Best read of the week


Pa. Health System Trains Staff on Care for LGBTQ Patients
NBC10: Mainline Health is introducing a new service for LGBTQ patients. The hospital is in the process of training 11,000 staff members in order to give LGBTQ patients the best care.

Additional news media reports on MLH physicians and the health care industry, excerpted from MLH’s daily Morning News Report:

Main Line Health News…

‘I Thought I Was Going To Die’: First-Of-Its-Kind Treatment Uses Sound Waves To Treat Common Heart Condition
CBS3: There is a medical first being conducted in Pennsylvania. Sound waves are being tested to treat a common heart condition.


Regional Health News…

Jefferson exec’s health care vision shaped by unique obstetrics career, wife’s cancer battle
Philly Voice: Bruce Meyer has a big job, big ideas and a bigger family








Healthcare Business News…

A Year After Spinal Surgery, A $94,031 Bill Feels Like A Back-Breaker
Kaiser Health News: Since her spinal surgery, Liv Cannon has been able to work in the garden and play with her energetic dogs without the prospect of hours or days of pain.


Quality and Safety News…


Why You Should Take A Peek At Your Doctor’s Notes On Your Health
Kaiser Health News: Liz Salmi’s long battle with brain cancer has included surgery, chemotherapy and many doctors’ visits along the way. When she requested her medical records and read her doctor’s notes, she says, they were like a time capsule of the care she has received.


Patient Care News…

Miracle Machine Makes Heroic Rescues — And Leaves Patients In Limbo
Kaiser Health News: ECMO, the most aggressive form of life support available, pumps blood out of the body, oxygenates it and returns it to the body, keeping a person alive for days, weeks or months, even when their heart or lungs don’t work.

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BMRH represented at APIC Conference


By Jen Myers, Marketing

Nurse Marian Salamon, represented Bryn Mawr Rehabilitation Hospital (BMRH) Infection Prevention, with a poster presentation, while attending the 46th Annual Conference, APIC 2019, June 12-14 in Philadelphia, PA. The Association for Professionals in Infection Control and Epidemiology (APIC) is an international organization. APIC estimated 2,500 attendees for the 2019 conference.  Included were representatives from Canada, Egypt and various African nations.


The presentation represents the need for administration, medical, nursing, therapeutic staff and environmental services, support/collaborate with one another while averting CRE transmission.


The poster is entitled: Carbapenmase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Investigation and Containment in an Acute-Care Inpatient Physical Rehabilitation Hospital Mandates a Multi-Faceted Approach


Co-Authors, photographed left to right: L-R  Bernadette Abate, Assistant Nurse Manager Maple Unit BMRH; Judith Latham, Nurse Manager Maple Unit BMRH;  David Horwich, MD, VP Medical Affairs BMRH; Rose Plumari, VP Administration BMRH; Primary Author: Marian Salamon, Infection Preventionist; Absent: Caitlyn Fasano, Infection Preventionist, Co-Author

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Finding Future Physician Partners


Main Line HealthCare has physician opportunities for a variety of different specialties.  Do you know someone who you would recommend?  Please take a moment and review our top positions and provide the link to a peer for more information.

  1. OB/GYN Specialists in Plymouth Meeting/Oaks Service Area.  This is an exciting start-up opportunity with plenty of growth potential coupled with strong system support.
  2. Neurology in Paoli. This is a well-established program in a beautiful community.  Perfect for someone looking for a practice with immediate patient population.
  3. Endocrinology at MLH. This is an exciting growth opportunity. A service need coupled with the strong system support.
  4. Neurosurgery at Lankenau and Paoli. There is demand and exceptional clinical support. This opportunity is ready for the right candidate.

For a complete listing of all the physician opportunities at Main Line Healthcare, please visit our web page:

Or contact: Rose Caione,, 484.580.4146 or Sonia V. Schatz, , 484-580-1834.

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STEEEP Huddle:  E for Efficient


This week’s STEEEP Huddlecontributed by Steve Czapla, System director, IT Customer Support, focuses on the MLH IT department’s launch of a new self-service password reset service powered by ServiceNow. This service provides MLH employees with the ability to reset their own network password easily and securely from their workstation or mobile device. By simply completing a one-time registration and selecting a few short personal challenge questions, you can rid yourself of the need to place a call to the ServiceDesk. Register now by clicking here, it takes less than 2 minutes to complete. *You will be asked for your employee ID and cell phone number when registering so please locate and have it available when you register. Once you’re enrolled, the next time you need to reset your password, you can do so easily from a non-MLH device or from your MLH device.


Please use this attached STEEEP Huddle template as a guide to conduct your unit-based Huddle or during your departmental staff meeting. In clinical areas that huddle every day, the discussion can expand over the course of the week to include specific examples of how that week’s topic applies to the unit or workgroup. For non-clinical areas, determine the best way to cover the weekly STEEEP Huddle in your departmental meetings. You can also access the STEEEP Huddle on the PE2020 site:


Reminder: In order to reinforce accountability, the question, “My unit routinely conducts the STEEEP Huddle,” will be included in our employee engagement survey this fall.

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Riddle Hospital Pro-Am Golf Tournament needs sponsors


By John C. Munshower, D.O., FACSG, board certified Family Medicine & Geriatrics, MLHS- clinical operations leader, division chief, Riddle Hospital-Dept. Family Medicine – MLHS


Riddle Hospital Colleagues:

As many of you know, the Riddle HealthCare Foundation hosts several major fundraising events throughout the year, benefiting the hospital in various ways.  Through the support of generous donors, the Riddle HealthCare Foundation has been able to purchase much needed equipment, send team members to conferences, and even offset expenses from large renovations like the emergency department or birthplace. The next major fundraising event for the Foundation is the annual Pro-Am Golf tournament coming up this fall , and this year I am happy to share with you all I am serving as the “Physician Chair.”  I took on this role to help promote the event with all of you, so we can have the best physician turnout to date!  This year’s tournament is on Thursday, September 12th at DuPont Country Club, and is a really fun way to support the Foundation, and particularly this year’s beneficiary, the EMS Department.


Sponsorships start at $500 for an individual golfer. The official brochure with all of the sponsorship details are coming soon, but for now please hold the date and let me know if we can count on your support!


Thank you all for your time and consideration. Please let me, or any of the foundation staff know if you have any questions at all. This is truly a great day to come out, turn off your pagers and cell phones from business calls, and simply enjoy a day with friends!

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Non-emergent ambulance transfers of admitted patients between hospitals must be pre-approved by Independence Blue Cross for their members.


By Christine C. Stallkamp, MD FAAFP, System medical Ddirector, Revenue Integrity and Care Coordination


Effective 6/1/2019, IBC stated that they will require pre-certifications for any of their patients travelling between acute care hospitals for non-emergent needs. This means that patients who need to be transferred for continuity of care with their PCP, specialist or surgeon must first get this approval, and it applies to transfers between our own MLH hospitals. The transfer center will attempt to obtain the approval on your behalf.  This may cause a delay in transfer for these patients, especially on nights and weekends outside of IBC’s typical business hours.


If you have a patient that is denied approval by IBC for an ambulance transfer, and you feel that this decision is clinically inappropriate or is detrimental to the care of the patient (for example, oncology care at Jefferson with a cancer-related complication, or recent orthopedic surgery at Crozer with a surgical complication), please let the transfer center know and the UM physician team can assist you in obtaining a Peer to Peer appeal phone call with the IBC medical director.  Please note that even if the patient is willing to “self-pay” out of pocket for the ambulance transfer, the hospitalization will still require a precertification/approval from IBC.

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SAVE THE DATE!  Population Health Day 2019: Creating Connections


Creating Connections, Conversations to Advance a Healthy Community for All, will be held on Friday October 18, 2019, 8am – 3pm at Lankenau Medical Center, Annenberg Conference Center. The program is a day of collaborative talks and roundtable discussions to assess the health of our community and highlight actions for change. Contact Megan Jones at or at 484.476.4625 for additional information.

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The diagnosis of malnutrition is under high scrutiny by Medicare


By Christine C Stallkamp MD FAAFP, System medical director, Revenue Integrity and Care Coordination


The diagnosis of malnutrition is often made with support of the nutrition team, using a national guideline, called ASPEN criteria.  Once the diagnosis is made, the physician must document the diagnosis and plan for treating the malnutrition. Other clinical findings, such as cachexia, weight loss over a defined period of time, BMI, hypo-albuminemia, muscle wasting, etc, must be documented as well to support the diagnosis. Further, documentation explaining how the malnutrition is impacting medical decision-making is key.


In the face of audits by Medicare and commercial payors, MLH must ensure proper assignment of the malnutrition diagnosis.  Please consider the following points when documenting malnutrition:

  • If you think your patient has a diagnosis of malnutrition, please consult the nutrition team to help you confirm the diagnosis, if they are not already on the case.
  • Use clear, recurrent documentation of malnutrition in progress notes, once the diagnosis is made. If you answer a query for malnutrition, this alone is not enough to support the diagnosis under potential audits.
  • Include daily documentation of how the malnutrition is being monitored and treated, and include it as a diagnosis on the discharge summary.
  • Support the diagnosis by including signs and symptoms of malnutrition in your daily notes.
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Groundbreaking diagnostic test developed at LIMR receives FDA authorization


For the first time a test that can aid in the detection of an infection in the synovial fluid surrounding a patient’s joint replacement has been authorized by the U.S. Food and Drug Administration (FDA). The Synovasure Alpha Defensin Lateral Flow Test Kit was developed by Carl Deirmengian, MD, an orthopedic surgeon in the Rothman Institute at Main Line Health and a clinical assistant professor of the Lankenau Institute for Medical Research (LIMR).


Previously, there were “no FDA-authorized diagnostic tests specifically designed to help health care professionals determine whether the inflammation around a prosthetic joint was due to an infection or another cause,” stated Tim Stenzel, MD, PhD, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health.


In the United States, approximately 700,000 knees and 400,000 hips are replaced every year, according to the American Academy of Orthopedic Surgery. While most of the surgeries provide pain-free function, some patients experience ongoing pain or complications and require more surgery. One reason for revision surgery is periprosthetic joint infection (PJI), which involves the joint prosthesis and adjacent tissue. PJI can be masked by other inflammatory disorders such as gout, arthritis or non-infectious loosening of implants, making accurate diagnosis difficult. Until now.


The Synovasure Alpha Defensin Lateral Flow Test Kit is the first diagnostic test authorized by the FDA that can assist clinicians in determining if the inflammation around a joint replacement is due to PJI. Knowing the exact cause of a patient’s inflammation can help clinicians appropriately treat failed prosthetic joints and reduce patient risk.


“We are thrilled that the FDA has authorized the diagnostic test, which demonstrated excellent performance in the clinical trial,” said Dr. Deirmengian. “Our goal was to provide surgeons with a more consistent and standardized approach to diagnose infection, which can both improve patient care and reduce health care costs.”


The test, which can detect PJI in 10 to 20 minutes, was developed by Dr. Deirmengian while his company, CD Diagnostics (later acquired by Zimmer Biomet), was incubated at LIMR.


While most previous strategies attempting to diagnose PJI aimed at trying to detect the pathogen, Dr. Deirmengian started looking instead at the characteristics of the patient’s immune response. Experiments completed in his LIMR lab showed that alpha defensin, a protein released by white blood cells that have been activated in response to infection, was an ideal biomarker for PJI. His team devised a test that could pinpoint alpha defensin in joint-surrounding synovial fluid.


“Our discovery 15 years ago that the white blood cells in a joint have a signature response to infection was a critical finding in the eventual development of the alpha defensin test,” said Dr. Deirmengian.


Before the FDA authorized Synovasure, regulators reviewed results from a clinical trial that analyzed 305 synovial fluid samples prospectively collected from individuals with a total knee or hip joint replacement and who were being evaluated for revision surgery. The study showed that 89.5% of subjects with an infection diagnosis based on standard-of-care criteria also were identified as positive for alpha defensin by the Synovasure Lateral Flow Test Kit.


George Prendergast, PhD, president and CEO of LIMR, congratulated Dr. Deirmengian and his team for their stellar achievement. “We are so proud of the role LIMR played in incubating Dr. Deirmengian’s technology and company in their very earliest stages,” said Dr. Prendergast. “Here at LIMR we employ a hybrid academic and entrepreneurial culture — we call it ‘acapreneurial’ — that organizes biomedical research so as to better leverage its transformative potential.”


A central element of LIMR’s acapreneurial model is the integration of a biotechnology start-up company incubator located side-by-side with laboratory and clinical researchers seeking to move their discoveries to the clinic. This innovative approach has enabled the launch of several biotechnology companies, including Dr. Deirmengian’s CD Diagnostics. Moreover, LIMR’s scientists have been awarded many patents for their innovations in healthcare. To learn more about LIMR’s technology development, visit


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Clinical Trial of the Week: Treatment trial for men with localized intermediate-risk prostate cancer


By Donna Loyle, communications specialist, LIMR


June is Men’s Health Month, which makes this an ideal time to highlight clinical study #NRG GU005, a randomized phase III trial comparing stereotactic body radiation therapy (SBRT) to intensity-modulated radiation therapy (IMRT) in men with stage IIA-B prostate cancer.


The study seeks to determine if SBRT is superior to IMRT in terms of genitourinary and gastrointestinal toxicity. There are two study arms: One undergoes IMRT once daily over less than 32 business days. The other undergoes SBRT at least every other day over less than 12 business days. Patients then undergo follow-up care for two years.


Study #NRG GU005 approved for Lankenau Medical Center. The principal investigators are Albert DeNittis, MD, and Paul Gilman, MD. For more, email or visit

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