and surgical specialty technologies.

The new clinical building on the UC Irvine campus will fulfill a vision that Gavin Herbert has worked for over 30 years to accomplish. The founder of Allergan, Mr. Herbert first recruited the internationally eminent Irving Leopold, MD, from New York to be the first chair of the ophthalmology department in the newly created UC Irvine School of Medicine. Now, Mr. Herbert has led the drive to raise the philanthropy for an outstanding   facility to deliver world-class patient care and simultaneously be the fulcrum for translational research that brings basic research into innovative new therapy. The project is funded 100% through philanthropy, with no state or university dollars. Currently $29.5M has been raised toward the total opening cost of $37M.

Roger F. Steinert, MD, was recruited from Harvard 8 years ago with the allure of the opportunity of helping to achieve this project. For Dr. Steinert, a Massachusetts native, a summa cum laude graduate of Harvard College and an Alpha Omega Alpha graduate of Harvard Medical School, and a faculty member of Harvard Medical School and the Massachusetts Eye and Ear Infirmary, the potential of the eye institute project and the draw of Orange County nevertheless was irresistible.

"I had frequently visited Orange County over several decades as part of my research in lasers and cataract   surgery," commented Dr. Steinert. "The potential for world-class innovation in prevention and treatment of blinding disorders is clear. Orange County has the highest concentration of eye technology industry in the world. When you combine that with a highly supportive community and a world-class university, the ability to make a difference is clear."

"Our vision is to provide leading eye care to Orange County, right here, right now, while also, by collaboration with the Orange County community and the university, be a global leader in developing the new technology of tomorrow. Simultaneously, we will support our profession with accessible continuing medical education and train the leaders of the next generation."

The new building just celebrated the traditional "Topping Out" event, recognizing the completion of the    highest level of the building. Full occupancy and patient care is scheduled for Summer 2013. The new building comprises 70,000 square feet, and includes patient care offices, translational and clinical research spaces,  ambulatory surgery, laser and oculoplastic reconstructive surgery, and conference and teaching spaces. Extensive work has gone into creating innovative architecture, including collaboration with the Braille Institute to minimize architectural barriers to patients with limited vision. High definition video can be transmitted over the internet to teaching sites in the Institute but also throughout the world. Medical records are fully electronic, facilitating communication to referring physicians. 

The location of the clinical facility is just 500 feet away from the 2 laboratories conducting basic research in stem cell therapy for age-related macular degeneration and the inherited blinding disorder known as retinitis pigmentosa; innovative immunological studies on developing the first effective vaccine against herpes simplex virus; laser imaging of microstructures in the eye that will guide understanding of disease processes and therapy; and the pediatric blinding condition of cystinosis.



Roger F. Steinert, MD, graduated from Harvard College and Harvard Medical School, going on to complete his ophthalmology training at the Massachusetts Eye and Ear Infirmary. His career-long clinical interests are corneal surgery, cataract and implant surgery, and refractive surgery. He maintains a consultation practice in these areas. His research has centered on optics, with an emphasis on lasers and related technology. Dr. Steinert's current appointment is the Irving Leopold Professor of Ophthalmology, Chair of the Department of Ophthalmology, Professor of Biomedical Engineering, and Director of the Gavin Herbert Eye Institute, as well as Vice President and President-Elect of the Medical Staff of UC Irvine Medical Center. He has published 5 textbooks, including Cataract Surgery, currently in its 3rd Edition, as well as over 90 book chapters and over 140 peer-reviewed scientific publications. He is past president and current program chair of the American Society of Cataract and Refractive Surgery and Associate Editor of Ophthalmology, the journal of the American Academy of Ophthalmology.


OCMA Specialty Spotlight:The PRECICE Device

Dr. Samuel Rosenfeld, an orthopedic surgeon with the CHOC Children's Orthopaedic Institute, is the first on the West Coast to perform a limb lengthening procedure using the PRECICE™ Remote Control Device. Developed by Irvine-based Ellipse Technologies, in collaboration with Dr. Stuart Green of UC Irvine, and cleared for use in the United States by the FDA in July 2011, the PRECICE represents a new era for limb lengthening.

The device, considered by physicians to be precise and gentle, is implanted with minimal incision   surgery. A magnetic motor assembly in a rod is placed inside the patient's bone and responds to an external remote controller. The surgeon uses the external remote controller to gently and more accurately control the rate of lengthening, including the potential to reverse the lengthening. In addition to providing a less invasive procedure for limb lengthening, PRECICE has been recognized for significantly reducing the potential for complications, such as infections, during the healing process. Presently, the device is used for lengthening the femur and tibia bones.

Leg length discrepancies can be congenital (present at birth) or acquired as a result of an accident, a significant fracture that does not heal or disease, such as cancer. The conventional approach for leg lengthening has been the use of an adjustable external fixation device attached to the bone with pins and adjusted by the surgeon. The leg lengthens as the bone heals. The procedure has been associated with a high rate of complications, most commonly infections at the pin sites.

An alternative to external fixation devices, the first implantable device - called the intermedullary skeletal kinetic distractor (ISKD) - was approved by the FDA in 2001. A telescopic rod implanted in the marrow cavity of the bone and activated by movement, the ISKD makes it more challenging to control the rate of lengthening, potentially resulting in nerve damage, poor bone healing and muscle contractions. With the better control of the PRECICE system, some of these issues may be eliminated.

Named a "physician of excellence" from the Orange County Medical Association, Dr. Samuel Rosenfeld is a pediatric orthopedic surgeon with special interests in muscular dystrophy, spina bifida and spasticity.

He received his medical degree from Pennsylvania State University College of Medicine; his internship in general surgery at the University of California Irvine Medical Center, where he also completed his residency in orthopedic surgery; and a fellowship in pediatric orthopedics and rehabilitation at Rancho Los Amigos Hospital in Downey, California. He's part of the multidisciplinary team of experts at the CHOC Children's Orthopaedic Institute.

The CHOC Children's Orthopaedic Institute is the only program of its kind in the region offering a wide range of comprehensive subspecialty programs specializing in the diagnosis and treatment of complex orthopedic injury, illness and disorders in children and adolescents. At the CHOC Orthopaedic Institute, highly experienced pediatric orthopedic surgeons and specialists, along with a multidisciplinary team, provide a complete range of clinical, surgical and ancillary support services for their patients in one convenient setting.


Dr. Samuel Rosenfeld is a pediatric orthopedic surgeon with special interests in muscular dystrophy, spina bifida and spasticity. He received his medical degree from Pennsylvania State University College of Medicine; his internship in general surgery at the University of California Irvine Medical Center, where he also completed his residency in orthopedic surgery; and a fellowship in pediatric orthopedics and rehabilitation at Rancho Los Amigos hospital in Downey, California.

 


The OCMA is Under New Leadership!

"Helping You Navigate Change"

The OCMA would like to announce the installation of the new

OCMA President, Standiford Helm II, MD 

Dr. Helm is available for one-on-one meetings with individual physicians to discuss relevant issues and concerns. If you would like to schedule a meeting with the new OCMA president, please contact Linda Johansen:

(949) 398-8100 ext. 102 or ljohansen@ocma.org

Standiford Helm II, MD, MBA, President

Standiford Helm II, MD, MBA, serves as OCMA's president. Dr. Helm is the medical director of The Helm Center for Pain Management in Laguna Hills. He is board-certified in anesthesiology and pain medicine. Dr. Helm joined OCMA/CMA in 1986. He has served on the Board of Directors since 2007. He has served on the OCMA Delegation to the CMA from 2005 - 2011, at which time he was elected to the CMA Board of Trustees. He previously served on the OCMA Nominating Committee. In addition, Dr. Helm served as president of OCMA Services, Inc. from 2002-2008 and previously served as a member of the OCMA Services Board from 1998-2002. Dr. Helm has been a member of the AMA since 2003.  

In addition to his memberships in AMA, CMA and OCMA, Dr. Helm belongs to the American Society of Interventional Pain Physicians (where he is currently the immediate past president), California Society of Interventional Pain Physicians (where he served as president from 2002 through July 2008, and currently serves as president emeritus), California Society of Industrial Medicine and Surgery (where he has been a member of the board of directors since 2007), the American Neuromodulation Society and the World Institute of Pain.

Dr. Helm received his medical degree from Tufts University in 1977. His internship in Internal Medicine was completed at Boston City Hospital in 1978. Dr. Helm's residency in anesthesiology was completed at UCLA in 1980. Dr. Helm received his M.B.A. at Pepperdine University in 1988.

Dr. Helm is a member of the following medical staffs: Mission Hospital Regional Medical Center, Saddleback Memorial Medical Center (Laguna Hills and San Clemente campuses), California Specialty Surgery Center, Mission Ambulatory Medical Center, and Saddleback Valley Outpatient Surgery.

Dr. Helm and his wife, Noel, reside in San Clemente. They have three children, one living in Boston, another living in Dallas, and the third living in London. His term of office runs from July 2012 - June 2013.


2012 - 2013 Executive Committee:

President - Standiford Helm II, MD
President-Elect - Thomas C. Kockinis, MD
Secretary-Treasurer - Sudeep Kukreja, MD
Past-President - Joanna K. Tan, MD


2012 - 2013 Board of Directors:

District I - Christian Lising, MD
District II - Rakesh K. Bhola, MD
District III - George Garcia, MD
District III - James E. Pierog, MD
District III - Paul B. Yost, MD
District IV - Quynh D. Kieu, MD
District IV - Smita B. Tandon, MD
District V - Abhay Parikh, MD
District V - William M. Thompson IV, MD
District VI - William E. Callahan Jr., MD
Southern California Permanente - Darla Holland, MD
St. Jude Heritage - Ramesh Rathod, MD
Resident Representative - Deena Ibrahim, MD

 

CEO / Executive Director:

Robert McCann, MHA


OCMA Specialty Spotlight: The Be Aware Foundation

Be Aware Foundation Releases Two New Videos that Empower Women to do Breast Self-Exam with Confidence

The Be Aware Foundation, a non-profit organization dedicated to raising awareness for early breast cancer detection, released two educational videos developed to empower women to perform breast self-exam (BSE) with confidence. The two videos can be viewed on the foundation's website (beawarefoundation.org) or on the foundation's YouTube channel (BeAwareFoundation).


Although mammography has been proven to be the best screening tool to detect breast cancer at an early stage, mammograms have some significant limitations. In women with dense breasts, mammograms miss approximately 30 percent of cancers. Some cancers show up as lumps between mammograms, and women under 40 years are not advised to do annual screening.

"Current guidelines for doing BSE are confusing," said Be Aware Foundation President Peggy Brooker. "The guidelines recommend that women should be aware of their breasts and report any changes to her doctor, but the guidelines also state that doing BSE should be a woman's choice." The next question is "how can a woman detect an early change if she is not doing regular breast self-examination?"

"My 40 years of treating women with breast problems has convinced me that women can be taught to do BSE with confidence," said Be Aware Foundation co-founder Dr. John West. "With the support of the Be Aware Foundation I have created two videos which spell out, step-by-step, what women must do to learn how to do BSE with confidence. These videos have the potential to save lives, save breasts and save money....and it's free for every woman to learn from."

 

Founded in 2004 by Tanja Cebula, a cancer survivor, and Dr. John West, the Be Aware Foundation is dedicated to saving lives by educating and inspiring women to follow early detection guidelines for breast cancer. Our volunteer RN's and breast cancer   survivors deliver a compelling educational program in a "lunch and learn" format to companies, agencies and other groups of women in Orange County. Women who attend our Pearls of Wisdom program are encouraged to fill out a Personal Plan of Action whereby they commit to following the early detection guidelines.

We send email reminders to perform monthly breast self exams and annual clinical exams and mammograms. These email reminders also offer important information about new developments in breast cancer prevention and treatment, as well as general women's health topics, and our Ask the Doctor topics. 


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