Invision Health Announcements

Margaret White, Family Nurse Practitioner, will join InvisionHealth on November 1,  2013. Dr. William Stephan and Margaret White, FNP,  have an office located at 4080 Delaware Avenue in Tonawanda, NY.

Margaret completed both her Bachelor of Science Degree in Nursing and her Master of  Science in Nursing from Niagara University.  In addition, she completed an Advanced Concepts in Critical Care program at Walter Reed Army Medical center in Washington, D.C.

Margaret has had vast experience working in both hospitals and private practice as a health care provider. She is a welcome addition to the InvisionHealth Family Practice medical staff .

Dr. William Stephan, a Family Medicine physician, will join InvisionHealth on November 1,  2013. Dr. Stephan’s office is located at 4080 Delaware Avenue in Tonawanda, NY.

As a member of our InvisionHealth Primary Care Team, Dr. Stephan is trained to assist patients of all ages. His patient-centered approach focuses on health and wellness education, disease prevention, and the treatment of acute and chronic illness and injury. True to the InvisionHealth mission, Dr. Stephan provides comprehensive and compassionate care.

Dr. Stephan completed his Bachelor of Arts degree with a major in Chemistry at Wesleyan University in Middletown, Connecticut. He is a graduate of University at Buffalo School of Medicine. Dr Stephan’s Family Medicine residency was completed at Southside Hospital in Bay Shore, New York, where he served as Co-Chief Resident.

Over the past 25 years, Dr. Stephan has practiced Family Medicine, the last eighteen years of which he has practiced in the Buffalo area. Dr. Stephan and our other InvisionHealth primary care physicians, continue to welcome new patients.

Thought-provoking Idea Provides Basis for Unique NCI Grant Awarded to RPCI Researcher

BUFFALO, NY — The National Cancer Institute’s (NCI) new Provocative Questions research funding program has awarded a prestigious grant to a researcher at Roswell Park Cancer Institute (RPCI) to investigate a promising but neglected or unexplored area of cancer research.

David W. Goodrich, PhD, Professor of Oncology in the Department of Pharmacology and Therapeutics, recently received a two-year, $406,247 award from the Provocative Questions Project.

The Provocative Questions Project emerged in 2012 in an effort to tackle long-standing questions about our understanding of cancer biology and cancer control. The grant is part of the NCI'sProvocative Questions Project to challenge cancer researchers to provide answers for 24 perplexing questions in cancer research. NCI solicited the scientific community’s help to formulate the list of key questions that, if answered, could lead to significant research advances.

Dr. Goodrich’s proposed research will aim to answer a question concerning the Mechanisms of Tumor Development or Recurrence: How does the order in which mutations or epigenetic changes occur alter cancer phenotypes or affect the efficacy of targeted therapies?

All cancers occur when something goes wrong in the DNA of a cell—a gene mutates or changes in a way that causes the cell to multiply haphazardly, creating a tumor, explains Dr. Goodrich.

“Scientists are cataloguing all the gene mutations that occur in human cancers, and we now know that each cancer contains many mutations that determine how the cancer behaves and how it responds to therapy,” he said. “What we don’t know, however, is whether the order in which these mutations occur influences these characteristics.”

His project will create a novel model to test whether varying the order and timing of mutations in two genes important for human prostate cancer, the PTEN and RB1 tumor suppressor genes, will ultimately affect the cancer’s aggressiveness and how it responds to therapy.

“Whether the order of mutations influences a cancer’s behavior is an important question for personalized medicine because how we treat a patient may be determined not only by the mutations in their cancer, but also on the order in which those mutations are acquired. Finding an answer to this provocative question will be significant for improving patient therapy and prognosis,” says Dr. Goodrich.

More than $12 million will be distributed to 30 grant recipients nationwide in this first of two funding cycles. Although each investigator takes on a separate distinct question, their combined impact will be substantial, and potentially change the way scientists approach cancer research and therapy.

RPCI Researchers Discover Novel Mechanism of Tumor Cell Invasion in Melanoma

BUFFALO, NY — The most devastating feature of cancer is that it often spreads throughout the human body and forms secondary tumors also known as metastases. One of the most aggressive metastatic cancers with no currently available curative therapy is melanoma, a type of skin cancer that originates from melanocytes, cells that normally make skin tan. Lifetime risk and mortality rates of metastatic melanoma have been steadily increasing for decades.

Formation of metastases largely depends on the ability of tumor cells to grow through surrounding healthy tissues, a process termed invasion. Cell invasion is controlled by a subset of G- proteins, a.k.a. guanosine nucleotide-binding proteins. These proteins could function only when bound to a special molecule, nucleotide guanosine triphosphate (GTP).

In a recent issue of Cell Reports, researchers from Roswell Park Cancer Institute (RPCI) and the University of Michigan, Ann Arbor, discovered a previously unrecognized mechanism by which tumor cells regulate activity of G-proteins and invasion. This mechanism is availability of GTP. Using cells from metastatic melanoma, researchers led by Mikhail A. Nikiforov, PhD, Professor of Oncology and Researcher in the Department of Cell Stress Biology at RPCI, discovered a gene, GMPR (guanosine monophoshate reductase) that mildly inhibits production of GTP in the cell.

Interestingly, this mild inhibition was sufficient to reduce activity of several G-proteins and, subsequently, invasion. Additionally, Dr. Nikiforov’s group demonstrated that invasion of melanoma cells could be regulated by the amounts of guanosine in cell culture media.

“If this is what is occurring in vivo, than we may be able to limit melanoma metastases by regulating guanosine amounts in human body,” says the study’s first author Joseph Wawrzyniak, a Ph.D. student and Research Affiliate in the Department of Cell Stress Biology at RPCI.

Moreover, the researchers discovered that amounts of GMPR were lower in samples of invasive than non-invasive human melanomas. Why is this important? Currently, there are no diagnostic and/or prognostic molecular markers for melanoma used in clinical settings. This could be exemplified by the fact that, according to Archives of Pathology & Laboratory Medicine, a false-negative diagnosis of melanoma was the single most common reason for filing a claim against pathologists between 1998 and 2003.

“Since GMPR expression differs between non-invasive and invasive melanomas at very early stages of the disease, this gene has a potential to be developed into diagnostic or prognostic marker,” says Dr. Nikiforov. “Accordingly, because of support from National Cancer Institute, American Cancer Society and private donors such as the Tietgen Family Foundation, experiments aiming at identification of novel markers for melanoma are currently underway.”

Lower-cost options to highest-cost drugs within reach

By Richard Vienne, D.O.

Back in 2005, 53 percent of prescriptions in upstate New York were filled with a generic. That prompted Univera Healthcare to launch a campaign to encourage people to ask their doctor or pharmacist about lower-cost options. Generics are approved by the Food and Drug Administration as being as safe and effective as their brand-name counterparts, at a lower cost. Today, 80 percent of prescriptions here are filled with a generic, saving upstate New Yorkers more than $1 billion since Univera’s effort began.       

The next big opportunity to reduce drug spending is with a class of medications known as biologics. These are drugs made with living organisms rather than chemical compounds. Biologics are the highest-cost medications, and are used to treat cancer, rheumatoid arthritis, multiple sclerosis and other conditions. 

Prices for biologics can range from $1,000 to more than $50,000 per treatment. Some can cost hundreds of thousands of dollars per year per patient. By 2014, 40 percent of all prescription drug spending is expected to be on these complex medications that are used by 2 percent of the population. 

Many biologics have lower-cost counterparts known as biosimilars, so named because they are highly similar to an already approved biological product and have the same safety profile and clinical benefit. While biosimilars aren’t yet available in the U.S., patients in Europe and Asia have used them to lower treatment costs by as much as 40 percent. One study projects that the U.S. could save $250 billion over 10 years if just 11 biosimilars were to enter the market. With more than 13,000 upstate New Yorkers suffering from multiple sclerosis alone, according to a Univera Healthcare Fact Sheet, interest here in biosimilars is high.   

The Affordable Care Act directs the FDA to speed approval of biosimilars to promote competition and reduce costs. While the federal government will determine whether particular biosimilars are interchangeable with the originals, each state will determine its own policy on substitutions. This has made the states the battleground for brand-name drug makers to defend their turf. This year alone, large pharmaceutical companies have lobbied 18 states for legislation that would limit biosimilars, with no success. California Governor Jerry Brown recently vetoed a bill that critics said would limit the use of lower-cost biosimilars at the expense of chronically ill patients.  

Brand-name drug makers have bypassed New York with their lobbying roadshow, but their arrival here is likely to be just a matter of time. That’s why it’s important for health care consumers and elected officials to be aware of biosimilars and their potential to dramatically reduce spending on this costly class of drugs. 

For more on generics, visit univerahealthcare.com.  

Richard Vienne, D.O., is Vice President and Chief Medical Officer at Univera Healthcare

Erie County 2013-14 Home Energy Assistance Program

HEAP is federally funded assistance with home heating costs and energy conservation for eligible households. Program components include benefit assistance for heat and electricity, weatherization referral, and cooling assistance (in summer months- based on medical necessity).

HEAP HOTLINE: 858-7644 APPLICATION REQUEST LINE: 858-1969

The HEAP office opens for the season to all applicants on November 18, 2013. Tentative program closing date is March 17, 2014.

The Heating Equipment (furnace) Repair and Replacement component is unavailable until further notice. Other options for assistance are in section 10.

Clients may apply for Regular HEAP benefits electronically by visiting: MyBenefits.NY.gov

Mailing of “Early Access” applications and SNAP or TA households HEAP Auto Pay is complete.

1.     Early Access and SNAP or TA Auto Pay for Regular HEAP

2.    Regular HEAP

3.    Emergency HEAP

4.    How to apply for HEAP

5.    Documentation Requirements: Regular HEAP

6.    Documentation Requirements: Emergency HEAP

7.    Subsidized Rent & HEAP Eligibility

8.    Wage Calculation

9.    Countable & Excluded Resources

10. Furnace Assistance, Weatherization Assistance Program, EmPower NY, Lifeline

11.  Other assistance if HEAP benefits are exhausted or program is closed

HEAP Income Guidelines 2013 – 2014

Monthly Household Gross Income Cannot Exceed:

Household Size	Gross Monthly Income
1	$2,175
2	$2,844
3	$3,513
4	$4,182
5	$4,852
6	$5,521
7	$5,646
8	$5,772
9	$5,897
10	$6,023
11	$6,461

1.     Early Access and SNAP or TA Auto Pay for Regular HEAP:

Early Access:

Households that received HEAP last season and have a senior citizen, disabled individual, or child age 5 or younger may have received an Early Access application in September 2013.

The only documentation required for an early access application is copies of earned income, if any (last 4 weeks proof of wages -pay stubs). Applicants who received HEAP last season are not required to submit proof of Social Security, SSD, workers comp, unemployment, utility bills, or proof of residency.

Households who believe they should have received an Early Access application but did not, or who need to replace a lost or damaged application, may call the HEAP Hotline at 858-7644 for assistance.

SNAP or TA Auto Pay:

Households currently receiving SNAP or TA assistance may qualify for an Auto Pay HEAP benefit that will be processed and credited automatically to heating bills in December or January. Households wishing to check the status of an Auto Pay may call the HEAP hotline at 858-7644. If household missed the Auto Pay, they may submit a HEAP application for processing prior to season opening.

Early Access and Auto Pay eligibility notices will be mailed in December, and benefits should appear as a credit on December or January heating bills. HEAP can notify heating suppliers of these benefits beginning 11/18/13. If necessary, the approval may restore service, or create a 30 day hold from termination of service, or result in a delivery of fuel.

2.    Regular HEAP benefit:

Regular HEAP for household’s main source of heat is available beginning November 18, 2013. 

Gas and Electric benefits appear as a credit on bill about 60 days after approval. Oil, propane, wood, pellets, and coal benefits produce a delivery of fuel totaling benefit amount.

• Household does not need a shut off notice or low fuel to receive Regular HEAP.
• 30 day “hold” is placed on heat account if benefit is approved.
• If there is a shutoff notice, service will not be shut off during that 30 days and utility company will not seek collection for the portion of the total bill equaling the benefit amount.
• If service is Off, benefit approval may restore service depending on total amount owed

There is no resource test for Regular HEAP; HEAP will not examine household’s savings or checking accounts etc.

Regular HEAP Benefit Amounts:

$400 base benefit	Natural Gas or Electric Heat
$600 base benefit	Deliverable fuel (i.e. oil, propane, kerosene)
$500 base benefit	Deliverable fuel (wood, coal, etc.)
Add on $25	Add an additional $25 to base benefit if: Household has Tier 1 income
Add on $25	Add an additional $25 to base benefit if: There is a vulnerable in the household – child age 5 or under OR an adult over the age of 60 OR disabled individual

“Renter’s Benefit” for Heat Included in Rent:

If Heat costs are included in Rent (NON SUBSIDIZED RENT ONLY), benefit amount is based on HH income:   $25 if income is Tier I, and $20 if income is Tier II.

If Heat is included in Rent, and Rent is subsidized, household is not eligible for Regular HEAP.

3.    Emergency HEAP: (Shut off Notice or Low Fuel Supply is Required)

Emergency HEAP benefits are available beginning January 2, 2014.

One Emergency “Heat Related” electricity benefit is available- IF there is a Shut off notice and electric is needed to run furnace or thermostat, and is not main source of heat.

One Emergency “Heating” benefit, for main source of heat is available- IF there is a shut off notice or low fuel supply & Regular benefit was already received.

There is a Resource Test for Emergency HEAP:

• HH may have no more than $2000 (or $3000 for a household with a member age 60 or older) in available liquid resources ($$ in savings, checking, stocks, bonds, CDs, IRAs, 401k). Monthly living expenses in savings are not counted and are determined on a case by case basis. Countable (liquid) and Excluded Resources are listed below.

Emergency HEAP Benefit Amounts:

$400	Natural Gas Heat Only
$560	Electric Heat – PSC and municipal electric companies
$600	Deliverable Fuel (i.e. oil, propane, kerosene)
$500	Other Fuel (coal, wood, wood products)
$160	Heat Related Electric – PSC and municipal electric companies

4.    How to Apply for HEAP: EFFECTIVE NOVEMBER 18, 2013

• If Service is OFF, or household is OUT of heating fuel:

• Household member or authorized representative** must report to HEAP for assistance

• 478 Main Street, Buffalo (8:00am-4:00pm)- All Households receiving TA or SNAP, and Heads of Household under 60 years of age, non disabled

• 291 Pearl Street, Buffalo (8:00am-4:00pm)- Heads of Household 60 or older, or under 60 and disabled (not receiving TA or SNAP)

• If Service is ON, but household has a current shut off notice or low supply (less than ¼ tank) of heating fuel:

• Household member or authorized representative may call the HEAP Hotline at 858-7644

• A HEAP Hotline representative will examine the situation and direct the application process accordingly. Client may or may not need to report.

• If Service is ON, with NO shut off notice and NO low fuel supply:

• HH may call the HEAP Application Request Line at 858-1969. An application packet will be mailed and there is no need to report

**An authorized representative may apply on behalf of individuals unable to appear at HEAP or unable to call the HEAP hotline. A signed and dated note from the applicant authorizing the individual to apply on their behalf is required.

5.    Documentation Requirements for Regular HEAP:

If Household is receiving TA or SNAP:

Regular HEAP: Many Active TA or SNAP households have Regular HEAP calculated and sent to heating supplier automatically (Auto Pay). No application for Regular HEAP is required for these HHs. If Auto Pay is not received, a HEAP application must be submitted with a current utility bill. HEAP Application Request Line: 858-1969.

If Household is not receiving TA or SNAP & received HEAP assistance last season:

A completed and signed HEAP application & the following Documentation are required:

o   Proof of GROSS EARNED Income (Wages) received with the last 30 days for all Household Members

                                              i.     If paid weekly, last 4 paystubs

                                            ii.     If paid bi-weekly, last 2 paystubs

o   Proof of UNEARNED Income is NOT Required (Social Security, Pension, Unemployment, Workers Comp, Disability, etc.)If you moved or there are new members in your Household, you must document those changes.

If Household is not receiving TA or SNAP & did not receive HEAP assistance last season:

A completed HEAP application and the following Documentation are required: 

• Proof of GROSS income received within the last 30 days for all household members
• Wages: If paid weekly, last 4 paystubs
• Wages: If paid bi-weekly, last 2 paystubs
• Award letters- if Applicable (Social Security, Pension, Unemployment, Workers Comp, Disability, etc.)
• Yearly statement of interest received (savings, checking, CDs, money market account, etc.)
• Dividend proof (stocks, bonds securities, etc.)
• Social Security Numbers for all HH Members
• One (1) form of ID for all HH members (Birth Cert. OR SS Card OR Drivers License OR School ID, etc.)
• Proof of Residency (Mortgage proof or Rent/Lease information
• Current Utility Bills

6.    Documentation Requirements for Emergency HEAP:

If Household received a Regular HEAP benefit this season:

• Shut off notice or statement of low fuel supply from company
• Proof of all HH liquid resources
• 1 form of ID for any new HH members (that were not listed on Regular HEAP application)

If Household did not receive a Regular benefit this season:

For main source of heat, no Emergency benefit is available until Regular benefit is exhausted.

Applicant may apply for Emergency for “heat related” electric, and Regular benefit for main source of heat simultaneously, and must provide all documentation for Regular & Emergency HEAP.

7.    Subsidized Rent & HEAP Eligibility:

If household receives Government Rental Assistance (Section 8, Belmont, etc.)
If Heat is included in rent	NOT eligible for HEAP assistance with heating costs
If Electric is included in rent	NOT eligible for HEAP assistance with electric costs
If Household pays directly for Heat	Eligible for Regular and Emergency HEAP towards heating bill (see above for benefit amounts) – “Heater’s Benefit”
If Household pays directly for “Heat Related Electric:**	Eligible for Emergency HEAP "heat related" electric benefits (see above)

8.    Wage Calculation for HEAP Applications:

HEAP calculates all wages using these formulas:

Paid Weekly – ((4 x Weekly gross)/4) x 4.3333 

Paid Bi-Weekly – ((2 x bi-weekly gross)/2) x 2.1666

Paid Bi-Monthly – (add 2 gross pay amounts- no other calculation)

9.    Liquid (countable) & Excluded (not countable) Resources for Emergency HEAP

Countable (these are counted for Emergency HEAP resource test):

·      Cash

·      Checking and/or savings account balances

·      Stocks/bonds

·      Time deposit certificates

·      IRA accounts, including remaining amounts from a closed out IRA

·      Lump sums from sale of property or insurance settlements and balances from any other lump sum not specifically excluded

·      401(K) and other retirement accounts

·      Income tax refunds (except EITC payments)

·      Any other available funds not specifically excluded

Excluded (these are not counted for Emergency HEAP resource test):

·      Amounts designated for an allowable current monthly living expense such as food, shelter, employment-related expenses, etc.

·      Money earmarked for payment of the current year‘s property and/or school taxes for the primary residence

·      One burial plot per household member

·      One written pre-arranged burial agreement with a cash value not exceeding $1,500 per household member and interest on the burial account

·      Accounts, such as PASS accounts, designated by the Social Security Administration as exempt from SSI resource limits

·      Real and personal property

·      Equipment

·      Automobiles and other vehicles

·      Payments from reverse annuity mortgages

·      Loans (including college loans, personal loans, home equity loans )

·      Credit cards or advances from credit cards

·      Individual Development Accounts (IDA)

·      Although a household is not required to obtain a non-utility fuel delivery on a credit basis, those households who have sufficient resources to pay for the delivery may be required to obtain the delivery and make payment when the resources can be accessed.

10. Furnace Assistance, Weatherization Assistance Program, EmPower NY, Lifeline

• National Fuel Emergency Heating Repair or Replacement Program

• The customer’s main source of heat (furnace) must be totally inoperable
• The applicant must own the home
• The entire household; ALL members of the household, are age 62 and older, or age 18 and younger, or blind, or permanently disabled, or on life support.
• Must be low income. Regular HEAP income guidelines are followed but higher income cases may be reviewed on an exception basis.
• Clients may call 686-6123 or 1-800-365-3234 for assistance.

• Erie County Emergency Aid for Families/Adults:

• Erie County Funded 0% Loan, or Grant if HH is receiving SSI.
• Erie County Department of Social Services Emergency Services Unit: 478 Main Street, 6th floor

• Home Performance w/ Energy Star- PUSH Buffalo

• Low interest loan/grant through NYS, may be up to 50% subsidized with a grant for eligible HHs. Loan can be paid “on bill” (equaling cost saved each month on energy bills based on installed measures).
• Contact 858-6955 for details

• Weatherization Assistance Program (WAP):

• HEAP Eligible Households qualify for WAP

• NO COST home weatherization services and energy conservation improvements: Attic and wall insulation, weather stripping, caulking, testing of furnace, other minor energy conserving home repairs.

• If Head of Household is 60 or older:

• Contact Erie County Senior Services Information and Assistance: 858-8526

• If Head of Household is under 60:
• Contact the HEAP office under 60 WAP Referral Program: 858-2634

• Renters may apply for Weatherization assistance, though Landlord may be asked to contribute 25% towards costs, unless Landlord is also HEAP eligible.

• May assist with furnace repair or replacement in limited circumstances

• EmPower NY:

• NO COST assistance for HEAP eligible households, funded through the New York State Energy Research and Development Authority (NYSERDA). Eligibility is based, in part, on gas and/or electric usage. Not all applicants will qualify for assistance. Services may include:
• Replacement of Refrigerators that are 10 or more years old
• Installation of high-efficiency lighting and insulation
• Tips on how to save energy
• May assist with furnace replacement even if cl received other Empower services previously. Client may need a "denial" from HEAP furnace program, stating that HERR is closed until further notice.

• Empower NY: 1-800-263-0960

• Call Senior Services I&A at 858-8526 for an application or for more information

• LifeLine Program: Low cost telephone service:

• HEAP eligible households can receive basic service for as low as $1.00 per month, plus per call charges and taxes.
• Clients should complete a Lifeline application and mail it to phone company with a copy of your HEAP award letter.
• Applicants can apply, or recertify Lifeline discount using last year’s HEAP eligibility notice, if current season notice is not yet received.
• Contact telephone service provider or Senior Services Information and Assistance at 858-8526 for information.

11. Other assistance if HEAP benefits are exhausted or program is closed

• Program Availability is subject to funding and these programs are generally not open year round

• National Fuel “Neighbor for Neighbor” heating bill assistance (All heat source types):

• Salvation Army: 883-9800 Ext. 230 (Open 9:00am to 4:30pm call for appointment) OR
• Catholic Charities: (Open 8:45am to 4:45pm)­­­­­ 856-4494

• Must be 60 years of age or older, or disabled, or have a serious medical condition
• Must have made at least 6 payments to heating company in the last 12 months
• Must have current account balance
• Do not need a shut off notice
• Need HEAP exhausted or HEAP denial proof

• “Care and Share” Electric Bill  assistance:
• American Red Cross at 886-7500
• Must have a Shut-off notice on electric bill
• Must have low income
• Need HEAP exhausted or HEAP denial proof

• Emergency Aid for Families through Erie County (EAF) – 478 Main Street 6^th floor, Buffalo

• Assistance for all ages, 0% Loan based program may assist with most recent 4 months bills

• Emergency Aid for Adults (EAA)- 478 Main Street 6^th floor, Buffalo

• Assistance for recipients of SSI or SSD. Grant program may pay recent and/or current bills.
• Must have a current shut off notice or be low on fuel, and exhausted all HEAP benefits for season (or HEAP is closed for season)
• Applicants whose service has been off for an extended period are not eligible

• Must bring the following to the interview:
• Everyone in the Household ages 18 and older must be present at interview
• Must have picture ID for anyone in household age 18 and older, and ID for anyone in household under 18
• Proof of Rent expense or if homeowner you must bring deed to home
• Current Gas, Electric, Phone bills
• Proof of all income of the entire household for last 8 weeks (including wages, child support, SS, SSI, pension, rental income, etc.)
• Letter from HEAP stating that benefits are exhausted/denied
• For National Fuel assistance applicants must attain a financial statement from National Fuel before applying for EAF or EAA (go to National Fuel Office at 409 Main Street, Buffalo)
• For National Grid or NYSEG assistance, contact electric company and tell them you are applying for EAF and request financial statement, they may send it directly to you or to EAF worker, depending on situation

• Erie County Emergency Assistance to request placement in a temporary shelter:

• Report to Erie County Emergency Housing Unit, 158 Pearl Street, Buffalo, Monday- Friday, between 8am-4pm. OR

• Call Erie County Crisis Services at 834-3131, after 4 pm, or during the weekend