WNEP News: Drive-thru medical care in Frackville

Story by WNEP News
Author: Chase Senior
Published: 4:58 PM EDT March 25, 2020
Updated: 4:58 PM EDT March 25, 2020

FRACKVILLE, Pa. — The waiting room is empty at Cornerstone Coordinated Health Care in Frackville, but the parking lot is getting a lot of traction.

“How can we see patients and keep them safe and out of the waiting room to limit exposure?” asked medical director Dr. James Greenfield. “One of the things we came up with is drive-thru medicine.”

Due to the coronavirus outbreak, Cornerstone is trying to limit almost all foot traffic and the spreading of germs inside the clinic. So if you feel ill and want to be seen, you don’t even have to get out of your car. A doctor or nurse will come to your car.

Signs on the door state that if you show any symptoms associated with COVID-19, you must return to your vehicle.

“Our medical assistant will come out and check vital signs. Then me, or one of the other providers, will come out and do an evaluation and decide what needs to be done,” said Dr. Greenfield.

The process to be seen is pretty easy. You’ll have to give the office a call to set up an appointment. Then, when you get here, you’ll park, and somebody will be out to see you.

“It is a crazy time. People are scared. They’re not sure what’s going on, but we’re going to be here. Health care, we need to be on the front line at this point, and this is why we signed up and why we’re here,” Dr. Greenfield added. “We’re not going anywhere. We’re keeping our doors open, and we’re going to do the best we can.”


Ways to stay warm and safe while working in the cold

ORWIGSBURG, SCHUYLKILL COUNTY (WBRE/WYOU) — As temperatures dip into the low 20s and teens, you know its time to bundle up.  Most of us are just outside going to and from, but what about those people who spend all day outside working?

When it’s this cold we need to take it seriously.  There are many dangers that come along with being outside when the temperature drops, especially when there’s a windchill.

“It’s a cold day,” said Thomas Rogal, Schuylkill County Maintenance Manager.

Just because it’s cold, doesn’t mean there aren’t roads to fix. PennDOT workers layer up before they clock in at 7 a.m. for another 8-hour day in the cold.

“The hard, windy days are by far the worst, it sucks the heat right out of you,” said Rogal.

They wear helmet liners, thick gloves and socks, boots, and of course layer up their coats.

“The key to stay warm in these conditions is to stay active,” said Rogals.

To prevent serious problems, they have safety talks twice a day.

“This is very deadly when its this cold,” said Dr. James Greenfield, local physician and ER doctor.

Doctors say the big things to watch out for:  frostbite — when your skin appears white, waxy and hard to the touch… Which can result in amputation.

“Frost bite can even happen faster than 20 minutes depending how cold it is,” said Greenfield.

Hypothermia  — when your body temperature drops into the low 90s or the 80s… Which can alter organ function.

“When you start to become hypothermic sometimes you don’t even notice it at times,” said Greenfield.

Signs include uncontrolled shivering, slurred speech, and confused behavior.  If you realize you are indeed too cold, experts say it’s best to warm up gradually.

Also, if you have asthma, doctors recommend keeping an inhaler with you during the winter months.  The cold air is dryer, and could affect your lungs. Another thing to keep in mind, your energy levels.

“You can get dehydrated quite easily if you’re not paying attention because you actually use a lot of energy to keep your body warm,” said Greenfield.

Experts recommend drinking warm, sweet beverages and eating high-calorie foods such as hot pastas to produce more energy that your body can use to keep you warm.

Experts also say it’s important to remember to wear a hat! The majority of heat leaves from your head and other extremities like your nose and ears, so it’s a good idea to cover those up, too.

Workers who take certain medications, or suffer from diseases like diabetes or hypertension, are at an increased risk when out in the cold.  If anyone experiences signs of frostbite or hypothermia, they should call for help.

Originally Published at PAHomepage here
By: Haley Bianco
Date: Dec 27, 2017 06:16 PM EST


Doctor from Cornerstone RHC returns from Everest to help kids

FRACKVILLE, SCHUYLKILL COUNTY (WBRE/WYOU) — A local doctor returns home after climbing the tallest mountain in the world — for a cause. Dr. James Greenfield put down the stethoscope and picked up his hiking gear to take on Mount Everest.

“We can do a lot more than we think if we put our mind to it,” said Greenfield.

He mastered the 10-day hike, but he says it wasn’t easy! Saying, if he was doing it for himself, he wouldn’t have signed up! But he was doing it for others, specifically for 150 kids in Kenya.

Greenfield is a volunteer with the nonprofit Care Highway International. As a doctor, he’ll visit the facility in Africa for health checks. But he’ll also go on expeditions like this to raise money for the organization.

“We’re only here for so long, and if we can do things that help someone else in this world, it’s worth it,” said Greenfield.

Because of the time of year, the group could not hike to the peak of the mountain — which is only open for a short period in the spring. Instead, they hiked to base camp — which is still very high up! Everest base camp is about 18-thousand feet above sea level.

Greenfield spent months preparing for the trek, and took his time on the mountain, adjusting to the high altitudes, and taking it all in.

“Knowing that we’re helping these kids out. That’s what really made it worth it,” he said.

Now that he’s back home, it’s time to get back to work as a doctor in Schuylkill and Carbon counties, but he says as he does, he’ll keep spreading awareness about the organization.

And he’s already planning his next adventure! He plans to visit the kids in Kenya in the spring of 2019.

“There’s always something we can do,” said Greenfield.

For more information on the nonprofit group click here.

Originally Published at PAHomepage here
By: Haley Bianco
Date: Dec 02, 2017 07:00 PM EST


Doctor from Cornerstone RHC climbs Everest to help kids in need

FRACKVILLE, SCHUYLKILL COUNTY (WBRE/WYOU) — A local doctor is climbing the world’s tallest mountain, For a cause. We first showed you Dr. James Greenfield packing his bags for the big trip, but now he’s hiking!

When he’s in the U.S., you’ll find Dr. Greenfield spending his time in Carbon and Schuylkill Counties. But today, he’s nowhere near there.

“There are periods of time that are very tough on this type of a journey,’ said Greenfield.

11-thousand feet up Mount Everest, Dr. James Greenfield and his team of travelers are climbing at least seven hours a day. And while it seems like this trek would be a bucket list item, these hikers are doing it for another reason.

They’re volunteers with Care Highway International, a charity that brings health care and education opportunities to kids in Kenya.

I Skyped with Greenfield and Chris Morrison, the organization’s founder. They’re mid-climb in what’s expected to be a ten day hike, but they were able to find internet access at a teepee camp in Namche Bazar.

“Some of these hills, getting a little oxygen — it’s not an easy thing. But we’re a team. We’re all there for each other and we’re not going to stop. We’re all helping each other,” said Greenfield.

They do big expeditions like this to raise awareness.

The group is keeping the public updated on their journey through an interactive GPS program and social media.

“We’re equipping our children for life’s challenges,” said a team member.

One U.S. dollar equals about 100 dollars in Kenya. There are 150 kids at Care Highway Interational’s Africa center. 300 U.S. dollars help feed all of them for three months. That’s what keeps these volunteers hiking up the freezing, dangerous terrain.

“I think it shows the commitment of the everyday people,” said Chris Morrison.

Because of the time of year, the group will not hike to the peak of the mountain. Their final destination will be base camp — where they’ll get a good view of the snow-covered mountain top, and have some time to acclimate. They expect to be there in five days.

Once they reach their destination, it will take them another four days to hike back down the mountain, and then come back to the U.S.

Originally published at PAHomepage here
By: Haley Bianco
Date: Nov 11, 2017 06:39 PM EST


Doctor prepares to climb Everest to raise money for kids

FRACKVILLE, SCHUYLKILL COUNTY (WBRE/WYOU) — A local doctor is preparing for the biggest personal challenge of his life, but that challenge isn’t just about him.

Dr. James Greenfield is packing his bags; he’s got boots, band-aids, and lots of layers, to keep him going as he climbs the tallest mountain in the world.

Before he flies to Asia, he’s preparing his lungs for the high altitudes.

But he won’t be making the journey alone. Six volunteers will trek up Mount Everest — with a common goal — raising money for disadvantaged children in Africa.

“We don’t realize how much we really do have in our country until you see places that really don’t have anything,” said Greenfield. Greenfield volunteers with Care Highway International– a charity that brings health care and education opportunities to kids in Kenya.

Last year, he joined the group and had his first experiences in Africa. As a physician, he offered free clinics, gave immunizations and physicals to children in need.

“They’re so grateful for anything you do. You go ahead and buy a girl a jump rope. She’s ecstatic,” said Greenfield.

He won’t be seeing the kids on this trip, but the money raised from sponsors of his trek and donations will go directly to the children.

“You don’t realize how far a little bit goes in a country like that,” said Greenfield.

One U.S. dollar equals about 100 dollars in Kenya.There are 150 kids at the CHI facility. 300 U.S. dollars feeds all those kids for three months.That’s what’s motivating Greenfield to make the 10-day trip up a freezing, dangerous mountain.

“It’s worth it,” said Greenfield.

For more information click here.

Article originally published at PAHomepage here
By: Haley Bianco
Date: Oct 18, 2017 06:00 PM EDT


CMS chief: ‘MACRA will promote coordinated, patient-focused care’

In remarks to the AOA House of Delegates, Andy Slavitt thanked DOs for the care they provide to rural and underserved patients.


What’s wrong with health care today? Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt, who has sought feedback from consumers and clinicians across the country on Medicare’s new MACRA physician payment system, has several ideas.

In remarks to the AOA’s House of Delegates, Slavitt cited a confusing, fragmented medical system; hard-to-use electronic medical record (EMR) systems; and burdensome reporting requirements as issues CMS hopes to address with the new payment system. CMS will issue its final rule on MACRA by Nov. 1, 2016, with physician reporting set to begin Jan. 1, 2017, though Slavitt indicated CMS is considering the possibility of delaying that start date.

Osteopathic example

To illustrate MACRA’s goals, Slavitt cited the practice model of James Greenfield, DO, whose Cornerstone Coordinated Health Care provides a one-stop shop for primary care, mental health and social services in a rural, underserved Pennsylvania town. “Our goal with MACRA is to promote coordinated, patient-focused care at a reasonable cost,” Slavitt explained. “Medicare will pay for the same services as always, but physicians will be paid more for better care, like having staff follow up with patients at home.”

How MACRA will work

MACRA will streamline existing reporting programs into one framework, Slavitt said, and will push EMR vendors to make their products interoperable. Small and rural practices will benefit from the chance to join medical home models, and advanced alternative payment models will offer physicians the chance to earn extra bonuses and be exempted from quality reporting requirements.

For DOs, Slavitt said, MACRA’s goals won’t be a huge departure. CMS’ policies aim to fall more in line with the patient-centered care DOs provide, he noted. “You’re focused on treating people, not symptoms, so people can live their lives and heal,” he said. “With all that’s happening in health care, it’s reassuring to see a profession heading in the right direction.”

To read Slavitt’s remarks in full, visit the CMS blog.


Remarks by Andy Slavitt before the American Osteopathic Association

July 22

Chicago, Illinois
Mr. President and Members of the American Osteopathic Association, I’m honored to be invited to address your annual business meeting. Hello and good morning. Thank you for hosting me. I want to give special thanks to:

  • Doctor John Becher, the President of the AOA [congratulations on your service to the AOA],
  • Doctor Boyd Buser, the President-elect of the AOA [congratulations on your new role],
  • Ms. Adrienne White-Faines, the AOA CEO,
  • Joseph Giaimo, Member of Board of Trustee, Chair of our Department of Governmental Relations,
  • All members of the American Osteopathic Association, and
  • Perhaps most of all, the DOs who serve our beneficiaries and consumers everyday, especially in rural and underserved areas.
    I want to start by recognizing your long history as osteopathic physicians who lead the nation to where we need to be on health care. Your focus on treating people, not symptoms; on prevention, not illness; in the link between physical and mental health and in all the things that surround a healthy lifestyle so people can live their lives, heal, and age in comfortable settings. In particular, I want to begin by thanking you for your commitment to serving Americans in rural and underserved communities. With all that surrounds health care as a system, it’s reassuring to see your profession focus on what matters most.
    Cornerstone is an example of your philosophy in action. A philosophy, while over a century-old, feels very modern today. We’ve just celebrated 50 years of the Medicare program and as we think about how we springboard into the future, it’s very clear that if our health care system continues to center on our big medical institutions, our testing machinery, our pharmaceutical pipelines — and not the people at the center of care, then we will not succeed– either by our beneficiaries or by our country. With 10,000 beneficiaries turning 65 every day, the baby boom population headed into their 70s, and the prevalence of chronic disease where one in four Americans has multiple chronic conditions, and a confusing, fragmented medical system, we won’t have enough taxpayers to support the kind of system we have.
    So it’s clear that for the next 50 years of Medicare we need to do things differently – do things more in the Cornerstone way. Here’s how we’re beginning that change:
  • Making primary care and prevention a bigger part of people’s lives so that treating illness can be a smaller part of our system. We will be paying for community-based diabetes prevention across Medicare beginning in 2018. And yesterday we were pleased to announce the participation of 20,000 practitioners in our Million Hearts model which focuses on prevention of strokes and heart attacks. I’m happy to note DOs from around the country like the Philadelphia College of Osteopathic Medicine are participating. Paying physicians not just to test or write a prescription, but to actually listen and explain and heal– a move we furthered with our actions in Advanced Care Directives and recent proposals to reward cognitive care;
  • Coordinating the care a patient receives so the entanglement of prescriptions, referrals, care instructions, and interpretations can be made simpler and clearer and so patients and families can lead their lives, not spiral around a system feeling worse and feeling more confused;
  • Moving towards helping people stay in their homes or in comfortable settings in their communities as they age and recover instead of institutions;
  • And, finally, we need technology and information to support us like it does in the rest of our lives, wrapping around the needs of patients and clinicians and how they use the health care systems, not residing in the silos of health IT companies.

But this is really what MACRA is about. It is the opportunity to change how Medicare pays for care, but also the opportunity to achieve something bigger: to support the kind of care that patients want– with physicians able to anticipate and focus on their needs.
While we are talking about how we pay for care in America, payment systems are not intended to be finely calibrated models that we expect to be performed to the test. In all my years, I have never met, nor do I hope to meet, a physician who makes her decision on how to treat a patient based on how she gets paid. She does what she thinks is right for the patient and hopes that the system will support her. Our job in implementing MACRA is to design policies that support the Cornerstones of the world in providing the care they think is best.

Goals for the Quality Payment Program
When Congress passed, and the President signed, the bipartisan Medicare Access and CHIP Reauthorization Act, we finally ended– permanently– the Sustainable Growth Rate (SGR) formula and brought the potential for long-term stability and reliability to the Medicare program.
With MACRA, we answered one question and opened up a set of others that are now ours to begin to address. So how did Congress approach the tough task of sustaining the Medicare program and how will we carry it out? What do you really need to know about the program? And what new sets of requirements are there to participate?

While any change can be distracting, the goal of the program is to return the focus to patient care, not spend time learning a new program. Medicare will still pay for services as it always has, but every physician will have the opportunity to be paid more for better care and for making investments that support patients — like having a staff member follow up with patients at home. MACRA also allows us to end the patchwork of alphabet-soup measurement programs like PQRS, VM, and MU and replaces them with a new single framework that can provide the basis for a more flexible, relevant and ultimately simpler-to-use system.
The new program brings changes intended to promote coordinated care at reasonable costs through a uniform merit-based system. It is defined in the statute to focus on quality– both standard measures of care and practice-based initiatives of a physician’s choosing and encourage the use of technology. Physicians and other clinicians who wish to go further will receive additional bonuses and will be able to join more advanced approaches to care for patients like medical homes, specialty models, and team-based models that improve quality and manage costs.

Implementation Approach and Priorities
Given the size of this change, we decided to engage more with patients and physicians than we ever had to figure out the best path to implementation.
Even with all the promise of MACRA, adding new regulations to an already busy health care system without improving how the pieces fit together just will not work. So, we adopted a new outside-in approach we label “user-driven policy design.” This approach calls on us to conduct an unprecedented effort of intensive listening and learning. And my first commitment is that we do this in as open, transparent, and iterative way possible.

Policy cannot be written from behind our desks. So, we asked our staff to put down their pens and take the unique opportunity to go into the field, meet with physicians, and listen. Starting with me, our career staff and our regions have been tasked with connecting us closer and closer to where care actually happens. And in May, we launched a listening tour across the country so that we could hear firsthand physician thoughts and concerns about the proposal to implement the Quality Payment Program.

Thanks to all of you, this listening tour has been incredibly valuable, and thousands of individuals have provided feedback on the initial proposal for the new Quality Payment Program. Whether you formally submitted one of the nearly 4,000 comments we received, or were one of over 64,000 attendees at one of our outreach sessions, there have been record levels of engagement in this implementation. These conversations are grounding our priorities and we are hearing some hard, but important truths.
To start with, many are frustrated at the overwhelming amount of paperwork they have to do and about measures the become exercise in compliance, instead of quality improvement; about how technology has often distracted instead of supported patient care; and how an accumulation of many small things imposed from afar add up to the feeling that we just don’t get it. This gives us all a place to start thinking about a new framework and the drive to develop a roadmap that not only improves patient care, but does it by beginning to address some of the very real causes of physician burnout.
For all of you who care deeply about serving Medicare patients and are contributing to making the health care system work better, this is a step toward a valuable partnership. And, while we can’t act on every suggestion—your voices as caregivers have been heard and your partnership is having a very real effect on the implementation of this program.
All of this feedback falls into priority areas for us.

First Area of Feedback – Impact on patients.
First of all, you should know that patients, consumers, and families are overwhelmingly supportive of a payment system that pays more for what works and supports the delivery of better care. And physicians and clinicians agree and tell us, in the words of one physician, “Let us practice medicine, and not practice documentation and bureaucracy. We don’t have it in us. We are caregivers. Let us do our job.”
This is the first area of input: to keep the focus on patients.
We must create a system that sharpens the focus on paying for what helps your patients get and stay healthy, rewards collaboration and gives physicians back more time to spend on patients. Fifteen minutes spent tapping at a keyboard is 15 minutes that can’t be spent on patient care. So we have included fewer metrics and more flexibility and a menu of activities that physicians can choose from that are patient-centered– such as expanding office hours, developing specific care plans, or using evidence-based aids that help support shared decision-making. And rather than more documentation, all physicians will need to do in many cases is select an activity and attest to it.

Second Area of Feedback – Simplified reporting and feedback.  
The second major area is to do everything we can to reduce the reporting requirements, simplify the scoring, and clarify the rules. Physicians also expressed interest in moving towards a quality improvement program– with more frequent, useful feedback, and away from a compliance program.
We started by reducing by one-third the number of quality metrics that need to be reported and we have aligned the measures across categories to end repetitive reporting. We got rid of technology measures that hindered usability, and moved the focus from “clicking” to care provision and collaboration. Part of reducing burden is becoming more flexible. If physicians already report using a registry or as part of an ACO, we will accept that.
It’s also time to ask a lot more of the technology and technology vendors. Most technology doesn’t adapt to our workflow– we adapt to the technology. And this is particularly true in the area of what many call interoperability– but which most physicians describe as allowing data to move back and forth between systems so they can follow the movement of a patient after they make a referral.
The burden needs to be on the technology, not the user. EHR vendors and hospitals that use them will now be required to open their APIs– so data can move in and out of an application safely and securely– and technology can become plug and play. Today’s data silos are more a function of business practices than technology capability and we cannot tolerate it any longer. This will not only help you track referrals, but serve another purpose– to eliminate the “desktop lock” that occurred based on early EHR purchases.

Third Area of Feedback – Impact on small and rural practices.  
Paperwork is one thing if you practice here at Northwestern or Rush, but quite another if you’re a small or solo practice without much, if any, back office staff. Our third focal area is on the impact of this program on small and rural practices to make sure we have a level playing field. This has been an important part of many of our conversations as we travelled the country, including strong feedback from this Association.
We know from experience that small practices can be just as successful as larger practices if the bar to participating isn’t too administratively burdensome. We are working directly with physician user groups to listen to how we can design additional ways to make that easier. Even more exciting are opportunities to join new medical home models like our CPC+ model for smaller practices, which will provide fewer reporting requirements, innovative telemedicine opportunities, and qualify for a 5 percent bonus.
I should also mention that to help smaller and rural practices, we will be deploying technical assistance through a network of learning collaboratives that are already on the ground in local markets. We will spend $100 million over the next 5 years on those efforts to support small practices.

Fourth Area of Feedback –  Pathway for Advanced Alternative Payment Models  
We heard directly from many physicians, and specialists in particular, that a one-size-fits-all program just won’t work. That’s why our fourth area of focus is to create and offer more approaches and more pathways to models like our medical home model, which qualify for what we call Advanced APMs.
These are models that pay a 5 percent bonus for participation. For example, Accountable Care Organizations that believe their ability to improve care and lower costs enough to take on financial risk. Or, payment approaches like we have launched for cancer care and kidney care.
We have an innovation center that is launching or improving on new payment approaches, so that over the next few years, physicians have more options to participate in something that’s right for their practice and right for their patients. There’s a special advisory committee set up by Congress expressly for the purpose of working with the physician community to develop these new approaches.

Fifth Area of Feedback – Physician readiness for new program. 
Finally, we have listened to feedback from physicians who want to make sure they are prepared for all the changes to come. We are committed to making the start as smooth as possible.
Most physicians participate today in many of the elements of MACRA, but we are getting a lot of good points that we must find ways to make sure physicians feel set up for success.
Some of the things that are on the table include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really begins.

Looking Ahead
This insight– around patient-benefits, simplicity, flexibility and support– are the things that will make the difference between a set of goals from policymakers and something that actually works. And it’s how we will begin to move Medicare and the rest of the health care system forward and anticipate the next 50 years of Medicare beneficiaries.
But after listening to many patients and clinicians, personally visiting practices and hearing the concerns expressed by many, I have no illusions that the changes we all see as so important can happen overnight. I also know that even with good changes, no one will be happy with all the details and that change creates uncertainty. There are always unintended consequences of new laws and regulations and we will need to work through those changes as well. So I’m asking for your ongoing collaboration over the next several years, so that we can implement, receive feedback, iterate, and progress.
I made a comment earlier this year that we lost the hearts and minds of physicians. We won’t win them back with empty promises of quick fixes. We win them back by listening, by making progress even in small steps, and by calling attention to where the system remains dysfunctional. We don’t have the option of running from the challenges we face– because it’s at the very heart of the care we get, that our family gets, that our country gets. With 140 million people in the Medicare, Medicaid, Insurance exchange, and Children’s Health Insurance Program, many on fixed and modest incomes, we will always rely on you on the front lines in taking care of these Americans and allowing them to live their fullest lives.
We must use every opportunity to commit to the quadruple aim as the key to defining a new future for the health care system. I have also seen what happens when the tide turns and so have many of you. For example, a physician in New Jersey told me that as part of a Medical Home, he is setting up Skype Villages to connect his elderly patients to each other. Another in Oregon fulfilled her vision of being able to coordinate real-time mental health handoffs as a game changer for her community. A physician in Arkansas told me that, once ready to retire early, he was extending retirement to 70 because how he was getting paid caught up to how he wanted to practice. And places like Cornerstone become bedrocks of their communities.
In several short years, our nation has brought access to health to 20 million new Americans. Many didn’t think we would get this done. But through hard work, listening, and adjusting we are on our way to fulfilling our country’s promise to provide care to all Americans.
It is now time to turn our attention to the underpinnings of the care system. And when all of us — policy makers, physicians, patients, hospitals, and innovators– focus with a unified purpose, we can make the significant progress that I believe is ahead of us. We can do it. It’s our responsibility to do it. We have no choice, but to do it, and we will if we rally around patient care first and foremost. I look forward to taking on these challenges together.
Thank you for your having me today. And thank you for bringing your gifts to heal our country when we need it most. I look forward to our continued work together.

Originally published at http://www.aspenhealthcareconsulting.com/content/remarks-andy-slavitt-american-osteopathic-association