The Journal
of the
Oklahoma Osteopathic Association
Oklahoma D.O. February 2013 January 2013
Volume 77, No. 8
Mary Shaw In this issue: Oklahoma Educational Foundation r 113th Annual Convention Registration Form r 2013 Legislative Report for Osteopathic Medicine r OOA Nomination Report President 2012-2013
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Oklahoma D.O. |February 2013
The Journal of the Oklahoma Osteopathic Association
Oklahoma
May/June 2012 January 2012 November 2012 February 2013
OOA Officers: Layne E. Subera, DO, FACOFP, President (Tulsa District) Bret S. Langerman, DO, President-Elect (South Central District) Michael K. Cooper, DO, FACOFP, Vice President (Northeastern District) LeRoy E. Young, DO, FAOCOPM, Immediate Past President (South Central District)
OOA Trustees: Kenneth E. Calabrese, DO, FACOI (Tulsa District) Dale Derby, DO (Tulsa District) C. Michael Ogle, DO (Northwest District) Gabriel M. Pitman, DO (South Central District) Richard W. Schafer, DO, FACOFP (Tulsa District) Christopher A. Shearer, DO, FACOI (Northwest District) Kayse M. Shrum, DO, FACOP (Tulsa District) Ronald S. Stevens, DO (Eastern District) OOA Central Office Staff: Lynette C. McLain, Executive Director Lany Milner, Director of Operations and Education Rachel Prince, Director of Communications Allison Rathgeber, Director of Member Services & Foundation Administrator
The Oklahoma D.O. is published monthly from the Oklahoma Osteopathic Association Central Office: 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335. Lany Milner, Graphic Designer and Associate Editor Copy deadline is the 10th of the month preceding publication. Advertising copy deadline is the 15th of the month preceding publication. For more information: 405.528.4848 or 800.522.8379 Fax: 405.528.6102 E-mail: ooa@okosteo.org The OOA Website is located at www.okosteo.org
Oklahoma D.O. | February 2013
Volume 77, No. 8
Lynette C. McLain, Editor Lany Milner, Associate Editor
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President’s Message provided by Layne E. Subera, DO, FACOFP, 2012-2013 President
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2013 OOPAC Contributors List
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OOPAC Challenge
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2013 Legislative Report
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Doctor of the Day Schedule
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Doctor of the Day Form
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113th OOA Annual Convention Program Overview
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Convention Registration Form
17
OOA Golf Classic Registration Form
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“Rural Medical Track Selective Rotations” provided by Duane G. Koehler, DO, Assistant to the Dean for Rural EducationO
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“Where We Are, How We Got There, Where We Are Going” provided by Val Schott, MPH, Chief Executive Officer
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“An Active Participant In the Care of the Growing Population of the Older Adult” provided by Joanne Alderman, APRN-CNS, RN-BC, FNGNA
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“Atherosclerosis, Inflammation and Cardiovascular Risks: A Review”
29
“Purpose and Fun” provided by Walli Daniel, 2012-2013 AOOA President
30
What DO’s Need To Know
34
“Technology Corner: Online CME” provided by the OOA Bureau on Information Technology
35
Health for the Whole Family: “Scratching the Surface of Psoriasis” Provided by the American Osteopathic Association
36
2013 Nominating Committee
37
By the Way
38
Foundation Update
39
Classifieds & Calendar of Events
3
President’s Message: Three things we can do now about pain issues by Layne E. Subera, DO, FACOFP, 2012 - 2013 OOA President
As Ground Hog Day approaches every year, we experience another Ground Hog Day of sorts a couple of weeks before Punxsutawney Phil actually crawls out of his hole, filing day at the legislature. This year, January 18th was the filing deadline for bills that will be considered in the coming legislative session. As expected, several familiar bills and issues have once again surfaced hoping for favorable conditions and not to see their shadows.
derstand that the Oklahoma Hospital Association is in support of this measure. This issue was voted down last year.
Last year there were nearly 2500 bills filed that were involved with healthcare delivery in the state of Oklahoma. This year, the legislative committee is working over similar number of proposed bills and compiling our tracking list of bills to watch and research. The OOA Bureau on Legislation met on February 6th to discuss and vote on positions to support or oppose to individual bills.
What type of consent process is necessary prior to spinal manipulative treatment? I understand that there's been a proposal to require patients to sign a legal release before they receive cervical manipulation from a chiropractor. Though there are documented rare cases of patients receiving injuries from cervical manipulation performed by chiropractors, data is lacking for osteopathic manipulative treatment. It is unclear how this proposal might affect osteopathic physicians.
The Oklahoma State University Medical Center (OSUMC) administration will be asking for an annual appropriation of $18.3 million funding commitment from the state. Currently the OU hospital in Oklahoma City receives over $40 million per year from the state for that region. For the last five years, OSUMC has received $5 million per year as part of a five year deal. Unfortunately, that agreement has run out and the hospital needs help. We feel that the Oklahoma State University Medical Center needs a long term commitment from the state. Hopefully, the recent proposal for the state to fund a new $25 million OU teaching mini hospital in Tulsa will not distract legislators from the fact that stabilizing OSUMC would be the most cost effective way to expand hospital based services to the underserved in Tulsa and Northeast Oklahoma.
Do physical therapists need to be doing electromyography? The physical therapists are asking to add electromyography to their list of practice rights. We have been gathering expert testimony on this issue and doing preliminary research on the safety and cost efficacy of this proposal.
As you can see, now is a time of year for physicians to become interested in the legislative process if they have not been active so far. Please get involved, support your political action committees and follow the legislative process in the news. If you have concerns about a bill or able to offer expert opinion please contact us here at the Association. We feel like we had a successful year last year because our members were energized about expanding rural residencies. We're looking to build on that success again this year for our members and patients. okDO
On another issue, we have seen a marked decrease in boardbased practice expansion since the legislature amended the Title 59 rule making process to require professional boards to gain approval of the legislature prior to expanding their members practice rights. However, there are a couple of patient safety issues that will be considered again this year. To what degree should certified registered nurse anesthetists be supervised? The CRNA's are asking for less practice supervision. Currently they are required to be supervised by a physician. They're asking for more independent practice rights. Apparently, there is an issue in the rural hospital setting where there are not enough physician supervisors who are willing to take responsibility for the anesthesia during a procedure. I un4
Oklahoma D.O. |February 2013
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800-261-1255 | cancercenter.com Scan to learn more about IORT Novac™7 ©2012 Rising Tide | February 2013 Oklahoma D.O.
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SUPPORT THE OOPAC MAKE THE PLEDGE
THANK YOU TO THE FOLLOWING W PHYSICIANS WHO HAVE ALREADY MADE THE PLEDGE Kenneth E. Calabrese, DO Thomas J. Carlile, DO Dennis J. Carter, DO Thomas H. Conklin, Jr., DO Michael K. Cooper, DO W Bobby N. Daniel, DO A. Gastorf, DO W Melissa Stanley E. Grogg, DO David F. Hitzeman, DO R. Randy Hunt, DO Duane G. Koehler, DO Bret S. Langerman, DO John S. Loose, DO C. Michael Ogle, DO W John F. Rice, DO Richard W. Schafer, DO Ryan W. Schafer, DO Christopher A. Shearer, DO LeRoy E. Young, DO
W W W HELP US MEET OUR GOAL
$17,601 Current Total
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Oklahoma D.O. |February 2013
Plan to Take the OOPAC Challenge in 2013! Give Back to OOPAC...
A P
Political Ac t i o n
O
Osteopathic
O
C
Oklahoma
Committee
Pledge annually and pay monthly with the OOPAC automatic credit card plan!
Take the OOPAC Challenge in 2013 and you will be helping with legislative efforts to preserve the osteopathic profession in Oklahoma! _____ OOPAC AUTOMATIC CREDIT CARD PLAN:
I choose to pledge annually & pay monthly with my credit card.
Please charge my contribution monthly to my:
o Visa
o $504 ($42 per month) o $1,008 ($84 per month)
o MasterCard
o American Express
o Discover o $1,200 ($100 per month)
_____ My personal check made payable to “OOPAC� is enclosed.
o $100
o $250-$500 (PAC Partner)
o $1,001-$2,499 (Executive PAC Partner)
o $501-$1,000 (Premier PAC Partner) o $2,500 + (Platinum PAC Partner)
______ Please charge my contribution of $________ to my: o Visa
or
o MasterCard
Account Number __________________________________ Exp. Date __________________
Name as it appears on Card ___________________________________ CID# ____________
Address_____________________________________________________________________
City, State, Zip _______________________________________________________________
Signature ___________________________________________________________________
Please mail to: OOPAC, 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335. This personal contribution is not deductible as a donation or business expense.
Oklahoma D.O. | February 2013
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Speaker of the House Representative T. W. Shannon District 62 - Republican
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LEGISLATI
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COMMITTEES: Ex Officio voting member on all House Committees
CAPITOL ADDRESS: 2300 N. Lincoln Blvd. Room 401 Oklahoma City, OK 73105 (405) 557-7374 LEGISLATIVE ASSISTANT: Belinda Clark (405) 557-7374
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DISTRICT ADDRESS: 504 SW 83rd Lawton, OK 73505
COUNTY(S) REPRESENTED IN DISTRICT: Comanche MUNICIPALITY(S) REPRESENTED IN DISTRICT: Lawton city ZIPCODE(S) REPRESENTED IN DISTRICT: 73501, 73505 YEAR ELECTED: 2007
TERM LIMITED: 2018
PERSONAL: T.W. Shannon is a 6th generation Oklahoman and 3rd generation Lawtonian. T.W. is an enrolled member of the Chickasaw Nation. He is a former Congressional Staffer having worked for U.S. Representatives JC Watts and Tom Cole. T.W. and his wife Devon, also a Lawton native, are the parents of a daughter, Audrey Grace, and a son, Tahrohon Wayne II. EDUCATION: B.A. Communications, Cameron University/ Juris Doctor Oklahoma City University PROFESSION: T.W. is a Business Consultant.
EMAIL: tw.shannon@okhouse.gov
W PROFESSION: Oil and Gas
LEGISLATIVE SERVICE: House of Representatives, 51st Legislature to present
President Pro-Tempore Senator Brian Bingman District 12 - Republican
EDUCATION: University of Oklahoma, BBA in Petroleum Land Management Legislative Experience: House Member 2004-2006; Senate Member, 2006 - present PERSONAL: Bingman was born on December 9, 1953, in Tulsa, OK. He received a BBA in Petroleum Land Management from the University of Oklahoma in 1976. He is currently employed by Uplands Resources Inc. in Tulsa as Vice-President of Land and Operations. Bingman served as Mayor of Sapulpa from 1992 -2004 and served in the House of Representatives for District 30 from 2004-2006. He was elected to the State Senate in November, 2006. He and his wife Paula, have three children: Annie, Blake and Rebecca. He is a member of the Sapulpa Chamber of Commerce and The Creek Nation. Professional affiliations include the American Association of Petroleum Landmen and the Oklahoma Independent Producers Association. Bingman is an active member of the First Presbyterian Church of Sapulpa. His hobbies include playing golf, spending time with his family and his four grandchildren Blake, Merritt, Ellie and Madilyn. 8
Senator Brian Bingman 2300 N. Lincoln Blvd., Rm. 422 Oklahoma City, OK 73105 (405) 521-5528 EMAIL: bingman@oksenate.gov Executive Assistant: Cheryl Boothe (918) 227-1856 Oklahoma D.O. |February 2013
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VE REPORT
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25 new
freshman
MEET THE NEW FRESHMAN CLASS Legislator Biggs, Scott Boggs, Larry Brooks, Corey Cleveland, Bobby Dahm, Nathan Echols, Jon Fisher, Dan Floyd, Kay Griffin, A J Henke, Katie Hulbert, Arthur Loveless, Kyle Matthews, Kevin McBride, Mark McCall, Charles McDaniel, Curtis O'Donnell, Terry Perryman, David Sharp, Ron Shaw, Wayne Smalley, Jason Standridge, Robert Turner, Mike Walker, Ken Wood, Justin
Branch/District House/51 Senate/7 Senate/43 House/20 Senate/33 House/90 House/60 House/88 Senate/20 House/71 House/14 Senate/45 House/73 House/53 House/22 House/1 House/23 House/56 Senate/17 Senate/3 House/32 Senate/15 House/82 House/70 House/26
Oklahoma D.O. | February 2013
Party Republican Republican Republican Republican Republican Republican Republican Democrat Republican Republican Republican Republican Democrat Republican Republican Democrat Republican Democrat Republican Republican Republican Republican Republican Republican Republican
Office 320 513B 520 325 533A 316 326 510B 520 314 321 533C 510B 315 322 316 319 539A 533 513A 323 429 400 317 324
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Phone Counties (405)557-7405 Grady*, McClain*, Stephens (405)521-5604 Haskell*, Hughes*, Latimer*, Okfuskee*, Pittsburg* (405)524-5522 Garvin*, Grady*, McClain*, Stephens* (405)557-7308 Cleveland*, Garvin*, McClain*, Pontotoc*, Pottawatomie* (405)521-5551 Tulsa (405)557-7354 Cleveland*, Oklahoma* (405)557-7311 Caddo*, Canadian* (405)557-7396 Oklahoma (405)521-5628 Kingfisher*, Logan*, Noble*, Pawnee* (405)557-7361 Tulsa (405)557-7310 Cherokee*, Muskogee* (405)521-5618 Canadian*, Cleveland*, Oklahoma* (405)557-7406 Osage*, Tulsa* (405)557-7346 Cleveland (405)557-7412 Atoka*, Garvin*, Johnston*, Murray* (405)557-7363 Leflore*, McCurtain* (405)557-7379 Rogers*, Tulsa*, Wagoner* (405)557-7401 Caddo*, Canadian*, Grady*, Kiowa* (405)521-5539 Oklahoma, Pottawatomie* (405)521-5574 Adair*, Cherokee*, Deleware*, Mayes*, Rogers* (405)557-7368 Lincoln*, Logan* (405)521-5535 Cleveland, Oklahoma (405)557-7357 Oklahoma (405)557-7359 Tulsa (405)557-7345 Pottawatomie
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The Following Report was Provided by the Oklahoma Prosperity Project
and the State Chamber
ELECTION RECAP
Top 3 Election takeaways: 1. In both the State House and State Senate, Republicans have attained their largest majorities in state history 2. Despite the relatively large number of incumbents being challenged in primaries, all but one were retained 3. Oklahoma voters said 'yes' to all state questions and 'no' to taxes
CONGRESSIONAL RACES
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This year, Oklahoma saw a race in every Congressional district. Congressional district 2 in eastern Oklahoma was open after incumbent Rep. Dan Boren announced that he would not seek re-election. In the other four seats, three incumbents were re-elected by voters while incumbent John Sullivan was defeated by challenger Jim Bridenstine. District History 1 Jim Bridenstine Bridenstine defeated incumbent John Sullivan in the Republican primary election 2 Markwayne Mullin Incumbent Dan Boren did not seek re-election 3 Frank Lucas Lucas was re-elected in the general election 4 Tom Cole Cole was re-elected in the general election 5 James Lankford Lankford was re-elected in the general election
OKLAHOMA SENATE
In the Oklahoma Senate, eight incumbents were retained by voters. The eight open Senate seats were predominatly filled by Republicans, though State Rep. Jabar Shumate (D-Tulsa) won a traditionally Democratic Senate seat in north Tulsa. Senate 53rd Legislature 54th Legislature New Senators Republicans 32 36 7 Democrats 16 12 1 Total 48 48 8
OKLAHOMA HOUSE OF REPRESENTATIVES
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In the Oklahoma House, three seats vacant at the time of the election were filled along with other open legislative seats. Ultimately, Republicans won most of the open seats while Democrats filled 3 seats. Only one incumbent was defeated in the House. House 53rd Legislature 54th Legislature New Representatives Republicans 67 72 13 Democrats 31 29 3 Total 98 101 16
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Oklahoma D.O. |February 2013
OKLAHOMA JUDICIAL RETENTION AND STATE QUESTIONS
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This year, every judicial candidate was retained by Oklahoma voters. At the same time, every state question on the Oklahoma ballot was approved by voters. While judicial candidates are typically retained, state questions are usually passed by voters less frequently.
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758 state
67.7% (voted YES) 32.3% (voted NO) Lowered the cap on property tax valuation increases summary:
question
762 state
question
759 state
question
59.2% (voted YES) 40.8% (voted NO) Banned affirmative summary: action by the State Chamber of Oklahoma
59.2% (voted YES) 40.8% (voted NO) Removed summary: Governor from parole process for nonviolent offenders
764 state
question
765 state
question
59.9% (voted YES) 40.1% (voted NO) Eliminated the commission overseeing the Oklahoma summary: Department of Human Services
766 state
question
Oklahoma D.O. | February 2013
56.7% (voted YES) 43.3% (voted NO) Expanded financing summary: capacity for water infrastructure projects
65% (voted YES) 35% (voted NO) Eliminated property taxes on summary: intangible personal property 11
Doctor of the Day Schedule Date
Doctor/Home Add
Senator/Rep
M-March 4
Lori Gore-Green, DO Senator Jaber Shumate PO Box 116331 Rep Kevin Matthews Carrollton TX 75011-6331
T-March 5
Mike Simulescu, DO 715 Meadowlark Lane Durant, OK 74701
Senator Josh Brecheen Rep Dustin Roberts
W-March 6 Gordon P. Laird, DO Senator Ann Griffin 39451 E 41st Rep Dennis Casey Morrison, OK 73061 Th-March 7 Stanley E. Grogg, DO Senator Gary Stanislawski 4520 S Birmingham Pl Rep Ron Peters Tulsa, OK 74105 M-March 11 Bobby N, Daniel, DO Senator Mike Mazzei 11729 S 66Th E Ave Rep Fred Jordan Bixby, OK 74008-8210 T-March 12 Jay D. Cunningham, DO Senator Rob Johnson 18808 Saddle River Dr. Rep Mike Turner Edmond, OK 73012
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W-March13
Thomas H. Osborn Jr., DO Senator Susan Paddock PO Box 572 Rep Steve Kouplan Holdenville , OK 74848-0572
Th-March 14
Keith S. Patterson, DO 9303 N 161st E Ave Owasso, OK 74055
M-March 18 T-March 19
Vacant
W-March 20
Vacant
Th-March 21 M-March 25
Michael E. Salrin, DO 11487 S 354Th Earlsboro, OK 74840-9011
T-March 26
Vacant
W-March 27
Martin D. McBee, DO 11000 Old River Trail Edmond, OK 73013
Th-March 28
Scott S. Cyrus, DO Senator Gary Stanislawski 11204 S. Winston Ave Rep Fred Jordan Tulsa, OK 74137
Senator Sean Burrage Rep David Derby
Vacant
Senator Ron Sharp Rep Justin Freeland Wood
Vacant
Senator Ron Sharp Rep Mike Shelton
Oklahoma D.O. |February 2013
March 2013 Doctor of the Day Month at the State Capitol ONLY 5 DAYS LEFT! The Oklahoma Osteopathic Association (OOA) will sponsor the Doctor of the Day Program during the month of March 2013 at the Oklahoma State Capitol. This is the 39th year osteopathic physicians have provided this service at the State Capitol’s First Aid Station during the legislative session. The Doctor of the Day program gives DOs an opportunity to bring osteopathic medicine to policy makers and to see their House and Senate members at work. Physicians are needed to serve as Doctor of the Day during March on Mondays, Tuesdays and Wednesdays from 8:30 am-4:00 pm; and on Thursdays from 8:30 am-noon. Each doctor can OOA.eps expect to see approximately 15-20 patients. If you are interested in volunteering for this program, please contact Rachel Prince at the OOA Central Office or complete the form below and fax it to the OOA at 405.528.6102 no later than February 15, 2013. We will notify your state senator and house member that you will be serving and you will be introduced in both the Senate and House chambers. We thank you in advance for helping make this program a success! OOA.jpg
Yes! I want to participate in the Oklahoma Osteopathic Association Doctor of the Day Program! OOA.png
Name:____________________________________________________________________________________ Office Telephone:____________________________________ Email:_________________________________ Home Address:_____________________________________________________________________________ City, State, Zip:_____________________________________________________________________________ State Senator:_______________________________________________ District #:_______________________ House Member:______________________________________________District #:_______________________ I prefer to serve on
Monday
Tuesday
Wednesday
Thursday
does not matter
Please fax this form to the Oklahoma Osteopathic Association Central Office at: 405.528.6102 no later than February 15, 2013. Oklahoma D.O. | February 2013
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annual convention Join the Oklahoma Osteopathic Association in celebrating its 113th Annual Convention being held at the Norman Embassy Suites-Hotel & Conference Center in Norman, Oklahoma. Connect with your peers and immerse yourself into this new and exciting learning experience. So saddle up on April 18-21, 2013 and let the 2013 Annual Convention be the place where you advance your medical education.
Sp ur
y
k ac Tr
rin
own the Specia D lt g
113th OOA Annual Convention Individualizing a Program for Your Specialty Needs Saddle up April 18-21, 2013
Welcome National Guests
Norman E. Vinn, DO President-elect of the American Osteopathic Association
LAUNCHING THIS YEAR
the ooa convention module
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Jeffrey S. Grove, DO ACOFP President-elect
Nancy Granowicz President of the AAOA
The OOA is introducing the association’s first ever convention module. The new module will allow for users to have an interactive experience with the event. The micro site will be linked to the OOA’s current webpage and will be completely dedicated to the Annual Convention. Visitors to the site will be able to view each speaker’s biography as well as download their presentations. This will eliminate the hundreds of pages attendees had to carry from presentation to presentation. In addition, visitors to the site will be able to quickly see the program schedule based on day, specialty track or case study. It is our hope that this feature will allow attendees to quickly find where they need to be and download the presentation immediately. In an effort to make registration as quick and easy as possible, attendees will be able to select their registration option, purchase meal tickets and even register for the golf classic all in one area. This one stop shop will help create a smooth registration process for all. The OOA recognizes the need to provide members and seminar attendees a convenient and worthwhile experience not only in their day to day interactions on our webpage but also at our events. It is our hope that these exciting changes will help make the overall experience a positive one. Oklahoma D.O. |February 2013
convention Program Overview
Convention Program Chair, Michael K. Copper, DO, has recognized the need for specialty programs in the state of Oklahoma and created a program for your specialty needs. The convention program will offer the following specialty tracks: EMERGENCY MEDICINE INTERNAL MEDICINE OBGYN ANESTHESIOLOGY RADIOLOGY SPORTS MEDICINE PSYCHIATRY OMT
thursday, april 18, 2013
Thursday’s morning programs will cover social media and professional issues that are affecting today’s physician. J.D. Polk, DO will be delivering the Opening Session: “The Rescue of the Chilean Miners” will take place from 11:00 am-12:00 pm. DON’T MISS OUT ON THIS EXCITING AND MOTIVATING PRESENTATION! J.D. Polk, DO, MS, MMM, CPE, FACOEP is the Principal Deputy Assistant Secretary for Health Affairs and Deputy Chief Medical Officer of the Department of Homeland Security (DHS). He began serving in this position in November of 2011. Prior to his work at DHS, Dr. Polk was the Deputy Chief Medical Officer and Chief of Space Medicine for the National Aeronautics and Space Administration’s (NASA) Johnson Space Center and an Assistant Professor in the Departments of Preventive Medicine and Emergency Medicine at the University of Texas Medical Branch. Dr. Polk has published extensively in the areas of emergency medicine, austere medicine, disaster response, air transport, aerospace medicine and medical management. He is an attending emergency physician with the Emergency Medicine Associates group as well as a Clinical Associate Professor of Emergency Medicine at the Edward Via College of Osteopathic Medicine. He is also an Affiliate Associate Professor and Senior Fellow in the School of Public Policy at the George Mason University. He has received numerous awards and commendations including citations from the Federal Bureau of Investigations, White House Medical Unit, Association of Air Medical Services, U.S. Air Force, and has received the NASA Center Director’s Commendation, the NASA Exceptional Service Medal, the National Security and International Affairs Medal and the NASA Exceptional Achievement Medal. Dr. Polk played an instrumental part in the Chilean Miners Rescue in Chile’s San José copper and gold mine and will share this experience.
friday 19/Saturday 20 Beginning on Friday, the morning session will consists of a case study presented by Drs. Ronnie, Amanda & Natasha Martin-Bray. Following the conclusion of the case study, physicians will break out into their designated specialty track. Published author and psychiatrist, R. Murali Krishna, M.D., has received national and international recognition for his commitment to increasing awareness of the power of the mind-body-spirit connection. He has been featured on network television news programs and publishes a column, Mind Matters. Dr. Krishna has received numerous awards for his work including the Exemplary Psychiatrist Award presented by the National Alliance for the Mentally Ill, the Heart & Soul Appreciation Award from the American Heart Association, and the Outstanding Asian American Award in 1995 for his efforts to help the victims of the Oklahoma City Bombing. In 2001, Dr. Krishna was named a Distinguished Fellow by the American Psychiatric Association for his extraordinary contributions in the field of psychiatry. He is co-founder and president of the James L. Hall, Jr., Center for Mind, Body and Spirit, an affiliate of INTEGRIS Health, and is president and chief operating officer of INTEGRIS Mental Health in Oklahoma City. Dr. Krishna will be leading the psychiatry specialty track on Saturday, April 20th from 2:00-3:00 pm.
sunday, april 21, 2013
Proper Prescribing and the MedPro Program will take place on Sunday, April 21st. Proper Prescribing will begin at 9:00 am and the MedPro Program will immediately follow.
Oklahoma D.O. | February 2013
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Oklahoma Osteopathic Association’s 113th Annual Convention April 18-21, 2013 Embassy Suites Norman - Hotel and Conference Center 2501 Conference Drive, Norman, OK 73069 Full name: _____________________________________________________________________________________________________________________ Preferred Name / first name for name badge: __________________________________________________________________________________________ Office address: _________________________________________________________________________________________________________________ City: ____________________________________________________________________ State: ____________________ Zip: _____________________ E-Mail: _______________________________________________________ Phone: ________________________________________________________ CONVENTION SYLLABUS: q I wish to receive my professional program syllabus in print. Note: all presentations will be available on the convention module. OTHER NAME BADGES NEEDED FOR: Spouse: ______________________________________________________________________________________ Guest(s): ______________________________________________________________________________________________________________________ Children/Teens : _________________________________________________________________________________________________________________ NOTE: All convention registrants, Teens, Children, and Guests MUST wear an OOA name badge to enter the exhibit hall. We suggest listing all of your guests above to save you time during the registration process. On/Before April 11, 2013 After April 11, 2013 q DO Member Registration (or other AOA divisional society member) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 $565 (Includes Sunday’s Proper Prescribing Lecture and Risk Management Program) q Retired DO Member Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 $325 q DO Nonmember Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,090 $1,115 q Spouse/Guest/Exhibitor Events Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $220 $245 q MD and Non-Physician Clinicians Registration* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 $565 q Osteopathic Medical Student: q OMS-I q OMS-II q OMS-III q OMS-IV . . . . . . . . . . . . . . . . . . . . .$0 $0 q Intern q Resident q Fellow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0 $0 Registration is complimentary for osteopathic students and physicians in postgraduate training. They are welcome to attend all programs and convention functions at no charge. Please make event ticket requests at the OOA Registration desk. Badge required.
q q q
DO Member Registration for Sunday Program Only** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $195 DO Nonmember Registration for Sunday Program Only** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $745 MD and Non-Physician Clinician Registration for Sunday Program Only** . . . . . . . . . . . . . . . . . . . . . . . . . . . . $195
$220 $770 $220
Non-registered OOA Members may purchase Banquet tickets. q I would like to purchase ________ Banquet ticket(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 each TOTAL AMOUNT DUE:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________
$100 each $______________
Registration includes name badges(s), registration gift and all meals and social events unless otherwise noted. *Registration includes name badge, certificate, and registration gift. **Registration DOES NOT include registration gift or meal tickets. q
Charge my VISA, MASTERCARD, AMEX, DISCOVER:
Card #: ________________________________________________________________________________________________ Exp. Date______________ CID # (3 digit number on back of card or 4 digit number on front of AMEX card) _______________ Zip code for cardholder: ____________________________ q
My check in the amount of $______________ is enclosed and made payable to the Oklahoma Osteopathic Association.
Mail this form and payment to: Oklahoma Osteopathic Association: 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335 or FAX: 405.528.6102 NOTE: All DO attendees must be members in good standing with their respective state association in order to attend at the announced fees. Otherwise, a DO may attend the convention by paying an additional $550, which may be applied towards OOA membership dues with completed application. Students, interns, residents, and fellows are not required to pay a registration fee and are welcomed to attend all convention functions at no charge. Requests for refunds must be received before April 11, 2013, and a $45 service fee will be charged. NO REFUNDS AFTER APRIL 11, 2013.
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Oklahoma D.O. |February 2013
Oklahoma D.O. | February 2013
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RURAL MEDICAL TRACK SELECTIVE ROTATIONS Provided by Duane G. Koehler, DO, Assistant to the Dean for Rural Education
CENTER FOR HEALTH SCIENCES
At the time this article is being written, Rural Medical Track (RMT) students are in the in the process of finalizing their fourth year rotations. Four months of the fourth year, for this group, involves selected elective rotations, thus the term selectives, in a variety of disciplines.
mine the disciplines of medicine in which they felt more exposure or experience would be most helpful prior to graduation (see Table 1 for survey results and physicians who agreed to serve selective preceptors). With that guidance, we at the OSU Center for Rural Health have begun to attempt to meet those needs indentified by the students.
Selectives, by design, are intended to be an integral part of the Rural Medical Track program at OSU CHS. The purpose is to increase exposure to specialized medical knowledge through clinical experiences. It is anticipated that the student gains a more in depth understanding about the interaction between the generalist and the specialist, as well as opportunities to gain added experiences.
Many others have been queried, and at the time of writing may not have responded. That is pointed out to say that if you have agreed but are not on the list, this is being written before we have received a final response. To any not mentioned, I will apologizeit is not an intentional oversight or slight.
The Rural Medical Track was introduced in this column in the May-June issue of this publication. It is based upon a grant funded by the Health Resources Services Administration. Since that introduction, students which have completed other programs focused on rural health care, were surveyed to deter-
To all others, if you have a desire to give back to the profession and to share your expertise with the future of the profession- feel free to make that desire known to the Center for Rural Health at the Center for Health Sciences. The author may be reached at duane.koehler@okstate.edu, or Dr. Pettit may be reached at william.j.pettit@okstate.edu. okDO
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Oklahoma D.O. |February 2013
Table 1: Requested Selective Choices Among Rural Medical Track (RMT) Students at OSU COM 2012
Specialty
# of Students Request
Preceptor(s)
Dermatology
9
Radiology Infectious Disease
8 6
Nephrology
5
David Eslicker, D.O. (Bartlesville); Sara Metcalf, M.D. & Tom Hall, M.D. (Stillwater); Miranda Smith, M.D. (Tulsa) George Erbacher, D.O. (Tulsa) Heather Bell, D.O. (Tulsa); Jorge Mera, D.O. (Tahlequah); Anthony Zeimet, D.O. (Joplin, Mo.) Beverly Mathis, D.O. & Ken Calabrese, D.O. (Tulsa); James Madison, D.O. (Tahlequah)
Critical Care Gastroenterology Pediatrics
4 4 4
Anesthesiology
3
Cardiology Endocrinology Plastic Surgery Urology Family Medicine OMM
3 3 3 3 2 2
Ophthalmology Pulmonology Emergency Medicine
2 2 1
ENT
1
General Surgery IM OB/GYN
1 1 1
Orthopedics Psychiatry
Oklahoma D.O. | February 2013
1 1
David James, D.O. & Leon Yoder, D.O. (Tulsa) Mike Stratton, D.O. (Muskogee) Dale Derby, D.O. (Owasso); John Navarro, M.D. (Lawton) Greta Warta, D.O. (Tulsa) Christian Hanson, D.O. (Tulsa) Laurie Duckett, D.O. (Tulsa) Scott Michener, M.D. (Lawton) Robin Dyer, D.O. (Tulsa); Jeff Jones, D.O. (Enid) Tim Frink, D.O. (Tulsa) Tim Soult, D.O. (OKC); William Wiley, D.O. (Tulsa); Shelley Zimmerman, D.O. (Norman); Mike Fitzgerald, D.O. (Lawton); Mike Ogle, D.O. (Enid) Richard Allen, D.O. (Grove); Dale Smith, D.O. (Lawton); Tre’ Landrum, D.O. (Ada) Damon Baker, D.O. (Tulsa) Mark Melton, D.O. (Ardmore); Angela Christy, D.O. & Joe Johnson, D.O. (Tulsa); Tammie Koehler, D.O. (Miami, Ok.) Patrick Gannon, M.D. & Clay Crawley, D.O. (McAlester)
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WHERE WE ARE, HOW WE GOT THERE, WHERE WE ARE GOING Provided by Val Schott, MPH, Chief Executive Officer Oklahoma Health Information Exchange Trust
It seems that the first of the year is a time we all make resolutions about what we want to do and where we want to go with our lives and our work. This causes a time for reflection to see where we have been. Not only is this good for us individually but also for organizations. I would like to do that for the Oklahoma Health Information Exchange Trust (OHIET). Where We Were When George W. Bush made the commitment to make electronic health records (EHR) available for all Americans, health care as an industry was really not ready to implement EHR but rather was willing to investigate the possibility and the promise of better care and cost efficiency. President Bush established the Office of the National Coordinator for Health Information Technology (ONC) in the Department of Health and Human Services (HHS) with some funding for demonstration projects to begin to use and or show the power of the electronic health record.1 Other than these demonstration projects, there was little progress toward a universal adoption of this technology in the health care arena. President Obama agreed with the Bush administration in their desire for all Americans to have their own electronic health record by 2014. A major focus of the Obama Administration was to be expanding coverage for health care services to all Americans and controlling the spiraling cost of health care. Use of EHR was judged to be an important cost saving measure just as it had been during the Bush Administration. As an incentive for providers to get to a meaningful use of this technology, the American Recovery and Reinvestment Act authorized incentive payments to providers to assist them in the purchase and implementation of EHR. Another incentive program was offered to the states to create the infrastructure whereby active practitioners could share appropriate patient data to assist in patient treatment and reduced duplication and costs. Funds were offered to the states in the form of grants to establish Health Information Exchanges on the state level. Oklahoma decided to participate, as did every other state. Since we were still deciding as to the appropriate form for this exchange to take, the Oklahoma Health Care Authority (OHCA), at the direction of Governor Brad Henry applied and was awarded the grant. This grant came through the ONC with specific guidelines and instructions as to how the grant funding was to be used. What We Did Oklahoma was initially undecided on how to structure this orga-
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nization to facilitate the sharing of health information, much less what the responsibilities of the organization should be. In applying for the grant, the OHCA established a rather large group representing virtually every entity in the state concerned with health. This included representatives from hospitals, clinics, virtually every provider group and consumers. Physicians, nursing groups, Physicians Assistants, pharmacists, laboratory services, dentists, behavioral health, and others were included. Administrators, hospital accountants, Native American groups, patient advocate groups, payer groups, and associated groups were included. The state universities and the state medical schools were represented, as were employer groups and the state Chamber. Also included were state agencies representing the state health department, the OHCA, the Department of Mental Health and Substance Abuse Services, the Insurance Department, the Office of State Finance and the Department Human Services participated. As you can see, this was a rather exhaustive list. More than one hundred people participated in the process that lasted the better part of eighteen months. Exactly what was the process? What was the desired outcome? Our task was to determine what the responsibilities would be and what structure the organization would take that had responsibility to lead the State of Oklahoma in to the electronic health record age. Although there were a myriad of issues, the major issues boiled down to protection of patient privacy and security of patient data, and the best way to control those issues while allowing for the efficient exchange of appropriate data needed to improve patient care. We decided early on that whatever structure the organization took, we would be a ‘network of networks’ meaning there would be no central data base or collection point for patient data, and local or regional efforts to share patient data would be incorporated into the statewide plan. Data sharing would rely on an agreement between and among the networks for data sharing that would protect privacy and security. While each option presented challenges, this option required the determination of what data was to be shared, how it was to be shared while at the same time protected, and what use could be made of the data. Would any data be available for compiled research? How would it be protected? Would it be de-identified? Given the nature of our state, could it be appropriately de-identified to prevent racial or socioeconomic profiling? Who would have the responsibility to decide?
Oklahoma D.O. |February 2013
How We Got Here The other major issue was what structure would this organization take? We were divided among three trains of thought. The first was for the organization to be a state agency. There seemed little push to create a new state agency given the funding problems of the state and nation. Remember, this process started about five years ago. Some wanted to place this function within a state agency, such as the Oklahoma State Department of Health (OSDH) or the OHCA. There was general disagreement among providers and provider groups for this option. Privacy and security were seen as very important and the provider community simply did not want to place that much information and authority in a government agency. Another train of thought offered by the provider community was a not-for-profit, tax-exempt agency. The proposed not-for profit would have a Board of Directors and would be responsible mainly to the provider community. This option did not provide any assurance for the services that state government agencies would necessarily need. These services, required by law, included immunization data and reporting as well as surveillance data for outbreaks and required disease reporting and other legal requirements. It would also not be afforded tort liability under the Governmental Tort Claims Act, which was a major concern. While providers generally favored this option, they recognized the shortcomings of the structure itself and the potential lack of control over a Board. The third option, really a compromise, was a state beneficiary public trust. The advantages of a public trust over a not for profit corporation included liability limitations under the Governmental Tort Claims Act and exemption from Oklahoma sales and use taxes. Advantages of a public trust over a state agency were that the trust was seen as a more autonomous entity with more flexibility than a state agency, and it would have the ability to issue bonds and other long-term debt.2 Board membership could also be recommended by category and skill sets required, even though appointing authorities would have no strict obligation to follow those recommendations. However, many times the appointing authority at least looks to these recommendations in filling Board positions. A disadvantage was that creation of a trust would require legislation approved by the Governor. This was a difficult issue. The legislature was already heavy into the 2010 session. An appropriate bill would have to be found, not to mention legislative sponsors in both houses of the legislature. The bill would have to be passed without amendment by both houses of the legislature then signed by the Governor. Any objection or change in the bill would kill the legislation, causing a delay until the next annual session. The time to take advantage of the grant money made waiting another year totally unworkable. Against these odds, authors were identified; a bill was written into an appropriate vehicle for the legislature to con-
Oklahoma D.O. | February 2013
sider and the bill was passed. The Governor then signed the bill into law and the Oklahoma Health Information Exchange Trust was born!3 Where Are We Now Like many new organizations, OHIET had many start up problems. Who would be on the Board? Should we ‘lobby’ for certain appointments to ensure representation? Who should be appointed to the Advisory Board? Most importantly, how should grant funds be used to promote and improve health outcomes in Oklahoma with the opportunity to reduce health care costs, our original goals. The Governor, Speaker of the House, and President Pro Tempore of the Senate appointed seven Trustees to serve as the Board of Directors. They organized themselves and elected a chair, Robert Roswell, M.D., a vice-chair and secretary, Jennie Alexopulos, D.O., and a treasurer, Sam Guild. Other Board members included Brian Yeaman, M.D., David Kendrick, M.D., Craig Jones and John Calabro. Through a process they selected a Chief Operating Officer and appointed the Advisory Board.4 Since John Calabro was selected as CEO, he was required to vacate his board position. Julie Cox-Cain was appointed in his place. The Advisory Board elected Val Schott as chair and OHIET was in business. OHIET gained an additional grant in 2011 designed to extend the benefits of EHR to long-term care, the Challenge Grant; since Dr. Brian Yeaman is the principal investigator for this grant, he resigned his Board position to eliminate any perceived conflict of interest. Dr. Yeaman subsequently was appointed to the Advisory Board where he provided excellent work in the design of the voucher programs. Joe Nicholson, D.O., was appointed to a full term to succeed Dr. Yeaman. After Mr. Calabro retired, Val Schott was named CEO in November 2011, and Mitch Thornbrugh was elected chair of the Advisory Board. In January 2012, Julie Cox-Cain resigned her Board position to allow her to serve on another state board. OHIET made a recommendation for her replacement, although no action on that recommendation has been forthcoming. Three other significant events occurred in the summer of 2012. OHIET had no staff essentially except for the CEO. Hiring staff was a problem. With assistance and guidance for the Oklahoma Central Purchasing Agency, OHIET developed a bid for administrative, accounting and reporting. The bid was let in June and the Community Services Council of Greater Tulsa, Inc. (CSC) was hired to perform those services. Additionally, Central Purchasing assisted OHIET in bidding for assistance with outreach; the Oklahoma Foundation for Medical Quality won that bid. Both of these acquisitions with the assistance of the Oklahoma Central Purchasing Agency were significant additions to the ability of OHIET to do the business of the grants Oklahoma received. The third acquisition did not require a bid because it is a contract with a sister state agency as proposed
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in the original grant application. OHIET contracted for the services of the University of Oklahoma College of Public Health with a sub award to the Oklahoma State University Center for Rural Health for program evaluation. This contract also calls for graduate assistants at the College of Public Health, and an administrative assistant and office space on that campus. These three events have provided the staffing and business structure that OHIET needed to move on with the business of a Health Information Exchange as proposed in the grant application. All have been very successful in enhancing the abilities of OHIET to perform and operate. What Have We Done One major struggle was how to go about spending grant funding to accomplish our stated purposes. The Trust with assistance from the Advisory Board developed the concept of vouchers that would be given to various providers to encourage connection of their electronic health records to one of the state health information exchanges which allow the electronic transfer of appropriate patient data. The Board, with the counsel and advice form the Advisory Board determined that a system of vouchers would be an appropriate way to provide benefit to Oklahoma providers, especially those in rural areas. Vouchers were devised for rural hospitals and rural providers. Working with the Oklahoma State University Center for Rural Health, OHIET adopted a definition of rural that included most of the state except for the metropolitan areas. The voucher system, vetted through the Advisory Board, was submitted to ONC who approved the program. Simultaneously, the Board considered and approved a plan for certification of Health Information Organizations (HIOs) that wished to do business in Oklahoma and wanted to accept vouchers from Oklahoma providers. Three HIOs have secured OHIET certification. They are MyHealth, NPHX, and SMRTNET. All three are Oklahoma based organizations and do business statewide. The vouchers are essentially designed to be redeemed through OHIET-certified HIOs to provide a coupon or discount for services to providers. They are designed for both hospitals and eligible professionals to provide service at two levels. The levels for eligible hospitals are as follows: Hospital Level 1 Interoperability: Send and receive CCDs via DIRECT standard messaging or equivalent, and query for and view data on individual patients via the web-based portal from the chosen HIO. Voucher value for funding “Level 1” will be applied toward the cost of contractual agreements made with participants Certified HIO. This could include Level 1-specific fees, including initiation fees and subscription service/support. Hospital Level 2 Interoperability: Connect directly with a certified HIO and send structured clinical data using HL-7 protocols for transmission of CCDs or other clinical data. 22
In particular, EH’s will be expected to exchange hospital and ED discharge summaries to the Certified HIO. Voucher value for funding “Level 2” will be applied toward the cost of contractual agreements made with participant’s Certified HIO. This could include Level 2-specific fees such as interface fees, initiation fees, and subscription service/support and will be based on the contractual arrangement with participants Certified HIO.5 The levels for eligible professionals are: Provider Level 1 Interoperability: Send and receive CCDs via DIRECT standard messaging or equivalent, and query for and view Data on individual patients via the web-based portal from the chosen HIO. Voucher value for funding “Level 1” will be applied toward the cost of contractual agreements made with participant’s Certified HIO. This could include Level 1-specific fees including initiation/credentialing fees and subscription service/support. Provider Level 2 Interoperability: Connect directly with a certified HIO and send structured clinical data using HL-7 protocols for transmission of CCDs as well as other structured clinical data and potentially unstructured text data in the form of reports and dictations. Voucher value for funding “Level 2” will be applied toward the cost of contractual agreements made with participants Certified HIO. This could include Level 2-specific fees, including Interface fees, initiation fees, and subscription service/support and will be based on the contractual arrangement with participants Certified HIO. Provider Certified EHR Connection: This one-time funding opportunity is included in the Provider Level 2 Voucher and provides for the connection of a Certified EHR database and is limited to one per practice approved for a Level 2 Voucher.6 Any hospital located in a rural area in Oklahoma as defined in the program announcement is eligible for a voucher. That is any Oklahoma hospital in any county other than Oklahoma, Cleveland, Tulsa, or Comanche counties. The same definition of rural is applied to eligible providers. This category includes physicians, nurse practitioners, and physician assistants who are in a PA- directed Federally Qualified Health Center. In addition, an eligible provider must meet four criteria. They are: 1. Be in the process of obtaining an Electronic Health Record system that has been certified by the Office of the National Coordinator for Health Information Technology (ONC), and 2. Have met or in the process of pursuing ‘Meaningful Use’ as defined by the ONC and the Centers for Medicare and Medicaid Services (CMS), and 3. Have a practice site is located in a rural area as defined by the application for the Eligible Provider Voucher Oklahoma D.O. |February 2013
Program, and 4. Have received or be eligible to receive incentive payment for meaningful users of certified electronic health records nder the American Recovery and Reinvestment Act.
Where Do We Go From Here Funding for these vouchers is time limited. Our grants are scheduled to terminate September 30, 2013. There is a possibility for a one-time extension until February 2014, but this is not assured.
The Challenge Grant is another success for OHIET and Oklahoma. “In order to improve the transitions in care, there is a clear need to engage providers in sharing information like care summaries, pharmacy data, medication lists, continuity of care document elements and direct messaging. That is why, as part of a three year challenge grant by the Office of the National Coordinator, Yeaman Consulting is focusing on improving transitions of care between hospitals and long-term care facilities by implementing electronic information exchange practices that support patient care during and after transitions.
If you are an eligible provider or an eligible hospital, I urge you to apply for these vouchers immediately. The funding is allocated for you so please take advantage of it while there is still time.
“Oklahoma’s Challenge Grant has engaged acute care hospitals, five long-term care facilities, case management, emergency departments and a multi-stakeholder governance committee to drive adoption of lightweight EHR in the LTCFs. The lightweight EHR is connected with a regional and well-established health information organization and driving the use case for Direct to help with transfers, standardized documentation and care transition coordination. This low cost and easily reproducible solution is proving many models to integrate disparate systems that currently exist as patients move across the care continuum and has received national recognition from the LTPAC community to the National Coordinator for Health Information Technology.”7 OHIET was awarded an additional grant to develop a program to encourage electronic data exchange among behavioral health providers. Oklahoma is one of six states to receive this grant. Our plan was to focus on Medicaid safety net providers. We wanted to encourage exchange of appropriate data between physical health providers and behavioral health providers. An additional goal was to use the same HIOs that already exist for this program further encouraging interaction between physical and behavioral health providers. An additional goal was to contribute to the sustainability of the certified HIOs and to have program activity statewide. OHIET developed a voucher program with these goals in mind.
The Board is grappling with a sustainability issue for OHIET. There are a variety of tasks that remain to be completed. First is a process and structure to provide certification to new applicants and recertification to currently approved HIOs. Second is a vehicle to insure on-going quality performance of the HIOs. Another is what role OHIET can and should play in the continuing evolution of the use of electronic data transfer. Of course, the overriding responsibility is the privacy and security of patient data and its use. Our main focus is to ensure the sustainability of the certified HIOs in Oklahoma. If we can provide for their sustainability, including a periodic recertification process and quality assurance for the electronic data sharing process including continued protection for privacy and security, we believe that the health of all Oklahomans will be improved. Then OHIET will have done its job. okDO REFERENCES: 1. “President Bush continues EHR push, sets national goal”, www.healthcarenews.com, April 26, 2004 2. Crowe & Dunlevy, “Recommendations Regarding Legal Structure for Qualified State Designated En tity to Receive SHIECAP Grant”, April 12, 2010 3. Oklahoma Health Information Exchange Trust, “Operational Plan – March 2011”, p.3 4. OHIET, “Advisory Board Nominees”, October 4, 2011 5. OHIET, “Voucher Funding Announcement No 2012-02”, p. 4 6. Ibid, p. 5 7. Brian Yeaman, M.D., “Challenge Grant Summary to ONC”, January, 2013
To date, OHIET has issued vouchers to forty-four rural hospitals with a value of $1,078,000. We have issued vouchers to twenty-seven safety net behavioral health providers at a value of $519,000. We have also just begun the voucher program for eligible providers and letters have been sent awarding 58 providers with $133,748 in vouchers. OHIET has approximately 120 eligible providers in the pipeline that will be approved shortly. Our goal is to issue vouchers to eighty rural hospitals and eight hundred rural eligible providers.
Oklahoma D.O. | February 2013
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AN ACTIVE PARTICIPANT IN THE CARE OF THE GROWING POPULATION OF THE OLDER ADULT Provided by Joanne Alderman, APRN-CNS, RN-BC, FNGNA The needs of our aging population are demonstrating unique challenges for healthcare providers. When it became a designated (Nurses Improving Care for Healthsystems Elders) site in 2007 OSU Medical Center positioned itself to care for this population. The NICHE program is the leading nurse-driven program that incorporates the multidisciplinary/interdisciplinary teams to assist hospitals in improving the care of older adults. This program provides proven resources and a support system to approximately 400 designated hospitals and healthcare facilities. Care offered at OSU Medical Center through the NICHE program is centered on preserving function, supporting independence, and promoting healing. OSU Medical Center staff knows that being in the hospital can be an overwhelming experience. When an older adult is admitted, they become part of the NICHE program. “We provide excellent, professional care for the patient and support their family”, states David Hitzeman, DO. According to Dr. Hitzeman, “Our nurses understand the special needs of older adults, and this understanding puts the patient and family at ease. Our goal is to have older
Exceptional Health Care
adults, who are placed in our care, return home as independently as possible.” NICHE recognizes that the majority of hospitalized patients are older adults. The older adult can present with more than one chronic illness, multiple medications, chronic pain, and the expected physiological changes that occur with aging. In addition to the tools and support provided by NICHE, the staff at OSU Medical Center is offered three major educational programs that prepare them to recognize the needs of, and intervene in the care of the older adult patient. Registered nurses and licensed practical nurses are offered two courses, the Geriatric Resource Nurse (GRN) and the review course for the National Gerontological Certification. The third course provides nurse aides with three days of geriatric education.
OSU Medical Center physicians and staff continue to bring the best evidence for our practitioners to translate into bedside care in order to serve our older adult patients with "excellent care, every patient, every time." okDO
OSU Medical Center To us, you are family. For over 68 years, families have trusted OSU Medical Center. Built on years of service to our community, rich traditions, and our commitment to train the physicians of tomorrow, we have helped multiple generations receive personalized health care. Our medical center is focused on the future and is undergoing extensive renovations. Offering exceptional care for all ages and making a difference is what we do best every day. OSU Medical Center offers: ● The nation’s largest Osteopathic academic medical center ● Fast track emergency care ● A team approach to quality health care ● Wound Care and Hyperbaric Center ● Largest statewide Telemedicine Program ● 24/7 physician referral For physician referral call, 918.599.4OSU
Exceptional health care, Every patient, Every time. 744 WEST 9TH STREET / TULSA, OKLAHOMA / (918) 599-1000
www.osumc.net 24
Oklahoma D.O. |February 2013
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OK_OsteoSoc_full_1c_7'375x9'75.indd 1 Oklahoma D.O. | February 2013
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3/28/11 11:05 AM
CENTER FOR HEALTH SCIENCES David F. Hitzeman, DO, FACOI, Editor Professor of Medicine Department of Internal Medicine Atherosclerosis, Inflammation and Cardiovascular Risk: A Review John Evans, DO Internal Medicine Resident Oklahoma State University Medical Center Jeffrey S. Stroup, PharmD, BCPS, AAHIVE Associate Professor of Medicine Oklahoma State University Center for
Health Sciences
Introduction Cardiovascular disease (CVD) is the number one cause of mortality worldwide (1). In 2008 it accounted for 17.3 million deaths and is expected to rise to 30 million deaths annually by 2030 (1). In the United States, the rate of CVD mortality declined from 19982008 by 30.6% with efforts to curb nicotine dependence and improve the management of modifiable coronary heart disease (CHD) risk factors such as hypertension, hypercholesterolemia, and diabetes (2). However, according to the American Heart Association (AHA), in 2008 greater than one-third of Americans had a BMI ≥ 30 kg/m2, nearly 37% (81.5 million) were prediabetic, and 44.4% (98.8 million) had low density lipoprotein (LDL) levels ≥ 200 mg/dL (3). The role of the CHD risk factors of: age, tobacco use, hypertension, diabetes, and hyperlipidemia in CVD was originally established from epidemiological data in the Framingham Heart Study (4,5). In a recent analysis of these conventional modifiable risk factors, one or more were present in approximately 80-85% of patients with CHD, but between 15-20% lacked any of these risk factors (6). This has prompted much debate over the presence of non-traditional CHD risk factors in patients previously classified as low 26
Oklahoma State University Center for Health Sciences College of Osteopathic Medicine 1111 West 17th Street Tulsa, Oklahoma 74107-1998
risk who experience major cardiovascular events such as myocardial infarction (MI) and stroke (7,8). As the inflammatory hypothesis of atherosclerosis gained consensus in the literature, the non-specific inflammatory biomarker C-reactive protein has emerged as a potential target of therapy (9-15). However, controversy remains concerning the utility of CRP as a CHD risk factor, especially when no causal link to CHD has been discovered. This review will summarize data from these trials regarding highly-sensitive Creactive protein (a sensitive CRP assay) levels and cardiovascular risk. Atherosclerosis and inflammation Atherosclerosis is a progressive, inflammatory disease characterized by gradual lipid storage and remodeling in the intima of large elastic and medium-sized muscular arteries causing ischemia to the brain, heart, or extremities, with the potential for acute thrombosis and infarction (17). The endothelial lining possesses several immunological motifs that regulate the binding and activation of platelets, macrophages, and T-cells. The initial endothelial insult is due to dysfunction induced by exposure to any one of the major CVD risk factors, such as hypertension, tobacco smoke, or hypercholesterolemia (16). Also, branch points in the vascular tree have a predilection for atherosclerosis formation due to loss of laminar flow and increased adhesion of leukocytes which promotes inflammation (18). Endothelial injury leads to impaired release of the potent vasodilator and anti-thrombotic molecule nitric oxide (NO) (19). In particular, an atherogenic diet can introduce oxidized low density lipoproteins into the intimal layers and promote a low-level inflammatory state. Both innate and adaptive
immunity participate in this process with lipid-laden macrophages (foam cells), T-cells, and smooth muscle cells accumulating within the lesion to promote remodeling of the core leading to necrosis and calcification. A fibrous cap consisting of smooth muscle cells and collagen rich matrix forms and becomes particularly vulnerable to rupture at sites adjacent to the endothelium. During atherothrombosis, activated macrophages and T-cells secrete inflammatory cytokines and metalloproteinases that destabilize the plaque to expose the thrombogenic inner core. The pro-inflammatory cytokines tumor necrosis factor (TNF), interferon-γ (IFN-γ), interleukin-1 (IL-1), and interleukin-6 (IL-6) are amplified throughout atherogenesis. CRP is produced primarily in the liver in response to an upstream increase in cytokines such as IL-6 (20). A relationship between pro-inflammatory cytokines and elevated CRP in atherosclerotic vascular disease has been repeatedly demonstrated in the literature. For example, in a study involving 446 emergency department admissions for acute coronary syndrome, CRP elevations > 7.44 mg/dL were associated with a significant risk of death after 5 years and increased congestive heart failure readmission rates after 2 years (21). In a second study involving a cohort of 76 patients on optimal statin therapy postcoronary artery bypass grafting, elevated CRP was positively correlated with coronary atherosclerosis burden (22). C-reactive protein in prevention trials An association between elevated C-reactive protein and increased risk of major cardiovascular events has been demonstrated in several post hoc analyses of major statin trials. These also highlight the purported anti-inflammatory properties Oklahoma D.O. |February 2013
of statins (23). In the 1996 secondary prevention study known as the Cholesterol and Recurrent Events (CARE) trial, 4159 patients with a prior history of MI and LDL between 115 and 175 mg/dL were randomized to receive placebo or pravastatin 40mg daily (24). Researchers discovered the magnitude of risk reduction attributable to pravastatin was greater in those with evidence of inflammation (54%) than among those without it (25%). Furthermore, the magnitude of CRP reduction in the treatment arm did not correlate with the magnitude of LDL reduction achieved, suggesting an independent, anti-inflammatory role for statins. In the 2001 AFCAPS/TexCAPS (Air Force/Texas Coronary Atherosclerosis Prevention Study) trial post hoc analysis, subjects with a “low” LDL of < 149 mg/ dL and no evidence of CHD benefited from pravastatin 40mg with a 37% reduction in MI and CV death when their hsCRP was > 1.6 mg/L (12). This benefit approached a similar reduction of these events with treatment of low HDL patients (<47 mg/dL) with LDL between 152 and 191 mg/dL without regard to hsCRP. Individuals with low LDL and hsCRP had no benefit, suggesting that treating the proposed underlying inflammatory state reduced cardiovascular events (25). In a study utilizing Intravascular Ultrasound (IVUS) known as the reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) trial, lower dose (40mg of pravastatin daily) and high dose (80mg of atorvastatin) were compared in a study of 502 patients with angiographic evidence of atherosclerosis (26). The advancement of atherosclerotic lesions were compared at baseline and at 18 months follow-up with a repeat IVUS revealing greater regression of disease noted in individuals treated more intensively for whom both LDL cholesterol and hsCRP levels were reduced concomitantly. Reduction in either LDL or hsCRP alone resulted in less than the median reduction of disease (26). The improved outcome with targeting of both LDL and hsCRP demonstrates the “dual target hypothesis”, for which some proponents lowering hsCRP note its Oklahoma D.O. | February 2013
separate contribution to cardiovascular risk (27). C-reactive protein as a target for prevention: The JUPITER trial The controversial primary prevention trial JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) remains the only randomized placebocontrolled study to date that evaluated hsCRP specifically as a risk factor for major cardiovascular events (13). Investigators randomized 17,802 men ≥ 50 years of age and women ≥ 60 years of age with LDL cholesterol levels < 130 mg/dL and hsCRP levels ≥ 2 mg/L and no history of CV disease or diabetes to 20mg of rosuvastatin daily versus placebo. The primary end point was first occurrence of MI, stroke, hospitalization for unstable angina, revascularization procedure, or CV death. Following the conclusion of the study, a 44% reduction in the primary endpoint was noted (p < 0.0001, 95% CI 0.46-0.69) with reduction in LDL cholesterol of 50% and 37% for hsCRP. The number needed to treat (NNT) for 2 years to prevent the primary endpoint was 95, with a NNT of 35 when the data was extrapolated out to 4 years. Though designed to last 4 years, JUPITER was concluded at just 1.9 years based on a decision from the independent data monitoring that there was a marked and conclusive benefit. The JUPITER study was subsequently criticized in follow-up analyses on many grounds. Of the 89,890 individuals initially screened, for example, 52% were excluded based on LDL > 130 mg/dL and 36% were excluded for hsCRP levels < 2.0 mg/L raising questions about its applicability to the general population (27,28). Of those included in the study, approximately 41% carried a diagnosis of metabolic syndrome and nearly 16% smoked, both conditions known to elevate CRP levels (29,30). The average LDL cholesterol was 108 mg/dL in both arms, actually considered borderline high as determined by the National Cholesterol Education Program, Adult Treatment Panel III guidelines (31). These observations would tend to overestimate the contribution of a lowered hsCRP to
reduction in the primary endpoint, tending to support the benefit of treatment to LDL, the traditional target of statin therapy. Conclusion CRP is a well-established biomarker for increased cardiovascular risk, although a causal role for CRP in atherosclerosis has not been elucidated. The JUPITER trial, the only large double-blinded placebocontrolled primary prevention study to target hsCRP as a measure of cardiovascular risk, revealed significant benefit to the studied population for reduced major cardiovascular events. However, its ultimate relevance is marred by its early stoppage and probable selection bias. It is likely that statins continue to provide benefit to the at risk general population based on lipid lowering characteristics alone (32,33). The United States Preventive Services Task Force reviewed the issue of non-traditional biomarkers in cardiovascular risk in early 2011, recommending continued usage of the Framingham risk model based on insufficient evidence that other biomarkers provided a significant benefit when reclassifying low or intermediate risk individuals into higher risk categories (34). This recommendation is well-received in a time where obesity and diabetes rates are at epidemic proportions, and it highlights the need to return to simple risk reduction strategies that engage patients to make fundamental lifestyle changes. Despite the controversial and inconclusive findings of studies like JUPITER, the vascular biology of atherosclerosis appears to support a significant, if not primary role for inflammation and immune activity and this warrants further clinical study. In order to provide clinical relevance to this compelling hypothesis, more direct targeting of inflammatory mediators in CHD is required, beyond the obvious cholesterol reductions or possibly pleiotropic benefits observed with statin therapy. In the upcoming Cardiovascular Inflammation Reduction Trial (CIRT), very low dose methotrexate (VLDM) will be used to target pro-inflammatory cytokines in a secondary prevention trial of individuals with known CHD (35). 27
References
1. Mendis S, ed., et. al. Global Atlas on Cardiovascular Disease Prevention and Control 2011. World Health Organization. WHO Press. 2011.
2. Miniño AM, Murphy SL, Xu J, Kochanek KD. Deaths: Final data for 2008. National Vital Statistics Reports; vol 59 no 10. Hyattsville, MD: National Center for Health Statistics. 2011.
3. Véronique RL, Go AS. Executive Summary: Heart Disease and Stroke Statistics—2012 Update A Report From the American Heart Associa- tion. Circulation. 2012; 125: 188-197.
4. Thomas R. Dawber, M.D., Gilcin F. Meadors, M.D., M.P.H., and Felix E. Moore, Jr., National Heart Institute, National Institutes of Health, Public Health Service, Federal Security Agency, Washington, D. C., Epidemiological Approaches to Heart Disease: The Framingham Study Presented at a Joint Session of the Epidemiology, Health Officers, Medical Care, and Statistics Sections of the American Public Health As- sociation, at the Seventy-eighth Annual Meeting in St. Louis, Mo., November 3, 1950.
5. Dawber TR, Gilcin FM, et al. Epidemiological Approaches to Heart Disease: The Framingham Study. American Journal of Public Health and the Nation’s Health. 1951; 41(3): 279-286.
6. Khot UN, Khot MB, et al. Prevalence of Conventional Risk Factors in Patients with Coronary Heart Disease. Journal of the American Medical Association. 2003; 290 (7): 898-904.
7. Balagopal P, de Ferranti SD, et al. Nontraditional Risk Factors and Bio markers for Cardiovascular Disease: Mechanistic, Research, and Clinical Considerations for Youth, A Scientific Statement From the American Heart Association. Circulation. 2011; 123:2749-2769.
8. Ridker PM. C-Reactive Protein and the Prediction of Cardiovascular Events Among Those at Intermediate Risk, Moving an Inflammatory Hypothesis Toward Consensus. Journal of the American College of Car- diology. 2007; 49(21): 2129-2138.
9. Hannson GK. Atherosclerosis-An immune disease, The Anitschkov Lec- ture 2007. Atherosclerosis. 2009; 202: 2-10.
10. Libby P, Ridker PM, Maseri A. Inflammation and Atherosclerosis. Circulation. 2002; 105: 1135-1143.
11. Hansson GK. Inflammation, Atherosclerosis, and Coronary Artery Dis- ease. The New England Journal of Medicine. 2005; 352: 1685-95.
12. Downs JR, Clearfield M, et al. Air Force/Texas Coronary Atherosclero- sis Prevention Study (AFCAPS/TexCAPS): Additional Perspectives on Tolerability of Long-Term Treatment With Lovastatin. The American Journal of Cardiology. 2001; 87: 1074-79.
13. Ridker PM, Danielson E, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. The New Eng- land Journal of Medicine. 2008; 359(21): 2195-2207.
14. Morrow DA, de Lemos JA. et al. Clinical relevance of C-reactive pro- tein during follow-up of patients with acute coronary syndromes in the Aggrastat-to-Zocor Trial. Circulation. 2006; 114: 281-288.
15. Nissen SE, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atheroscle- rosis: a randomized controlled trial. Journal of the American Medical Association. 2004; 291 (9): 1071-1080.
16. Ridker PM, Buring JE, et al. Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Wom- en, The Reynolds Risk Score. Journal of the American Medical Associa- tion. 2007; 297 (6): 611-619. 17. Ross R. Atherosclerosis – An Inflammatory Disease. The New England Journal of Medicine. 1999; 340 (2): 115-126.
18. McLenachan JM, Vita J. et al. Early evidence of endothelial vasodila- tor dysfunction at coronary branch points. Circulation.1990; 82:
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19. Norris M, Morigi M. et al. Nitric Oxide Synthesis by Cultured Endo- thelial Cells Is Modulated by Flow Conditions. Circulation Research. 1995; 76: 536-543.
20. Hansson GK, Libby P. The immune response in atherosclerosis: a dou- ble-edged sword. Nature. 2006; 6: 508-19.
21. Kavsak PA, Macrae AR, et al. Elevated C-reactive protein in acute coro- nary syndrome presentation is an independent predictor of long-term mortality and heart failure. Clinical Biochemistry. 2007; 40 (5-6) 326- 329.
22. Momin A, Melikian N. et al. The association between saphenous vein endothelial function, systemic inflammation, and statin therapy in pa- tients undergoing coronary artery bypass surgery. Journal of Thoracic and Cardiovascular Surgery. 2007; 134 (2): 335-341.
23. Jain M, Ridker PM. Anti-inflammatory effects of statins: clinical evi- dence and basic mechanisms. Nature Reviews Drug Discovery. 2005; 4:977-987
24. Ridker PM, Nader R, et al. Long-Term Effects of Pravastatin on Plas ma Concentration of C-reactive Protein. Circulation. 1999; 100: 230- 235
25. Ridker PM, Rifai N, et al. Measurement of C-reactive protein for the targeting of statin therapy in primary prevention of acute coronary events. The New England Journal of Medicine. 2001; 344: 1959-1969.
26. Nissen SE, Tuzcu EM, et al. Effect of intensive compared with moder- ate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. Journal of the American Medical Associa- tion. 2004; 359: 2195-2207.
27. Cannon CP, Braunwald E. et al. Intensive versus moderate lipid lower- ing with statins after acute coronary syndromes. The New England Journal of Medicine. 2004; 350: 1495-1504.
28. de Lorgeril M, Salen P, et al. Cholesterol lowering, cardiovascular diseas es, and the rosuvastatin-JUPITER controversy: a critical appraisal. Ar- chives of Internal Medicine. 2010; 170 (12): 1032-1036.
29. Kaul S, Morrissey RP. et al. By Jove! What is a clinician to make of JU PITER? Archives of Internal Medicine. 2010 (12): 1073-1077.
30. Lemieux I, Pascot A, et al. Atherosclerosis and Lipoproteins: Elevated C-reactive protein, another component of the atherothrombotic profile of abdominal obesity. Arteriosclerosis, Thrombosis, and Vascular Biol- ogy. 2001; 21: 961-967.
31. O’Loughlin J, Lambert M, et al. Association between cigarette smok- ing and C-reactive protein in a representative, population-based sample of adolescents. Nicotine & Tobacco Research. 2008; 10(3): 525-532.
32. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Journal of the American Medical Association. 2001; 285 (19):2486-2497.
33. Taylor F, Ward K, et al. Statins for the primary prevention of cardiovas- cular disease. Cochrane Database of Systematic Reviews. 2011, Issue 1.
34. U.S. Preventive Services Task Force. Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment: Recommendation State- ment. Annals of Internal Medicine. 2009;151(7):474-482.
35. Ridker PM. Testing the inflammatory hypothesis of atherothrombosis: scientific rationale for the cardiovascular inflammation reduction trial (CIRT). Journal of Thrombosis and Haemostasis. 2009; 7 Suppl 1: 322-329.
Oklahoma D.O. |February 2013
Purpose and Fun! Provided by Walli Daniel, RN, 2012-2013 AOOA President After the holidays and precious time with family and friends, the AOOA has returned to work, refreshed and planning for 2013. 2012 was a year of sweeping changes, and a renewal of our core commitments. With a few months left before our state convention in April, the work is not finished and we are preparing for the final stretch. Last year we were encouraged to “think outside of the box” and we did. There have been parties, new programs such as “Manvocates” (the advocates have a new word!), community service and broadbased scholarship programs awarding every student, not only a select few. Our new database has opened up our ability to communicate with our members. The AOOA is now on the web and will be completed soon with all of the bells and whistles we’ve come to expect. You can visit us on advocates4okosteo.com or on our Advocates for Oklahoma Osteopathic Association Facebook page. We will soon have our own .org email addresses and now have a new address for all correspondence: P.O. Box 701132 Tulsa, OK 74137 You can even pay your dues or join us online! We had a graphic designer create the artwork for beautiful AOOA lapel pins with the outline of our great state to give to every paid Advocate. We want to identify each proud member and have an immediate connection. They will be ready in 4-6 weeks. Be sure to join or renew! We have also designed gorgeous merchandise for purchase online or at convention. Oklahoma Advocates are known nationally for our affinity for “bling” and beautiful jewelry.
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Upcoming Advocate Activities: February 20: Meeting in Oklahoma City Board Meeting at the OOA Office / Lynette McLain, Executive Director, is the featured speaker. Luncheon following with the South Central District members March 15: Oklahoma City Thunder Game The “Manvocates” are sponsoring the OSU bus from Tulsa to Oklahoma City. Ticekts sold out in 2 hours. Due to the high demand, the AOOA will sponor this event next year. Be on the look out for future inforrmation.
! T U O SOLD
Brew with the Grewe’s The AOOA “Manvocate” program invites you to learn the art of beer brewing from master brewer Terry Grewe, DO. Dr. Grewe will host up to 12 guests for the demonstration in his home. Price is $10 per person, which includes snacks and your very own six pack to take home. Space is limited! Please contact Ryan Miller at 918.851.0442.
Do you need more copies of the 2012-2013 OOA Annual Directory?
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Volum
As an application of our database we are mailing our membership dues statements this month along with a copy of our first ever “Newsletter” containing all of the activities and events planned with you in mind. We have polled and found the two main reasons new members join is “Purpose and Fun.” We are rich in both! Follow our social media and see for yourself.
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Extra copies are great to have at the office or home! Please call the OOA Central Office for more information. 405-528-4848 or go to www.okosteo.org to order your copy TODAY!
Oklahoma D.O. | February 2013
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What DO’s Need To
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EHR Incentive Programs: Several Changes to Stage 1 Meaningful Use Measures Begin This Year The Stage 2 rule for the Electronic Health Record (EHR) Incentive Programs included changes to the Stage 1 meaningful use objectives, measures, and exclusions for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs). Some of these Stage 1 changes took effect on October 1, 2012, for eligible hospitals and CAHs, or January 1, 2013, for EPs. Several are optional, but others are required. Stage 1 Changes and Timing: • Computerized Physician Order Entry (CPOE) o Change: Addition of an alternative measure based on the total number of medication orders created during the EHR reporting period o Timing: 2013 and onward o Change: Revised the description of who can enter orders into the EHR and have it count as CPOE o Timing: 2013 and onward (regardless of what stage of meaningful use the provider is attesting to) • Electronic Prescribing o Change: Additional exclusion to the objective for electronic prescribing for providers who are not within a 10 mile radius of a pharmacy that accepts electronic prescriptions o Timing: 2013 and onward • Record and Chart Changes in Vital Signs o Change: Age limit increased for recording blood pressure in patients from ages 2 to ages 3; no age limit for height and weight o Timing: Optional in 2013; required starting in 2014 o Change: Exclusion if the EP sees no patients 3 years or older, if all three vital signs are not relevant to their scope of practice, if height and weight are not relevant to their scope of practice, or if blood pressure is not relevant to their scope of practice o Timing: Optional in 2013; required starting in 2014 • Public Health Reporting Objectives o Change: Require that providers perform at least one test of their certified EHR technology's capability to send data to public health agencies, except where prohibited o Timing: Required in 2013 and onward (for all Stage 1 public health objectives) • Electronic Exchange of Key Clinical Information o Change: Objective for electronic exchange of key clinical information no longer required for Stage 1 for EPs, eligible hospitals, and CAHs o Timing: No longer required in 2013 and onward For more details about each of these changes review the Stage 1 Changes Tipsheet. Quarterly Provider Specific Files for the Prospective Payment System are Now Available The January 2013 Provider Specific Files (PSF) are now available for download from the CMS website in SAS or Text format. The files contain information about the facts specific to the provider that affect computations for the Prospective Payment System. The SAS data files are available on the Provider Specific Data for Public Use In SAS Format web page, and the Text data files are available on the Provider Specific Data for Public Use in Text Format web page. The Text data files are available in two versions. One version contains the provider records that were submitted to CMS. The other version also includes name and address information for providers at the end of the records. Insulin Pen Safety – One Insulin Pen, One Person The Centers for Disease Control (CDC) has been working to promote safe use of insulin pens, in light of growing awareness of the risk of reuse. Insulin pens are meant for one patient only, but there have been recent occurrences of insulin pens being used for more than one patient. The CDC’s injection safety campaign recently introduced a brochure and poster for clinicians and patients about the safe use of insulin pens. The brochure and poster as well as other resources can be found on the Insulin Pen Safety web page: http://www.oneandonlycampaign.org/content/insulin-pen-safety. CY 2013 Outpatient Prospective Payment System Pricer File Update The Outpatient Prospective Payment System (OPPS) Pricer web page has been updated with outpatient provider data for January 2013. The January provider data is available for use and may be downloaded from the OPPS Pricer web page under “1st Quarter 2013 Files.” New MLN Educational Web Guides Fast Fact A new fast fact is now available on the MLN Educational Web Guides web page. This web page provides information on Evaluation and Management services; Guided Pathways that contain resources and topics of interest; lists of health care management products; and easy-to-understand billing and coding educational products. It is designed to provide educational and informational resources related to certain Medicare Fee-For-Service initiatives. Please bookmark this page and check back often as a new fast fact is added each month
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Oklahoma D.O. |February 2013
Get Paid for 2012: Medicare EPs Must Attest by February 28 for the EHR Incentive Program Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must complete attestation for the 2012 program year by February 28, 2013. In order to be eligible to attest you must have completed your 2012 reporting period by December 31, 2012. CMS encourages Medicare EPs to register and attest as soon as possible to resolve any potential issues that may delay their payment. Medicaid EPs should check with their State for their attestation deadline. CMS has several resources located on the EHR Incentive Programs website to help EPs properly meet meaningful use and attest, including: • A Registration & Attestation web page that includes information on registration and attestation, and links to additional resources. • The Meaningful Use Attestation Calculator, which allows EPs and eligible hospitals to determine if they have met the Stage 1 meaningful use guidelines before they attest in the system. • The Attestation User Guide for Medicare Eligible Professionals, providing step-by-step guidance for EPs participating in the Medicare EHR Incen tive Program on navigating the attestation system. • The Attestation Worksheet for Eligible Professionals, allowing users to enter their meaningful use measure values, creating a quick reference tool to use while attesting. Important Update on 2013 Electronic Prescribing Payment Adjustment Hardship Exemptions On November 1, CMS finalized two new electronic prescribing (eRx) significant hardship exemption categories pertaining to the EHR Medicare and Medicaid Incentive Program in the 2013 Medicare Physician Fee Schedule Rule. Specifically, these hardship exemptions categories are: § Eligible professionals who achieve meaningful use during certain eRx timeframes. For the 2013 eRx payment adjustment, this will include any eligible professional who achieved meaningful use during January 1, 2011 through June 30, 2012 and has attested to this by January 31, 2013. § Eligible professionals who demonstrate intent to participate in the EHR Incentive Program and adoption of Certified EHR Technology by registering for the EHR Incentive Program by January 31, 2013. Please note: EHR Incentive Program participants must provide their entire EHR Certification Number in the CMS EHR Certification ID field during registration to receive this hardship. Eligible professionals do not need to apply for these 2 EHR-related hardship exemptions through the Quality Reporting Communication Support web page (Communication Support Page). They only need to register or attest for the EHR Incentive Program by January 31, 2013. However, if an eligible professional previously registered for the EHR Incentive Program but did not supply the EHR Certification Number for their EHR product at that time, and has not since achieved meaningful use, they need to go back and add that piece of information to their registration before January 31, 2013. Register and attest for the EHR Incentive Program. For questions relating to participation in the Medicare and Medicaid EHR Incentive Program, please contact EHR Incentive Program Information Center at 888-734-6433 (TTY 888-734-6563.) As a reminder, CMS re-opened the Communication Support Page to allow individual eligible professionals and CMS-selected group practices the opportunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship requests should be submitted via the Communication Support Page on or between November 1, 2012 and January 31, 2013. Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final. The following eRx hardship exemption categories are available for request on the Communication Support Page: § Inability to electronically prescribe due to state, or federal law, or local law or regulation; § The eligible professional prescribes fewer than 100 prescriptions during a 6–month payment adjustment reporting period; § The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642); and § The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643). For more information on how to navigate the Communication Support Page, please reference the following documents: § PQRS & eRx Quality Reporting Communication Support Page User Manual § Tips for Using the Quality Reporting Communication Support Page To be assured that we receive your hardship exemption request, it must be summated through the Communication Support Page by 11:59pm ET on January 31, 2013. Important—please note that this is for the 2013 eRx payment adjustment only. Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate timeframe later in calendar year 2013. Eligible professionals who experience difficulties accessing the Communication Support Page or have questions about the eRx Incentive Program should contact the QualityNet Help Desk at 866-288-8912 or qnetsupport@sdps.org. The help desk is available Monday through Friday from 7am through 7pm CT. CMS Created a New Tipsheet to Help Specialists Meet Meaningful Use CMS recognizes that not every meaningful use measure applies to every provider participating in the Electronic Health Record (EHR) Incentive Programs. To help specialty providers successfully meet meaningful use measure requirements and navigate the EHR Incentive Programs, CMS created the Meaningful Use for Specialists Tipsheet. Tipsheet topics include: • Reporting measure exclusions; • Using other providers’ data; • Determining office visits for applicable measures; and • Applying for a hardship exemption. The tipsheet also includes links to resources that can help specialists successfully participate in the EHR Incentive Programs. For helpful materials you can also visit the Educational Resources page on the EHR Incentive Programs website. Oklahoma D.O. | February 2013
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2013 Self-Nomination/Registration for PQRS Group Practice Reporting Option — Updated Medical group practices comprised of 2 or more eligible professionals can participate in the 2013 Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) to potentially earn an incentive payment of 0.5% and avoid a negative payment adjustment of -1.0% on Medicare Part B Physician Fee Schedule (PFS) services. CMS defines a group as a single taxpayer identification number (TIN). In order to participate in PQRS – at the group level – an authorized group representative must sign the group up and select one of three group reporting mechanisms: • the GPRO Web Interface (only for groups with 25 or more eligible professionals), • a qualified registry, or • CMS-calculated administrative claims (only for avoiding negative payment adjustments). New federal regulations require that medical practice groups comprised of 100 or more eligible professionals (as of October 15, 2013) will be subject to the value-based payment modifier based on performance in 2013. Groups of this size that fail to self-nominate/register for PQRS – as a group – will see a 1% negative impact on all physician payment under the Medicare PFS in calendar year 2015. Groups meeting the size threshold must sign-up as a group during one of two sign-up periods to participate in the 2013 PQRS. The first opportunity for group practices to sign-up ends on January 31, 2013. There will be a second opportunity to sign-up July 15, 2013 through October 15, 2013. First Self-Nomination/Registration Period: (December 1, 2012 – January 31, 2013) During the December 1, 2012 through January 31, 2013 timeframe, group practices will be able to self-nominate/register and select the GPRO Web Interface or a registry reporting mechanism only. Unlike previous program years, group practices will not be able to opt-out of reporting at the group level once they have self-nominated/registered; but groups will be able to change their group reporting mechanism until October 15, 2013. Groups wishing to participate in the 2013 Electronic Prescribing (eRx) GPRO must self-nominate/register during the December 1, 2012 through January 31, 2013 timeframe. Groups choosing to participate only in eRX cannot self-nominate/register online. These groups should email PQRS_Vetting@mathematicampr.com. Steps for 2013 PQRS GPRO Self-Nomination/Registration Period (December 1, 2012 – January 31, 2013): 1. Sign-in to the Physician and Other Health Professionals Quality Reporting Portal with an Individuals Authorized Access to CMS Computer Ser- vices (IACS) account. If you do not have an IACS account you will be able to register for one from the same page. 2. Once you are signed into the Portal, click the “Create Self Nomination Request” link located on the left side of the web page. This will take you to the self-nomination screens on the Communication Support Page. 3. Select “Group Practice Reporting Option {Group Practice}” as the requestor type and hit “submit.” Fill out the required fields on the screens that follow. See the user manual for additional information or click the Help icon. Resources: • For all PQRS/eRx program related questions and/or help with IACS, contact The QualityNet Help Desk at 866-288-8912 or qnetsupport@sdps. org. The help desk is available Monday through Friday from 7am through 7pm CT. • Additional information about 2013 PQRS GPRO self-nomination/registration and requirements is located on the PQRS Group Practice Report- ing Option web page. • Additional information about the value-based payment modifier is located on the Value-Based Payment Modifier web page. Planning Your ICD-10 Transition Activities for 2013 The year 2013 brings two crucial ICD-10 transition milestones for providers: • April 1, 2013: Testing ICD-10 with colleagues/staff within your practice • October 1, 2013: Testing ICD-10 with business trading partners like payers, clearinghouses, and billing services Review your ICD-10 timeline and make sure you are on track to meet these milestones. Jump-starting Your Transition. To prepare for testing, be sure you have completed the following activities: • Review ICD-10 resources from CMS, trade associations, payers, and vendors • Inform your staff/colleagues of upcoming changes • Create an ICD-10 project management team • Identify how ICD-10 will affect your practice • Develop and complete an ICD-10 project plan for your organization o Identify each task, including deadline and who is responsible o Develop plan for communicating with staff and business partners about ICD-10 • Estimate and secure budget (potential costs include updates to practice management systems, new coding guides and superbills, staff training) • Ask your payers and vendors—software/systems, clearinghouses, billing services—about ICD-10 readiness; review contracts/proposals o Ask about systems changes, a timeline, costs, and testing plans o Ask when they will start testing, how long they will need, and how you and other clients will be involved o Select/retain vendor(s) • Review changes in clinical documentation requirements and educate staff by reviewing frequently used ICD-9 codes and new ICD-10 codes Depending on your organization, some tasks above may be performed on a compressed timeline or performed at the same time as other tasks. Testing • April 1, 2013: Start testing ICD-10 codes and systems with your practice’s coding, billing, and clinical staff o Use ICD-10 codes for diagnoses your practice sees most often o Test data and reports for accuracy • October 1, 2013: Begin testing transactions from start to finish using ICD-10 codes with payers and other business partners Expect to continue testing transactions and fine-tuning your transition up until the ICD-10 compliance date of October 1, 2014.
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Oklahoma D.O. |February 2013
Osteopathic Continuous Certification Rather than being a single event, certification should be a continuous, lifelong process. The American Osteopathic Association's Bureau of Osteopathic Specialists (BOS) has mandated that each specialty certifying board implement Osteopathic Continuous Certification (OCC). OCC will serve as a way in which boardcertified DOs can maintain currency and demonstrate competency in their specialty area. The only change to the current osteopathic recertification process is the addition of a Practice Performance Assessment. Each specialty certifying board has been working to develop OCC with the goal of having implemented the OCC process by Jan. 1, 2013. If you hold a timelimited certificate, you will be required to participate in the five components of the OCC process in order to maintain your osteopathic board certification. Five Components of OCC COMPONENT 1 - Unrestricted Licensure: Requires that physicians who are board-certified by the American Osteopathic Association (AOA) hold a valid, unrestricted license to practice medi- cine in one of the 50 states. In addition, these physicians are required to adhere to the AOA’s Code of Ethics.
COMPONENT 2 - Lifelong Learning/Continuing Medical Education: Consistent with your current commitment to lifelong learning, this component requires that all recertifying physicians fulfill a minimum of 120 hours of continuing medical education (CME) credit during each three-year CME cycle — though some certifying boards have higher require ments. Of these 120+ CME credit hours, a minimum of 50 credit hours must be in the specialty area of certification. Self-assessment activities will be designated by each of the specialty certifying boards.
COMPONENT 3 - Cognitive Assessment: Requires provision of one (or more) psychometrically valid and proctored examinations that assess a physician’s specialty medical knowledge, as well as core competencies in the provision of health care.
COMPONENT 4 - Practice Performance Assessment and Improvement: Requires that you engage in continuous quality improvement through comparison of personal practice performance measured against national stan- dards for your medical specialty.
COMPONENT 5 - Continuous AOA Membership: Membership in the professional osteopathic community through the AOA provides you with online technology, practice management assistance, national advocacy for DOs and the profession, access to professional publications, and continuing medical education opportunities.
Attention providers and hospitals! Check out these upcoming WebEx Seminars. ...and yes, they are FREE. (Limited Capacity) WHEN: Wednesday, February 13, 12:15-1:15pm (CST) TOPIC: "Transmitting Messages to the Okla. State Dept. of Heatlh" SPEAKER: Jason Felts, MS WHEN: Wednesday, March 27, 12:15-1:15pm (CST) TOPIC: "2014 Clinical Quality Measures" SPEAKER: Dawn Jelinek, BS WHEN: Wednesday, April 17, 12:15-1:15pm (CST) TOPIC: "Medicare Audits" SPEAKER: Ashley Rhude, BS WHEN: Wednesday, May 22, 12:15-1:15pm (CST) TOPIC: "HIPAA 101" SPEAKER: Lindsey Mongold, MHA
Oklahoma D.O. | February 2013
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TECHNOLOGY CORNER: ONLINE CME Provided by the OOA Bureau on Information Technology
In 2010 trends predicted that over 50% of physician CME would be delivered online in 2016 (Medical News). Well we’re halfway there and can we say this prediction is on course to be correct? According to a recent survey by MedData Group, over 84% of physicians surveyed would prefer to receive credits online but 43.6% say they do not attend online CME often. This leads us to wonder if there is enough osteopathic online CME to satisfy the demand. The OOA recognizes the need for online CME and has been working diligently with the Association Osteopathic State Executive Directors (AOSED) to implement a platform that would be able to support the requirements to earn American Osteopathic Association (AOA) Continued Medical Education (CME) credits. Let's take a quick look at the AOA’s Online CME Policies (American Osteopathic Association): To receive Category 1-A Credits: • The seminar must be real-time, interactive confere- ncing CME on the Internet or case presentations, which includes both an online pre and post test and allows the participant to ask questions of the pre- senter in real-time during or immediately after the presentation. • To receive credit for interactive Internet CME, os - teopathic physicians must complete a CME quiz with a passing grade of 70%, and the sponsor of the program must provide this information to the AOA, along with the category and number of CME credits requested. To receive Category 1-B Credits: • Category 1-B credit will be awarded to audio and video programs on the Internet sponsored by AOA- accredited Category 1 CME sponsors. These courses are typically programs that are available on an on demand schedule and are not a real-time, interactive simultaneous conference. • To receive credit for interactive Internet CME, os- teopathic physicians must complete a CME quiz with a passing grade of 70% and the sponsor of the program must provide this information to the AOA, along with the category and number of CME credits requested. The OOA staff attended the AOA’s CME Sponsor Conference this past January to learn the new rules and regulations for the 2013-2015 CME Cycle. Currently, out of the 120 required CME credits, physicians are only able to receive 9 Online Cred34
its per three year cycle. With the demand of online learning increasing, this number may need to be reevaluated in the coming years. As stated above, to earn 1-A credits the lecture must be live streaming and interactive. The MedData group survey reflected that 80% of physicians prefer the “on-demand” experience as they can learn when their schedule permits. Many on demand platforms offer the ability to host pre and post tests as well as give the participants the opportunity to submit questions. The AOA will need to consider can a seminar be considered 1-A if these questions were responded to by the lecturer in a “timely” fashion. With technology advancing faster than policies there will always be room for improvement and innovation. The OOA & AOSED are committed to launch this online platform in the coming months. We would love to hear from you regarding what you are specifically looking for in an online CME experience. The Bureau on IT has set up an online survey with a few short questions that would help the OOA ensure we are satisfying your online CME needs and communicating your comments and concerns to the AOA. Please scan the QR code to take the survey. Questions regarding this article may be directed to Rachel Prince, Communications Director, at Rachel@okosteo.org.
From the American Osteopathic Association Communications Department
HEALTH FOR THE WHOLE FAMILY DOs and other members of the profession consider the American Osteopathic Association’s “Health for the Whole Family” series a great way to promote the profession and educate patients about a variety of health topics. To use this month’s article, you have permission to simply make copies of the article (see page 35).
Oklahoma D.O. |February 2013
Scratching the Surface of Psoriasis Anyone who has struggled with flaky skin or red patches on their elbows, knees and scalp knows that psoriasis is not just another skin problem, but a chronic condition that can affect your physical and emotional well-being. Psoriasis, a common condition that typically begins between the ages of 15 and 35, is not contagious, but can be uncomfortable, and, at times, embarrassing for those who have been diagnosed. William T. Kirby, DO, a dermatology osteopathic physician from Los Angeles, explains the common symptoms and provides treatment options for managing psoriasis. What are the common symptoms? According to Dr. Kirby, psoriasis is a skin condition that occurs when the immune system mistakenly speeds up the growth cycle of skin cells. This dysfunction causes a buildup of itchy, thick, red skin with flaky, silver-white patches called scales. Other common symptoms of this condition include: • Severe dandruff on the scalp • Joint pain or aching • Nail changes, including thick yellow-brown nails, dents, and nail lifts off from the skin • Genital lesions in males • How can I ensure a proper diagnosis? “If you suspect that you might have this condition, schedule a visit with your dermatologist or rheumatologist,” Dr. Kirby advises. Your doctor will review your medical history and perform a physical examination of your skin, scalp and nails. In rare cases, a diagnosis may require a biopsy. When you meet with your health care provider, Dr. Kirby recommends having an honest dialogue. “Your physician should understand the impact of psoriasis, not only on your physical health, but your emotional health as well,” he says. “Discuss the frequency of flare-ups or other medical conditions (such as fever or joint pain), disclose all your current medications, and share information about any family members with psoriasis. The only way to receive the proper diagnosis and treatment is to be open with your primary care provider.” Is the condition controllable? Psoriasis flare-ups may go away for a long time, but they return sooner or later. Even though psoriasis is a lifelong condition, it can be controlled with treatment. "There are several environmental factors that may trigger an attack of psoriasis or make the condition more difficult to treat,” Dr. Kirby explains. Common triggers include: • Bacterial or viral infections, including strep throat and upper respiratory infections • Dry air or too much/too little sunlight • Injury to the skin, including cuts, burns and insect bites • Some medicines, including anti-malaria drugs, beta-blockers and lithium • Too much alcohol “Treatment is planned according to the type and severity of your condition. The goal of treatment is to control your symptoms and prevent infection,” Dr. Kirby adds. Your doctor might prescribe one or a combination of the following treatments: • Topical treatments, such as retinoid containing vitamin D or A, skin lotions with salicylic or lactic acid to remove the scaling, oint ments that contain coal tar or anthralin, cortisone creams, or dandruff shampoos. • Systemic treatments (e.g. pills or injections) that affect the body's immune response. • Phototherapy, a treatment in which your skin is carefully exposed to ultraviolet light. Prescription for managing psoriasis There is no known way to prevent psoriasis. “Oatmeal baths, keeping the skin clean and moist and avoiding your specific psoriasis triggers, like stress, may help reduce the number of flare-ups,” says Dr. Kirby. “While there may not be a cure for psoriasis, with appropriate treatment, it usually does not affect your general physical health. Work with your doctor to develop a psoriasis treatment plan that’s right for you.”
Preventive medicine is just one aspect of care osteopathic physicians (DOs) provide. DOs are fully licensed to prescribe medicine and practice in all specialty areas, including surgery. DOs are trained to consider the health of the whole person and use their hands to help diagnose and treat their patients. Oklahoma D.O. | February 2013
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OOAâ&#x20AC;&#x2122;s Bureau News 2013 Nominating Committee Members from the OOA Nominating Committe and their respective Districts met Thursday, January 3, 2013 at the OOA Central Office to make nominations to fill vacancies on the OOA Board of Trustees, Delegates, and Alternate Delegates of the American Osteopathic Association (AOA) House of Delegates. Members in attendance were: Thomas H. Conklin Jr., DO-Eastern District; James I. Graham, DO-North Central; Chad Owens, DO-Northwestern; Bret S. Langerman, DO-South Central; Kenneth E. Calabrese, DO-Tulsa; Trudy J. Milner, DO-President 2007-2008; Gilbert M. Rogers, DO-President 2008-2009; Duane G. Koehler, DO-President 2009-2010-Northeastern; Scott S. Cyrus, DO-President 2010-2011; LeRoy E. Young, DO-President 2011-2012. Recommendations for consideration by the Membership of the Oklahoma Osteopathic Association: 2013 Vacancies To Be Filled: President-Elect (Becomes President): Vice President (One-Year Term): Trustee (One-Year Term ending 2014): Trustee (One-Year Term ending 2014): Trustee (Three-Year Term ending 2016): Trustee (Three-Year Term ending 2016):
Michael K. Cooper, DO C. Michael Ogle, DO Melissa A. Gastorf, DO Timothy J. Moser, DO Ronald S. Stevens, DO Dale Derby, DO
2013 AOA House of Delegates (Delegates) 1. Bret S. Langerman, DO, Chairman of Delegation 2. Michael K. Cooper, DO, Vice Chairman of the Delegation 3. David F. Hitzeman, DO 4. Joseph R. Schlecht, DO 5. Scott S. Cyrus, DO 6. Stanley E. Grogg, DO 7. Layne E. Subera, DO 8. LeRoy E. Young, DO 9. Duane G. Koehler, DO 10. Kayse M. Shrum, DO 11. C. Michael Ogle, DO 12. Gabriel M. Pitman, DO 13. Christopher A. Shearer, DO 14. Ronald S. Stevens, DO 15. Trudy J. Milner, DO 16. Thomas J. Carlile, DO 2013 AOA House of Delegates (Alternates) 1. Melissa Gastorf, DO 2. Timothy J. Moser, DO 3. William J. Pettit, DO 4. Bobby N. Daniels, DO 5. Dennis J. Carter, DO 6. Justin S. Sparkes, DO 7. James P. Riemer, DO 8. Gordon P. Laird, DO 36
9. 10. 11. 12. 13. 14. 15. 16.
H. Zane DeLaughter, DO Gregory H. Gray, DO Gilbert F. Rogers, DO John F. Rice, DO Terence E. Grewe, DO Jeffrey Jones, DO Tammie L. Koehler, DO Ray E. Stowers, DO Oklahoma D.O. |February 2013
2013 Proposed OOA Bylaw
The proposed Bylaws will be voted on during the Association’s annual business meeting at 2:00 pm, Thursday, April 18, 2013 at the Norman Embassy Suites. During the December 6, 2012 meeting, the OOA Board of Trustees approved the following dissolution clause to be added to the OOA Bylaws and Constitution. According to the OOA Bylaws, Article IX. Amendments, the Bylaws may be amended by this Association at any annual session by a two-thirds vote of the accredited voting members in attendance at such session...
“Upon dissolution or other termination, all remaining assets, after payment in full of all its debts, obligations, and necessary final expenses, or after the making of adequate provision therefore, shall be distributed to such tax exempt organizations with purposes similar to those of the organization as shall be chosen by the then existing Board of Directors.”
Bureau on Membership The OOA Board of Trustees welcomes the following new members to the OOA family! Jean-Maria Langley, DO Otolaryngology Tulsa, OK
Oklahoma D.O. | February 2013
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Foundation Update ... For the next few months, the foundation will highlight the lay members of the OEFOM Board of Trustees. We began the series with a salute to the OEFOM President, Mary Shaw, followed by an acknowledgement to Steve Whitfill for his 20 years of service on the OEFOM Board of Trustees. This month we would like to focus on the philanthropic efforts of Sherri L. Wise, President and CEO of the Osteopathic Founders Foundation (OFF) located in Tulsa, Oklahoma. Ms. Wise serves on the OEFOM board as a representive of the OFF, which is in accordance to the OEFOM bylaws. Her term will expire in 2014. Ms. Wise has served on several local and national boards, including the Oklahoma Science and Technology Research and Development Board (OSTRaD), the National Association of Osteopathic Foundation, the Community Service Council of Greater Tulsa, the Special Olympics International and the Special Olympics Oklahoma Board of Directors. During her time with these foundations and associations, Ms. Wise has been appointed to many prestigious councils including the Council on Womens Health Issues with the American Osteopathic Association, the Council on Education Grants with the American Osteopathic Foundation and the President’s Advisory Council with the Special Olympics International.
n OEFOM Memorials n
She is currently in charge of coordinating health services for the Special Olympics state competitions, as well as a member of the Board of Directors for the Bridges Foundation, which provides vocational services for individuals with developmental disabilities. She is the synergy behind the production of the infamous WinterSet ball, the Annual OFF fundraiser with proceeds benefitting several Tulsa charities. In addition to these volunteer engagements, Ms. Wise performs her fulltime role dutifully managing the assets of the OFF on behalf of its Board of Directors. She has added interest in the osteopathic post graduate training programs in the Tulsa area and is also involved in the OSU-COM Alumni Association by hosting the group’s regular meetings. Sherri also hosts a monthly meeting of the retired physicians group from the Tulsa District. Ms. Wise’s interest in the students at OSU-COM is demonstrated by her accompanying them to Washington DC supporting AOA’s DO Day on the Hill, mentoring them in the legislative process. Ms. Wise earned her education from the University of Central Oklahoma in Edmond, OK where she was granted her Bachelor of Science degree in Accounting. She is a certified public accountant and a member of the Oklahoma Society of Certified Public Accountants. Sherri Wise brings a bevy of qualities and benefits to the Foundation’s Board and complements her fellow Board Members talents. okDO
Contributing In Memory of Lewis J. Bamberl, DO John D. Corpolongo, DO Dr. Stanley and Barbara Grogg Jerry L. Nelms, DO Dr. David and Rita Hitzeman Jerry L. Nelms, DO Dr. Thomas and Glenda Carlile Katrina Larson Lynette and Don McLain Atha Pettigrew Dr. Thomas and Glenda Carlile Atha Pettigrew
Jerry A. Nelms, DO
(August 28, 1939 - January 2, 2012) Dr. Jerry A. Nelms, age 73, long-time resident of Coweta passed away on January 2, 2013 at his home in Coweta surrounded by his loving family. Dr. Nelms was born on August 28, 1939 in Tishomingo, OK and was the son of Dr. Lucian L. and Ruby A. (Jones) Nelms. He graduated from Coweta High School and then attended Northeastern State University in Tahlequah, OK and Kansas City College of Osteopathy where he earned his degree in Osteopathic Medicine. Dr. Nelms married Linda 38
Shieldnight on July 4, 1986 in Tulsa, OK. He owned and operated Dr. Jerry A. Nelms Family Clinic in Coweta for 18 years and was a doctor for 45 years. He was an active member of the First United Methodist Church in Coweta and enjoyed golfing, watching TV, fish fry’s and spending time with his family. Jerry will be missed as a loving husband, father, grandfather and friend. Oklahoma D.O. |February 2013
Classified Advertising
OFFICE BUILDING FOR SALE: 6501 S. Western, OKC, OK 73139. Over 1 1/2 acres total size, 10,000 sq ft building divided into 3 doctors offices. 1200 sq foot private office upstairs with private bathroom and shower. 2 double sided fireplaces, over a dozen chandeliers, rough wood cathedral ceilings. Alarm and phone system in place, double glass doors in entrance, back patio with separate storage building. Larger office is fully equipped with exam tables, Pap table, chairs, medical instruments, QBC (CBC) machine, autoclave, medical supplies, and much more. For information contact: Captain David Simpson at (405) 820-5360.
OFFICE FOR LEASE: Great Location - Central to Norman Reg. Hospital & Healthplex! 2121 W. Main. Approx. 1700 s.f. available, incl. 5 rooms & 3 restrooms. Gas, Elec. & Water paid. Call (405) 321-1497 or email adoverstr@yahoo.com. Also for Sale: 2 Hamilton Exam tables. Call (405)321-1497 or email adoverstr@yahoo.com.
Calendar of Events March 6, 2013 Medicine Day at the State Capitol March 14, 2013 DO Day on the Hill Washington, DC
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CLINIC FOR SALE: by owner. Fully equipped: LAB, XRAY, EKG. Well established clinic, near Integris Southwest Medical Center is available for sale. Clinic is well equipped and is ideal for one or more physician practice as well as a variety of specialties. Clinic has: waiting room with refrigerated water cooler, wheelchair accessible restroom, reception and staff work stations, Nurses station, 5 - 7 exam rooms with sinks and running water, large multipurpose procedure room, 3 private offices with built-in bookcases, (One Office with 3/4 Bath), additional staff and patient restrooms, large upstairs (currently used for storage) and variety of other medical equipment. Misys Medical Software. Large Parking Lot. “Must See Inside” the all steel building located at 2716 S.W. 44th St. in OKC to appreciate the effort placed upon providing convenient and up to date medical care. Price: $425,000-PRICE IS NEGOTIABLE. Doctor prefers to sell, but would consider leasing. If interested, please call: Evelyn Francis at (405) 249-6945.
FULL or PART-TIME OPPORTUNITY / TREATMENT OF OPIATE DEPENDENCE WITH SUBOXONE: I have been practicing addiction medicine for three years and have reached the 100-patient limit for treating opiate dependent patients with SUBOXONE. I have a waiting list of interested persons and adjoining office space is available for lease in the CITYPLEX Towers near ORU at 81st Street and S. Lewis Avenue. Whether you want to begin prescribing SUBOXONE or plan to continue treating current patients with SUBOXONE, I am interested in sharing the waiting room, office staff, phone/fax/Internet, and billing services. Contact: Constance Honeycutt, DO 918-779-5907 or e-mail suboxone-rocks@hotmail.com
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OFFICE FOR RENT: Excellent area with high traffic count. Established location. Utilities are paid. Completely remodeled, very nice. Easy access from all areas of town, 7300 S Western, OKC. $1500 per month. Please call Dr. Buddy Shadid 405.833.4684 or 405.843.1709.
113th OOA Annual Convention Individualizing a Program for Your Specialty Needs
DOCTORS WANTED: to perform physical exams for Social Security Disability. DO’s, MD’s, residents and retired. Set your own days and hours. Quality Medical Clinic-OKC, in business for 16 years. Call Jim or JoAnne at 405-632-5151.
PHYSICIAN NEEDED: The practice of Terry L. Nickels, DO is currently seeking a part-time Family Physician with OMT Skills to help cover the office. If interested please contact Dr. Terry Nickels at (405) 301-6813.
Saddle upupApril 18-21, Saddle April 18-21, 2013 2013 Bret S. Langerman, DO
General Convention chair
Michael K. Cooper, DO, FACOFP Convention Program Chair
IMMEDIATE NEED: for FP & ER (and more) Physicians, PAs and NPs: PT, FT and temp jobs. Bimonthly pay. Pd Malpractice and expenses. Call Sonja @ 877-377-3627 and send CV to sgentry@oklahomaoncall.com Oklahoma D.O. | February 2013
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Prsrt Std US Postage Paid Okla City OK Permit #209
OKLAHOMA OSTEOPATHIC ASSOCIATION 4848 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105-3335
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SPRINGFIELD, MO Oklahoma D.O. |February 2013