Understanding the important work of the Nevada State Public Health Laboratory

Dr. Thomas Schwenk Dean of the School of Medicine and VP of Health Science

Most of you probably know little about the work of the Nevada State Public Health Laboratory (NSPHL). You should know more, because the lab scientists and technicians are literally working around the clock to protect you and all Nevadans from a wide range of potential infections, food-borne illness, and unsafe water, as well as providing emergency response to biological and chemical terrorism, and testing every Nevada baby for more than 30 hereditary diseases.

Established in 1909, the NSPHL serves as Nevada’s centralized lab, representing a first line of defense in the rapid detection of a public health threat. The laboratory is part of the University of Nevada, Reno School of Medicine and located on the University campus.

Here are a few facts to help you understand the important work of the NSPHL and how it serves the entire state, so well. The laboratory performs over 550,000 tests each year to help keep Nevadans safe and healthy—that’s more than 2,000 tests each day. Over 400,000 of those tests are conducted on newborn babies, with each baby being tested twice in the first 10-14 days of life for conditions ranging from cystic fibrosis to congenital hypothyroidism to sickle cell disease to severe combined immunodeficiency disease. Every day, the NSPHL is confronted with questions and challenges, ranging from the safety of water in the Truckee River to outbreaks of whooping cough in local schools to whether the West Nile virus has come to Nevada.

The NSPHL is staffed by over 30 scientists and technicians, with a budget of over $7m/year. But, the cost per Nevada resident has dropped over the years, with state funding per capita declining from $644 in 1998 to $564 in 2018 due to an increasing level of efficiency and success by the laboratory management in seeking grants and contracts from other sources.

The NSPHL also has a new Director, Mark Pandori, Ph.D. Dr. Pandori has over 15 years of high-level experience in public health laboratory leadership, most recently as Director of the Alameda County Public Health Laboratory in Oakland, California. He earned his Ph.D. from the University of California, San Diego, completed a fellowship at Harvard University, and holds several certifications in diagnostics and public health microbiology. He will serve as a faculty member in the Department of Pathology and Laboratory Medicine at UNR Med where he will teach medical students and residents, in addition to his laboratory leadership responsibilities.

Dr. Pandori will continue the outstanding tradition of public health leadership that the state has enjoyed with Dr. Trudy Larson, professor and dean of the School of Community Health Sciences, who has served as NSPHL director since July 2014.

The NSPHL is an example of community service and engagement that characterizes the core mission of UNR Med at its best, to serve the state, to improve the health and quality of life and to contribute to a Healthy Nevada. Nevada residents can be confident that their public health is in good hands with the leaders and scientists at the Nevada State Public Health Laboratory.

Trust!

If you’re not at the table, you’re on the menu

Physicians are busy and need representation in a myriad of legislative, professional and community forums. Our priority forums are the places where we practice medicine and interact with our patients. They trust us to provide the best possible care.

This is why WCMS and NSMA are so important to us as professionals. They provide a critical forum for physicians to set priorities that lead to optimum healthcare in our community. Together, our collective voices will be loud and strong before the legislative and regulatory bodies that shape how we practice medicine. We are present and active with other professional associations in enhancing the quality of care and influencing regulations that affect us and colleagues.

My goals for 2020 are to:

Increase our members by 20%
Work even more closely with the UNR Reno School of Medicine
Work closely with AWCMS
Develop closer relationships with our younger generation physicians
Work to improve the health of our patients in Washoe County

To achieve these goals:

Each of us to bring one new member this year. The endorsement of a peer is far more valuable than any ad, email or brochure that may cross your desk. So, please bring in a member and help that person get engaged. As an added incentive, the first member to enroll seven new members will be awarded with a wine weekend for two in Sonoma County. My challenge is for one of you to beat me to it!
Collaboration is key to our success. It enables WCMS to tap resources and talents with a wide range of healthcare expertise in this community without duplicating efforts. We will continue to strengthen our community partnerships, with special emphasis on the medical school, and seek one or two new ones.
One of the most important partnerships is with the Alliance of WCMS, an awesome yet unrealized resource for recruiting and retaining members. We plan to work more closely than ever with the Alliance in enhancing both organizations.
We must find successful ways to engage young physicians and new physicians coming to Reno. I welcome any and all ideas.

Finally, thanks to all who have been or are engaged on the board, a committee or commission. Your contributions are what makes this a great organization. I invite those of you who are not engaged, to get involved. Join a committee, attend the events and share you story through our newsletter.

I’m excited about the year ahead and look forward to leading the 2020 board.

WCMS Year in Review

A busy year is winding down. Many gave your time, expertise and passion during an intense legislative year. Thank you for the hours spent formulating strategies around our legislative priorities, participating in our weekly Legislative Core Group and attending the NSMA House of Delegates in fall. A full listing of our legislative successes is available.

I thank our NSMA commissions and Committee Members for their time and wisdom. You helped to move the practice of medicine forward and you paved the way for continued representation by the House of Medicine in this emerging world of corporate practice.

Special thanks to Amanda VanderClay, MD, completing her board term; Vijay Aluru, MD, our resident board member now in graduate training, and Jackie McBride, our third-year medical student.

Our member database is live. Now, it is your responsibility to help keep it updated. If you haven’t done so, go to nvdoctors.org and click “log in.”
Please check our refreshed newsletter and website and consider joining us for the networking Happy Hour every Third Thursday at the Renaissance Shore Bar.

It has been a great experience serving as you president. I appreciate the encouragement, counsel and support. Let’s make 2020 visionary.

Please join us in welcoming NSMA’s new Executive Director, Jaron Hildebrand.

Prior to joining NSMA, Jaron has served as the director of government affairs for the Nevada Trucking Association since October 2012. Jaron has an extensive background in government affairs and has lobbied five sessions of the Nevada Legislature. He also has political and campaign experience working as field director for Congressman Mark Amodei where he coordinated and promoted events, established grassroots relationships and oversaw logistical operations for campaign materials sent throughout the state.
Jaron is a native of Reno, Nevada. He graduated from the University of Nevada in 2010, with Bachelor of Political Science and Communications, while minoring in European History. Jaron is an adventurous traveler, a sports enthusiast and enjoys spending time with his wife Kaitlin and eight-month-old son, Calvin.
You can contact Jaron at the NSMA office at (775) 825-6788 or email him directly at [email protected]

It is that time of year again — July 1 is here and along with it, the changing of the medical season. It is time for all of us to transition from the roles we grew comfortable with into a new position with new responsibilities and expectations.

Some residents are graduating and embarking on fellowship or new jobs—with at least 11 years of education under their belts.

Interns are steadier on their feet in the hospital. For some, just 2 years until graduation. For others, they are finally moving into the specialty training.

Former fourth year medical students have graduated and taken the Hippocratic oath. They are falling from the top of the medical school food chain to getting lost in the corridors of a new hospital.

Our new fourth year medical students are preparing to apply to residencies and are happy to waive goodbye to the grueling MS3.

Newly minted MS3’s — like myself—are anxiously awaiting board score results and the first days of rotations. We have climbed the mountain that was step 1 only to realize it was just a foothill and the steepest slopes are still to come.

Our incoming MS2’s spent the last several months watching the upperclassmen stress about Step 1 and are enjoying “the last summer of their lives” before they too start the step 1 climb.
And our incoming MS1’s are excited, hopeful, and in preparation for the start of their medical education.

Good luck to everyone in their transitions and congratulations on another year of progress towards your goals—whatever they may be. And if you have already made your full metamorphosis into a provider, look for the students finding their footing and give them a hand during this change of seasons.

The NSMA house of delegates is the forum for us to present and debate the ideas, concerns, and issues that affect our daily work lives and the health of all Nevadans, to set policies and give direction to our lobbyists and our representatives to the AMA to put those ideas and issues into action on the state and federal levels. This is a particularly important meeting for our interests to be forwarded to and heard by our legislators during Nevada Legislative session. If you want to have your say regarding any other issues, you need to PARTICIPATE!

WCMS Bylaws changes now require interested physicians to volunteer to participate as delegates and alternate delegates for the County delegation to he annual NSMA meeting to be held at The Row, Reno NV. For more information on NSMA’s annual meeting please visit www.nvdoctors.org

This year, both delegates and alternate delegates are encouraged to participate in the House of Delegates meeting, to bring forth ideas, comments, opinions, and resolutions regarding resolutions brought to the house of delegates; however, each county society is only allotted a finite number or delegates for votes. Alternate delegates will be “seated as delegates” when necessary to fill our quota for votes, to maximize our voice and allow for as much participation as possible.

Sign-ups by email for our delegation positions start today and will be on a “first come” basis to fill our allowed number of delegates and alternates.

If you have a gripe, a concern, or an idea about how government, hospitals, other doctors, insurers, etc affect your practice, or about how to better serve your patients, now is the time to get involved and be heard at the NSMA house of delegates.

NSMA has a core group of dedicated members who put in incredible effort during the last legislative session focusing on advocacy. Ask any of these folks about the value of NSMA and they will readily jump in with successes from 2019: our efforts to improve the opioid law to make the rules more patient and physician friendly, or to stop very bad legislation to unwind tort reform, or some of our public health successes. Those physicians who may be less “plugged in” to our daily activities often ask me what is the value of my membership in NSMA? What is it all for?

For those physicians and for each of us, it’s worth a pause to consider: What would have happened to Nevada physicians if the NSMA was not at the 2019 Legislative Session?

Without the NSMA in 2019, you as a Nevada physician would face:

Less Protection from frivolous lawsuits and weakening of KODIN
Continued frustration for patients and physicians dealing with opioid prescriptions
More mandated CME and yearly unfunded reporting requirements
Mandated E-prescribing of all medications starting in 2020, without exemptions or waivers
An outright ban on balance billing with no protection for physicians’ contracts or the market
Scope of practice creep including independence for Physicians Assistants
A moratorium on necessary surgeries for babies and children to correct hypospadias
No improvements for patient protections in insurance coverage
No increased transparency in insurance rental markets
No Maternal Mortality Review Committee to improve maternal mortality and morbidity

Fortunately, NSMA was there for you and your patients, working tirelessly to improve the practice of medicine in Nevada. In 2019, NSMA:

Prevented legislation from being introduced that would impact tort reform protections
Improved the process of opioid prescribing. (AB239)
Stopped harmful mandates including CMEs and reporting requirements, instead working with agencies to provide physicians who treat veterans with information to treat their patients.
Negotiated a mandate on e-prescribing to apply to only prescriptions for controlled substances, to be implement in 2021 in alignment with new federal rules and which allows for several exemptions and waivers to ensure the needs of patient care and physician practices are met. (AB310)
Negotiated a hard-fought deal on out of network billing in emergency situations that includes protections for existing contracts, dispute resolution system that considers the low dollar amounts of most out of network bills and establish a reporting requirement that ensures transparency in networks and contracting practices of insurers. (AB469)
Prevented independence for PAs and began discussions to help PAs be successful in their practices within the practice team. These discussions will be on-going through the interim.
Prevented legislation that would ban necessary surgeries and began an important dialogue with proponents of the legislation to better communicate the clinical side to address their concerns of unnecessary surgeries.
Improved patient protections by protecting pre-existing conditions and requiring insurance agencies to register case contacts with the office of consumer health advocates to help patients navigate complicated insurance plans and sparse networks.
Improved transparency by requiring insurers to disclose to physicians, those renting networks and provide physicians with the opportunity to decline to be a part of the rental arrangement.
Established Nevada’s Maternal Mortality Review Committee (AB169) to study instances of maternal mortality and morbidity and to make recommendations to improve the lives of Nevada mothers, and
Represented Nevada Physicians with dedication and integrity.

As we often say at NSMA about politics and policy making, “you’re either at the table or you’re on the menu.” NSMA was at the table for you in 2019, and with your help, we will continue to be there, protecting you and your patients for years to come.

Geriatric Specialty Care HBMC, established in 2001, serves more than 1,100 Medicare beneficiaries in Gardnerville, Carson City, Reno, Sparks, Fallon, Fernley and Elko. Patients residing in private homes, assisted living and group care settings are seen onsite by clinicians. In addition, patients, families and caregivers have direct access to a comprehensive care coordination team that includes nurses, medical assistants and other support staff. GSC employs face-to-face, cloud-based electronic medical record technology and telehealth for chronic care management, transitional care and community-based programs serving their patients, families and caregivers.

Washoe County Medical Society salutes Reno-based Geriatric Specialty Care (GSC) for being ranked in the top 2% nationally of Home Based Medical Care (HBMC) practices.

The ranking comes from a review of Medicare claims in 2013-14 by the American Academy of Home Care Medicine (AAHCM), the Home Centered Care Institute (HCCI) and Westat, an independent research services organization. The Geriatric Specialty Care team includes Washoe County Medical Society (WCMS) members: Reed Dopf, MD, WCMS president; Carl Heard, MD; Steven Phillips, MD, and Steven Rubin, MD.

“We are proud of being ranked among the top 2% nationwide,” said Steven Phillips, MD, president and CEO, “But more important, by seeing patients where they live, we get a better picture of their situations, which results in a more robust care plan for chronic illness management. In addition, our care model is saving an average of $10,000 a year per patient.”
The Geriatric Specialty Care HBMC practice was among the top 10 of 330 HBMC programs nationwide which made more than 100 house call with patients in 2014. The programs were evaluated for overall patient care and potential savings to the Medicare and Medicaid program (CMS).

The claims review analyzed fee-for-service Medicare claims that included patient demographics, medical conditions, a frailty index that assesses one’s ability to perform daily activities (dressing, grooming, bathing, eating and toileting), risk adjustment scores, along with other benchmarks to characterize patient complexity. In addition, utilization of emergency department, acute inpatient hospital and home health care services, along with claims-based quality measures used for Accountable Care Organizations (ACOs) and the Independence at Home (IAH) demonstration were used to characterize practice performance.

She is a family medicine physician and works in the urgent care at Saint Mary’s Regional Medical Center. Although she is a practicing physician, her journey in the medical field started out as a physician’s assistant. Dr. Curry-Winchell has a master’s in physician assistant studies which took her two years to achieve after completing her undergraduate program. She practiced as a physician assistant for three years in occupational, family, and urgent care specialties. Her PA position gave her a foundation to practicing medicine.

Dr. Curry-Winchell explained that she was eager to learn more and wanted to be able to provide as much care as she could to her patients as a physician. So, she made the switch to becoming a physician to increase her knowledge of medicine. Once deciding to make that switch from physician assistant to physician, she had to go back to medical school for four years. After completing her four years of medical school, she then started her three years of residency focusing on family medicine. This is a grand total of eleven years of education to be in her position.

When asking Dr. Curry-Winchell about what the 20 under 40 award means to her she simply explained that she was very grateful and thankful to have received this award. “ The best part was the opportunity to highlight the charity, the Women and Children’s Center of the Sierra,” Dr. Curry-Winchell said, adding that she volunteers with this organization

The selection committee is made up of two board members from Young Professionals Network (YPN), two former 20 under 40 awards recipients, two area executives, and lastly one community member who has been involved significantly with the 20 under 40 award program. In order for a candidate to stand out, individual professional success and community leadership is among the top criteria for nominations.

The 2019 Sierra Nevada Top 20 Powerful Women is sponsored by Northern Nevada Business. This prestigious award is given to a woman who facilitates change and continues to help different organizations throughout the community. Another accolade she has been awarded is resident teaching honor roll at the UNR School of Medicine, as well as multiple outstanding patient care awards. Dr. Curry-Winchell also works at the CARES program as an assistant medical examiner.

These accolades surely will not be the only ones received by Dr. Curry-Winchell throughout her medical career. She has made such an impact on the community and will continue to do so. Jennifer Williamson, business development and marketing communications manager at Saint Mary’s, who works closely with Dr. Curry-Winchell could not say enough about her.

She explained, “Dr. Curry-Winchell is always willing to help when called upon and does it with a smile on her face. All of the people and patients that Dr. Curry-Winchell interacts with have nothing but pleasant things to say about her.” Those are just a few highlights as to why she was awarded the 20 under 40 award.

Studying the structure of the human body is one of the most important courses for health care professionals. All physicians remember their first day in the anatomy lab. We enter the laboratory with anxiety, fear, wonder and awe.

We also enter the anatomy lab with a clear understanding of the sacredness of the human body, and a clear appreciation of the sacredness of the covenant we share with our first patient-an anatomical donor whose final act was to donate their body for the training of health care professionals. We remember that first day with extreme gratitude to the generosity of the donor and their ultimate gift to medical education.

Last week we honored these donors-our students’ very first patients-during our annual Anatomical Donation Memorial Service at Walton’s Sierra Chapel. Every summer, UNR Med first-year students express their appreciation to the donors’ families and friends during a memorial service featuring song, speech and poetry.

The memorial service provides a fitting tribute and closure to the yearlong anatomy course and provides medical students with the opportunity to show their appreciation for the great gift their donors have made to anatomical research and education. The School of Medicine and our students invite the family and friends of donors to attend the service to learn more about the anatomical donation program and gain a sense of closure for the loss of their loved one.

Through the anatomical donation program at UNR Med, which began in 1987, donors teach medical students about far more than gross anatomy. Cadavers posthumously teach medical students how to care, detach, work as a team and develop a sense of curiosity and discovery.

Many medical schools solely provide anatomy training through technology. While we believe there is no substitute for true human touch, it is important for us to acknowledge that technology can enhance the ever-evolving study of human anatomy.

As of last fall, the anatomy lab now includes an AnatomageTM life-sized digital dissection table, made possible through a generous gift from the William N. Pennington Foundation. Not meant as a substitute for, but rather a supplement to human cadavers, life-sized cadavers are revolutionizing anatomy in three-dimensional high definition with the click of a button or touch of a screen that resembles and oversized computer tablet mounted on a wheeled stretcher.

The AnatomageTM Table allows medical students to examine a virtual human body layer-by-layer, perform digital dissections and identify anatomical features with ultra-high quality visualization that provides instant access to photorealistic human anatomy.

In the traditional cadaver course of dissection, whether removing a vein, artery or organ, only so much cutting can be done and internal or underside views can be hidden or blocked. By pausing the digital dissection, students are able to interact with the dissection, turn it around and look at in three-dimensions.

Second-year medical student Miguel Gonzales, Class of 2022, said the use of both cadavers and technology provides a beneficial blend of instruction in anatomy education.

“I strongly believe there is no substitute for having actual cadavers, but the Anatomage Table offers supplemental instruction that cannot be achieved with a traditional cadaver,” Gonzalez said. “The ability to view a perfect, digital cadaver allows me to see and learn everything I need to know to build a solid anatomy foundation for working on a more challenging, traditional cadaver.”

But the Anatomage Table is a supplement to, not a replacement for, traditional dissection. It cannot at all replace the emotional power of understanding the life and death of a cadaver donor, or the educational value of memorializing the donor’s gift with poetry, song and eulogies, or the professional value of learning how to thank the family for their loved one’s ultimate gift.

Understanding the important work of the Nevada State Public Health Laboratory

Trust!

If you’re not at the table, you’re on the menu

My goals for 2020 are to:

To achieve these goals:

WCMS Year in Review

Please join us in welcoming NSMA’s new Executive Director, Jaron Hildebrand.

Changing of the Seasons

Call For Delegates to the NSMA Annual Meeting

If you have a gripe, a concern, or an idea about how government, hospitals, other doctors, insurers, etc affect your practice, or about how to better serve your patients, now is the time to get involved and be heard at the NSMA house of delegates.

What if Nevada State Medical Association was not at the 2019 Legislative Session?

Geriatric Specialty Care Home-Based Medical Care Practice Receives National Recognition

Geriatric Specialty Care

HBMC Average

Paving the Way for Young Medical Professionals

Teaching Anatomy Through Tech and Touch