The Journal of the Oklahoma Osteopathic Association
OKLAHOMA D.O.
May/June 2013 March 2014
Volume 78, No. 9
LIGHTS CAMERA ACTION
PAGE 1
Oklahoma D.O. | March 2014
Oklahoma D.O.
IN THIS ISSUE: • 114th Annual Convention Program • OOA/OEFOM Golf & Tennis Tournaments • ACGME Update
WE KNOW OKLAHOMA HEALTHCARE AT PLICO, WE ARE HONORED TO INVEST IN OSTEOPATHIC EDUCATION AND COMMITTED TO PROTECTING YOU THROUGHOUT YOUR CAREER IN MEDICINE.
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Oklahoma D.O. PAGE 2
— KIRK JEWELL, PRESIDENT, OKLAHOMA STATE UNIVERSITY FOUNDATION
PLICO 405.815.4800 PLICO - OK.COM FINANCIAL STABILITY RATING ® OF A, EXCEPTIONAL Oklahoma D.O. | March 2014
The Journal of the Oklahoma Osteopathic Association
OKLAHOMA
May/June 2013 March 2014
D.O. Volume 78, No. 9
Lynette C. McLain, Editor Lany Milner, Associate Editor
OOA Officers: Bret S. Langerman, DO, President (South Central District) Michael K. Cooper, DO, FACOFP, President-Elect (Northeastern District) C. Michael Ogle, DO, Vice President (Northwest District) Layne E. Subera, DO, FACOFP, Past President (Tulsa District) OOA Trustees: Kenneth E. Calabrese, DO, FACOI (Tulsa District) Dale Derby, DO (Tulsa District) Melissa A. Gastorf, DO (Southeastern District) Timothy J. Moser, DO, FACOFP (South Central District) Gabriel M. Pitman, DO (South Central 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 Lisa Creson, Administrative Assistant Jessica Hansen, Special Projects Coordinator Matt Harney, MBA, Director of Advocacy and Legislative Marie Kadavy, Director of Communications and Membership Lany Milner, Director of Operations and Education
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.
Oklahoma D.O. | March 2014
6
114th OOA Annual Convention Program
13
OOA Convention Registration Form
14-15
OOA/OEFOM Golf/Tennis Tournament Information & Registration Form
16
Bureau News
17
Doctor of the Day Schedule
18
“The Rural Clinic Rotation: Bringing ‘Rural’ Home” provided by Duane G. Koehler, DO, Assistant to the Dean for Rural Education, OSU Center for Rural Health
20
What DO’s Need To Know
24
“OSU-MC GI Program” provided by Jamie Calkins, Marketing/Media Coordinator
26
March Birthdays
28
Student Scoop provided by Trace Heavener, OMS-II
30
“Assessment of Ticagrelor and Prasugrel Use at an Academic Medical Center”
32
“The Dangers of Distracted Driving” provided by the American Osteopathic Association
34
Legislative Report provided by Matt Harney, MBA
36
2014 OOPAC Pledge Form
37
2014 OOPAC Contributions
38
2013-2014 OOA Directory Order Form
39
Classifieds & Calendar of Events
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The OOA Website is located at www.okosteo.org
“Presidential Message” provided by Bret S. Langerman, DO, 2013-2014 President
Oklahoma D.O.
For more information: 405.528.4848 or 800.522.8379 Fax: 405.528.6102 E-mail: ooa@okosteo.org
4
BRET S. LANGERMAN, DO President 2013 – 2014 oklahoma osteopathic association PRESIDENTIAL MESSAGE
Oklahoma D.O. PAGE 4
A
After what I consider to be a long and cold winter, spring is finally approaching! With warmer weather we will see our outdoor landscapes reincarnate with new flowers, leaves and grass. What was old seems to become new again. And though all of this sounds very nice for our great outdoors, we are also seeing a change in the climate at the legislature this year. At the time this message was written, there are bills making their way through the Oklahoma Legislature that are gaining momentum and will negatively affect the way we practice medicine on a daily basis. It is certainly no secret that Oklahoma ranks very high in the abuse of prescription narcotics. There are state agencies that will tout various statistics and percentages of abuse and deaths in our state secondary to overdose and compare those numbers to other states across the nation. And again, though there is no doubt we have a crisis here, I find it interesting that there are no standards across the nation for how this information is collected, what constitutes abuse, and what constitutes death by overdose. When Oklahoma is compared to other states by such statistics, there is really no way to compare “apples to apples.” My concern here is that it’s these same state agencies that are using potentially flawed data to direct the lawmaking process. They want to shift the blame for this epidemic to physicians and then make laws that force us as physicians to police the abusers. There seems to be no onus placed on the abusers themselves. One such bill will mandate that physicians check the Prescription Monitoring Program (PMP) every time you prescribe a controlled substance to a patient. And to clarify, this includes all controlled substances, not just narcotics. Failure to do so can result in punitive fines that will be charged to you for each occurrence. While the PMP is a wonderful tool that we as physicians should utilize to help in the overall process of taking care of our patients, its use should not be mandated by law. These same state agencies have been unable to provide studies or data (other than anecdotal reports) to support that using the PMP in this fashion will actually decrease prescription drug abuse. I am not trying to advocate that we as physicians do not bear some of the burden in curbing this
abuse across our state. We do have an obligation to do what we can, but placing one more mandated barrier to providing care to our patients is certainly not the way. I would also like to mention briefly two other pieces of legislation that directly affects us as physicians. House Bill 2384 is circulating through the halls of the Capitol. This bill is being written to address the shortage in Medicaid funding and in essence will cut physician reimbursement across the board. There is additional legislation that will grant physical therapists the right to evaluate, diagnose and treat patients without the approval of physicians. This in essence gives physical therapists direct access to patients by bypassing the expertise of the physician. Bypassing the physician involvement in this process, I fear, will lead to many missed diagnoses and potential harm to patients. I will close by recommending that you explore where these potential pieces of legislation are in the process and what language is in the bills at this time. The legislative process and the language within these bills change on a near daily basis so I certainly hope that positive changes have occurred since this message was written. It is now more important than ever for you to get involved personally to help guide our lawmakers to enact legislation that will help instead of hinder patient care. Your one phone call or letter to your representative or senator does make a difference. The OOA tracks this legislation in real time and can provide you with further information and updates. If you have questions, please do not hesitate to contact our central office. Always remember, you as physicians have the education, training and expertise to be the authority when it comes to patient care. Stay safe and enjoy the spring!
OK
DO
Oklahoma D.O. | March 2014
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Oklahoma D.O.
If you or a loved one is fighting breast cancer, you owe it to yourself to find out more.
PAGE 5
Scan to learn more about IORT Novac™7 Oklahoma D.O. | March 2014
©2012 Rising Tide
the LEADING MEN OF THE 114TH ANNUAL CONVENTION
MICHAEL K. COOPER, DO, FACOFP
BRET S. LANGERMAN, DO
C. MICHAEL OGLE, DO
OOA President-Elect Convention Chair
OOA President
OOA Vice President Convention Program Chair
Oklahoma D.O. PAGE 6
national guests
DUANE G. KOEHLER, DO, FACOFP ACOFP Governor
ROBERT S. JUHASZ, DO President-Elect of the American Osteopathic Association
RAY E. STOWERS, DO, FACOFP dist. Past President of the American Osteopathic Association
Oklahoma D.O. | March 2014
WEDNESDAY, APRIL 23 9:00 NOON5:00 8:3010:00
OOA/OEFOM Golf & Tennis Tournament Oak Tree Country Club, Edmond, Oklahoma Convention Registration: Norman Embassy Suites Presidential Reception Honoring OOA President Bret S. Langerman and First Lady DeLaine Langerman 8:009:00
114th Annual
s le track du e h c s IALTY
SPEC
THURSDAY, APRIL 24 11:00NOON NOON2:00
2:003:30
 10:0011:00
OPENING SESSION: V. Burns Hargis, President, OSU LUNCH WITH EXHIBITORS OOA ANNUAL BUSINESS MEETING Presiding: Bret S. Langerman, DO
ACOFP UPDATE Presiding: Ryan Schafer, DO, President,
Oklahoma Society ACOFP Special Guest: Duane G. Koehler, DO, FACOFP, ACOFP Board of Governors
OKLAHOMA HOUSE OF DELEGATES MEETING
Oklahoma D.O. | March 2014
Oncology Track Importance of Integrative Oncology
Lorenzo Cohen, PhD (Professor and Director of the Integrative Medicine Program, Houston, TX)
Complementary Individual Medicine
Katherine Anderson, ND, FABNO (naturopathic medicine, Tulsa, OK)
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4:305:30
9:0010:00
Oklahoma D.O.
3:304:30
& 0 1 ICD ician Physrsement u b m i Re
Anesthesiology 114th Annual
Y T L A I C E SP
s trackhedule sc
FRIDAY, APRIL 25
8:009:00 9:0010:00
10:0011:00
11:00NOON
NOON2:00 2:003:00
Oklahoma D.O. PAGE 8
3:004:00
4:005:00
Emergency Medicine
Internal Medicine
MORNING SESSION: “Interventional Pain Management: The Basics”
“Not Just for Kids Anymore! Intraosseous Vascular Access in the Emergency Department-Use of the Humeral IO in Adult Patients”
“Medical Certification of Airmen with Coronary Artery Disease, Valve Replacement and Atrial Fibrillation”
Larry D. McKenzie, DO (certified pain management, anesthesiology, Tulsa, OK)
Justin W. Fairless, DO, FAAEM (certified emergency medicine, Tulsa, OK)
Warren S. Silberman, DO, MPH (certified preventative medicine, internal medicine & aviation/ aerospace medicine, Oklahoma City, OK)
“Perioperative Diabetes Management: The Ups and Downs”
“Emergency Medicine in the Boonies”
“Asthma Update”
Neal W. Siex, DO (certified anesthesiology, Tulsa, OK)
Arthur G Wallace Jr., DO, MPH, FACEP (certified emergency medicine, Jenks, OK)
Thomas W. Allen, DO, MPH, FACP, FCCP (certified internal medicine, sports medicine & pulmonary medicine, Tulsa, OK)
“Post Pain Control By Use of Regional Blocks and Pain Pumps”
“The Freestanding Emergency Department: Fad or The Wave of the Future!”
“Considerations and Evaluation of the Preoperative Patient”
Dale Derby, DO (certified anesthesiology & family practice, Owasso, Oklahoma)
Chad E. Borin, DO (certified emergency medicine, Oklahoma City, OK)
Melinda R. Allen, DO, FACOI (certified internal medicine, Grove, OK)
LUNCH PROGRAM: “The Obese Anesthesia Patient and Obesity Surgery”
“Hypothermia Treatment Post Cardiac Arrest”
“Calcium Disorder”
Brian T. Harris, DO (certified anesthesiology, Tahlequah, OK)
Timothy A. Soult, DO (certified emergency medicine, Oklahoma City, OK)
Henry M. Allen, DO (certified internal medicine & nephrology, Oklahoma City, OK)
“PreOp Eval - What Anesthesia Wants to Know and Why. What’s It’s Worth to You”
“Alternative Airway Management”
“New Developments in Diabetes”
Daniel P. Kite, DO (certified emergency medicine, Oklahoma City, OK)
Kenan L. Kirkendall, DO (certified internal medicine, family medicine & pediatrics, Woodward, OK)
“Basic Perspectives on Disasters”
“Update on Adult Exercise Guidelines & Weight Management”
David E. Hogan, DO (certified emergency medicine, Oklahoma City, OK)
Stephanie J. Husen, DO (certified internal medicine, pediatrics & sport medicine, Edmond, OK)
Ronald S. Stevens, DO (certified anesthesiology, Muskogee, OK)
“Perioperative Evaluation and Treatment of the Cardiac Patient for Non-cardiac surgery” Jay D. Cunningham, DO (certified anesthesiology, Oklahoma City, OK)
Oklahoma D.O. | March 2014
OBGYN
Oncology
OMT
Neurology/ Psychiatry
Treating the Whole Patient with Trauma Osteopathically
Ronnie B. Martin, DO, FACOFP, dist (certified family practice, Blacksburg, VA); Amanda D. Martin, DO (orthopedic surgery, Birmingham, AL); and Natasha Martin-Bray, DO (certified internal medicine, Fort Lauderdale, FL)
“Breast Cancer: Screening, Prevention, Diagnosis“
“Exercise Prescription for Low Back Pain”
“Clinical Neuro Anatomy Review for the Practicing Physician”
Marvin Williams, DO, FACOG (certified in Maternal Fetal Medicine and Obstetrics & Gynecology, Oklahoma City, OK)
Pamela Crilley, DO (certified oncology & internal medicine, Philadelphia, PA)
Mark H. Thai, DO (certified OMM & family practice, Tulsa, OK)
Jay K. Johnson, DO (certified neurology, Tulsa, Oklahoma)
“Drop-in Prenatal Liability: Tag You’re It”
“Pulmonary Nodules”
“Basic Science for Alleviation of Chronic Musculoskeletal Pain”
“Migraine, Spells, & Medication Overuse”
Joseph R. Johnson, DO (certified obstetric & gynecological surgery, Tulsa, OK)
Daniel A. Nader, DO, FCCP, FACP (certified Pulmonary Medicine and Internal Medicine, Tulsa, OK)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
David Lee Gordon, MD, FAAN, FANA, FAHA (certified neurology & vascular neurology, Oklahoma City, OK)
“Abnormal Uterine Bleeding Associated with Ovulatory Dysfunction”
“Cervical / Ovarian Cancer “
“Basic Science for Alleviation of Chronic Musculoskeletal Pain Lab”
“Women’s Issues in Epilepsy”
Elizabeth K. Harris, DO (certified obstetrics & gynecology, Tahlequah, OK)
Tashanna K.N. Myers-Gibson, MD, FACOG, FAAHPM (certified obstetrics & gynecology, gynecologic oncology and hospice and palliative medicine, Springfield, Massachusetts)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
Andrea S. Hakimi, DO (certified neurology & clinical neurophysiology, Oklahoma City, OK)
AOA Update & MOL/OCC
Robert S. Juhasz, DO (certified internal medicine, Warrensville Heights, OH)
“Differential Diagnosis of Dementia”
Bryan C. Roehl, DO, FACOOG (certified obstetrics & gynecology, Ada, OK)
Timothy Holder, MD, FAAFP (Oncology & Internal Medicine, Tulsa, OK)
Kelley J. Joy, DO (certified OMM & family practice, Tulsa, OK)
Jimmie D. McAdams, Jr., DO (certified psychiatry, Tulsa, OK)
“An Overview of Quality Initiatives in Women’s Health: The Paradigm Shift from Fee for Service to Value Based Purchasing”
“Genetics”
“Practical OMT: Demonstrating High-Yield Techniques For a Busy Family Practice”
“Movement Disorders- When to Refer?
Guy W. Sneed, DO, MBA, FACOOG, C-HCQM (certified obstetric & gynecological surgery, Tulsa, OK)
Michael A. Kayser, DO, FACMG, John L. Owens, DO (certified FAAP (Certified Medical Genet- OMT & family practice, Pryor, ics & Pediatrics, Tulsa, OK) OK)
Cherian A. Karunapuzha, MD (certified neurology, Oklahoma City, OK)
Urinary incontinence”
“Precision Medicine”
“Clinical Applications of Transcranial Doppler Ultrasound”
Diane Evans, DO, MS, FACOOG, FACOG (certified obstetrics & gynecology Walnut, MS)
Maurie Markman, MD (certified Internal Medicine, Medical Oncology, Hematology, Philadelphia, PA)
OMT Workshop
Ryan K. Hakimi, DO (certified neurology , Oklahoma City, OK)
PAGE 9
“Making OMM Work in a Primary Care Setting”
Oklahoma D.O.
“Comorbidities and Cancer Management”
AFTERNOON SESSION
“What’s New in Prenatal Screening”
Oklahoma D.O. | March 2014
MORNING SESSION
“Amniotic Fluid Abnormalities”
Anesthesiology 8:009:00 9:0010:00
10:0011:00
11:00NOON
Oklahoma D.O. PAGE 10
SATURDAY, APRIL 26
114th Annual
SPECI
s trackhedule ALTY sc
3:004:00
4:005:00
Internal Medicine
MORNING SESSION: Anesthetic Considerations in Chronic Pain Patients”
“So When the DEA Calls.....”
“Incorporating Mental Health into Internal Primary Care”
Daniel G. Morris, DO (certified pain management, anesthesiology, Tulsa, OK)
Jerry C. Childs, Jr., DO (certified emergency medicine, Oklahoma City, OK)
Thomas D. Schneider, DO (certified internal medicine, Tahlequah, OK)
Labor Anesthesia”
“Sepsis-Presenting to the ER”
“Caution: DMARD Zone”
Michael J. Major, DO (certified anesthesiology, Oklahoma City, OK)
Billy R. Bryan, DO, FACEP (certified emergency medicine, Oklahoma City, OK)
Debbie A. Gladd, DO (certified internal medicine & Rheumatology, Tulsa, OK)
“Postop Cognitive Decline”
“Oklahoma’s Native Dangers”
“Pulmonary Evaluation Revisited”
Ty A. Martindale, DO (certified anesthesiology, Oklahoma City, OK)
Kristopher K. Hart, DO, FACOEM (certified emergency medicine, Oklahoma City, OK)
James S. Seebass, DO (certified pulmonary medicine & internal medicine, Tulsa, OK)
NOON1:30 1:302:00 2:003:00
Emergency Medicine
LUNCH PROGRAM: “What Are In Anesthesia Infuriation Management System and How do I get me one?”
“Forensic Medicine in the ER: Helping the Police Investigators”
“The Physicians Prescription for Nutrition”
Ronald S. Stevens, DO (certified anesthesiology, Muskogee, OK)
Larry T. Lovelace, DO, FACEP (certified emergency medicine, Oklahoma City, OK)
Michele L. Neil, DO (certified internal medicine & sports medicine, Tulsa, OK)
“Neuro Trauma”
“EHR’s in the ER, The Good, Bad, and Ugly”
“Chronic Kidney Disease”
John B. Hill, DO (certified anesthesiology Norman, OK)
Gregory H. Gray, DO (certified emergency medicine, Tulsa, OK)
Beverly J. Mathis, DO (certified nephrology & internal medicine, Tulsa, OK)
“Emergency Management of Atrial Fibrillation”
“New Cholesterol Updates”
James B. Williams, DO, FACOEP (certified emergency medicine, Oklahoma City, OK)
Natasha N. Bray, DO (certified internal medicine, Fort Lauderdale, FL)
Oklahoma D.O. | March 2014
OBGYN
Oncology
OMT
Neurology/ Pediatrics Psychiatry
Treating the Whole Patient with Trauma Osteopathically
Ronnie B. Martin, DO, FACOFP, dist (certified family practice, Blacksburg, VA); Amanda D. Martin, DO (orthopedic surgery, Birmingham, AL); and Natasha Martin-Bray, DO (certified internal medicine, Fort Lauderdale, FL)
“Endometriosis Treatment”
“Skin Cancer”
“Childhood Obesity Identification and Treatment”
Constance G. Honeycutt, DO (certified OMM, addictive diseases & family practice, Glenpool, OK)
Brian K. Lepley, DO (certified pediatric, Oklahoma City, OK)
“Prevention of Stroke: Treatment of Acute Ischemic Stroke & Treatment of Hemorrhage/ Aneurysm”
R. Troy Lehman, DO, FACOOG (certified obstetrics & gynecology, Woodward, OK)
Peter M. Knabel, DO
“Recurrent Pregnancy Loss”
“Prostate Cancer “
“Foot Treatment”
Diane Evans, DO, MS, FACOOG, FACOG (certified obstetrics & gynecology Walnut, MS)
Douglas Kelly, MD (boardcertified radiation oncologist, Tulsa, OK)
Michael K. Cooper, DO, FACOFP (certified OMM & family practice, Tulsa, OK
“The Short Cervix”
“Communicating with the Cancer Patient”
“OMT Practicum - Neck and Upper Thoracic Dysfunctions.”
“Apply Osteopathic Principles to the Structural Exam of a Developing Child”
“Office Based Evaluation and Management of Concussion”
Marvin Williams, DO, FACOG (certified in maternal fetal medicine and Obstetrics & Gynecology, Oklahoma City, OK)
Carol Dillard, PhD, LPC, LMFT
Robin R. Dyer, DO (certified OMM & family practice, Tulsa, OK)
Lisa E. Hart, DO (certified pediatric, Tulsa, OK)
Gabriel M. Pitman (certified Neurology, Oklahoma City, OK)
OSU-COM UPDATE ALUMNI MEETINGS
Charles Morgan, MD
“Child Abuse and Neglect”
“Psych 101: How to Address the Psychiatric Needs of Your Patients in an Family Practice Setting”
Jeffrey M. Hunt, DO (certified Internal Medicine, Tulsa, OK)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
Sarah J. Passmore, DO (certified pediatric, Tulsa, OK) and Michael A. Baxter, DO (certified pediatric, Tulsa, OK)
W. John Mallgren, DO (certified psychiatry, Claremore, OK)
“Method for Alleviation of Chronic Musculoskeletal Pain Lab”
Draion M. Burch, DO, FACOOG (certified obstetrics & gynecology, Pittsburgh, PA)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
Lecture Title
“Making Sense of Clinical Osteopathy: Functional Pathways to Recognition of Disease”
“Pediatric Concussion Assessment & Management”
Jay M. Williamson, DO (certified obstetrics & gynecology, Tulsa, OK)
Barry S. Rodgers, DO (certified Neuromusculoskeletal medicine & OMM, Oklahoma City, OK)
Stephanie J. Husen, DO (certified pediatrics, internal medicine & sports medicine, Edmond, OK)
Oklahoma D.O. | March 2014
“Rural Psychiatry/Telepsychiatry and The Future”
Vincel R. Cordry, Jr., DO (certified psychiatry, Oklahoma City, OK) “A Review of the Newer Oral Anticoagulants and Reversal Strategies” Ryan K. Hakimi, DO (certified neurology and Neurosonology, Oklahoma City, OK)
PAGE 11
“The “L- Word”- Lesbian Health AND “T-Talk”-Transgender Health”
Oklahoma D.O.
“Method for Alleviation of Chronic Musculoskeletal Pain”
AFTERNOON SESSION
“Colorectal”
MORNING SESSION
Buns of Steel Buns of Still “Puns of Still: Similes, Analogies, and Metaphors: Explanation of OMT Techniques for Patient Understanding and Enjoyment”
SUNDAY, APRIL 27 7:0010:00
10:0011:00
AOA CO*RE Rems Program
Thomas F. Jan, DO, FAOCPMR (certified physical medicine & rehab, Massa[equa, NY) & Daniel G. Williams, DO (certified Neuromusculoskeletal Medicine and Osteopathic Manipulation, Indianapolis, IN)
Opioid Prescribing Guidelines forOklahoma Health Care Providers in the Office-Based Setting Proper Prescribing Course-Sign in Required
Layne E. Subera, DO, FACOFP (certified family practice, Skiatook, OK)
11:00 1:00
Medical Protective Program
Gail Harris, Senior Risk Consultant (Clinical Risk Management, Vegas, NV)
annual convention activities
HOTEL RESERVATIONS For hotel accommodations, please contact Wendy at Embassy Suites Norman - Hotel and Conference Center at 405-253-3547.
Oklahoma D.O. PAGE 12
Standard Suite is $145.00 a night. Check in: 3:00 pm/ Check out: 12 Noon. To avoid cancellation charges, reservations should be cancelled by 3:00 pm Room Cut-off is March 23, 2014 Room Amenities include: Two 32” televisions , Two phone lines with voicemail and data ports, Wireless Internet access, Hospitality center with microwave, refrigerator, and coffee maker. Don’t forget to mention you are with the OOA!
SeekingSitters
AHIIG PRE-REGISTRATION is greatly appreciated! register online or on the convention form on page 13
Oklahoma D.O. | March 2014
Oklahoma Osteopathic Association’s 114th Annual Convention April 24-27, 2014 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: _____________________ Email: _______________________________________________________ Phone: ________________________________________________________ OTHER NAME BADGES NEEDED FOR:
check the box, if you plan to register this child in SeekingSitters
Spouse: ___________________________________________________________________________________ Guest(s): __________________________________________________________________________________ Children/Teens :
(age)
(age)
(age)
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 17, 2014
DO Member Registration (or other AOA divisional society member) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 (Includes Sunday’s Proper Prescribing Lecture and Risk Management Program) Retired DO Member Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 DO Nonmember Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,090 Spouse/Guest/Exhibitor Events Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $220 MD and Non-Physician Clinicians Registration* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 Osteopathic Medical Student: OMS-I OMS-II OMS-III OMS-IV . . . . . . . . . . . . . . . . . . . . .$0 Intern Resident Fellow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0
After April 17, 2014
$565
$325 $1,115 $245 $565 $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.
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. I would like to purchase ________ Banquet ticket(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 each
$100 each
TOTAL AMOUNT DUE:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________
$______________
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. Charge my VISA, MASTERCARD, AMEX, DISCOVER:
Card #: ________________________________________________________________________________________________ Exp. Date:______________ Name (as it appears on card): _______________________________________________________________________________________________________ Billing Address: __________________________________________________________________________________________________________________ City: _______________________________________________________________ State: ___________________________ Zip: _______________________ 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: Due to the number of specialty tracks, a print syllabus will not be offered. A digital syllabus will be sent to registrants in advance for those wishing to print their own. 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 welcome to attend all convention functions at no charge. Requests for refunds must be received before April 17, 2014, and a $45 service fee will be charged. NO REFUNDS AFTER APRIL 17, 2014. Oklahoma D.O. | March 2014
PAGE 13
Oklahoma D.O.
WEDNESDAY, APRIL 23, 2014
z
FORE
q LOVE
the
of OSTEOPATHIC MEDICINE
OAK TREE COUNTRY CLUB 700 West Country Club Edmond, OK 73025
Register Today for the OOA/OEFOM Golf & Tennis Tournament
2014 OOA & OEFOM
GOLF &Wenesday, TennisApril Tournament 26, 2014 Oak Tree Golf and Country Club The Oklahoma Osteopathic Association and the Oklahoma Educational Foundation for Osteopathic Medicine present FORE the LOVE of Osteopathic Medicine Golf and Tennis Tournament. Proceeds will go towards scholarships and provide financial assistance to osteopathic students where state For more information, please see the attached brochure funding is not available. Registration will begin at 7:00 am in the west main clubhouse with a continental breakfast. Golfers will have the opportunity to practice in the practice facility with range balls, prior to the shotgun start. After the conclusion of both tournaments, all players will convene back in the main clubhouse for lunch and the awards ceremony.
GOLF 9:00 am Shotgun start • 4-person scramble-Limited number of participating teams Foursome- $700 Individual-$175 • All who purchase a mulligan package will be entered into the million dollar shootout, which will take place prior to the awards ceremony • 1st/2nd/3rd place teams will receive certificates to the Pro-Shop • Dress Code: Shirts must have collars and sleeves, NO jeans, cargo shorts/pants, cut-off shorts, t-shirts, tank tops, sweat pants, jogging apparel or athletic shorts
Oklahoma D.O. PAGE 14
TENNIS
• Single Player $150/$300 Doubles • Round-RobinTournament Format Players will have two hours of open play in a roundrobin format with partners at appropriate levels. Players/ Doubles will enter into two bracket elimination play, for upper and lower levels, to keep it competitive.
all Participants will receive: • Continental Breakfast & Lunch • Complimentary on-course beverages • Swag bag
FORE the LOVE Sponsor-$5,000
you will receive: • Exclusive logo placed on tournament t-shirt • One (1) Golf Foursome • One (1) Tennis Single • One (1) Hole Sponsorship • One (1) Court Sponsorship • Listed on all marketing material
LUNCH SPONSOR-$3,000
you will receive: • One (1) Golf Foursome • One (1) Tennis Single • One (1) Hole Sponsorship • One (1) Court Sponsorship • Listed on all marketing material • Assists with the awards ceremony
Hole Sponsor-$600
you will receive: • One (1) Single Player • One (1) Hole sign on the golf course • Listed on all marketing material
Court Sponsor-$400
you will receive: • One (1) Single Player • One (1) Court sign on the tennis court • Listed on all marketing material
Oklahoma D.O. | March 2014
REGISTRATION sponsorship level
FORE the LOVE Sponsor LUNCH Sponsor HOLE Sponsor COURT Sponsor
Please indicate how you would like your sign to read: __________________________________________
GOLF PLAYER INFOrmation
TENNIS PLAYER INFOrmation
INDIVIDUAL TWO PLAYERS THREE PLAYERS FOURSOME
INDIVIDUAL TWO PLAYERS
Please list player(s) information 1. ________________________________________ 2. ________________________________________
Please list player(s) information 1. ________________________________________ 2. ________________________________________ 3. ________________________________________ 4. ________________________________________
PAYMENT information
sponsorship level FORE the LOVE Sponsor - $5,000 LUNCH Sponsor - $3,000 HOLE Sponsor - $600 COURT Sponsor - $400
PLAYER INFOrmation
MISCELLANEOUS
please provide 200 items to the OOA central office
Oklahoma D.O. | March 2014
American Express MASTERCARD
visa discover
credit card information __________________________________________ CREDIT CARD NUMBER _________________________ __________________________ EXPIRATION DATE CID NUMBER
__________________________________________ BILLING ADDRESS _____________________________ ___________________ CITY/STATE ZIP
PAGE 15
MULLIGAN PACKAGE- $40 I WILL PROVIDE SWAG BAG ITEMS
Oklahoma D.O.
INDIVIDUAL GOLF - $175 GOLF FOURSOME - $700 INDIVIDUAL TENNIS - $150 DOUBLES - $300 OTHER: _____________________
PAYMENT check is enclosed
Bureau News: 2014 Nominating Committee
Members from the OOA Nominating Committe and their respective Districts met Thursday, January 2, 2014 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); Michael D. David, DO (Northeastern); Sean D. Boone, DO (Southeastern); Bret S. Langerman, DO (South Central); L. Janelle Whitt, DO (Tulsa); John C. Ogle, DO (Northwest); Duane G. Koehler, DO-2009-2010 OOA President; Scott S. Cyrus, DO2010-2011 OOA President; LeRoy E. Young, DO-2011-2012 OOA President; Layne E. Subera, DO-2012-2013 OOA President.
Recommendations for consideration by the Membership of the Oklahoma Osteopathic Association: 2014 Vacancies To Be Filled: President-Elect (Becomes President): Vice President (One-Year Term): Trustee (One-Year Term ending 2015): Trustee (One-Year Term ending 2015): Trustee (Three-Year Term ending 2017): Trustee (Three-Year Term ending 2017):
C. Michael Ogle, DO Gabriel M. Pitman, DO Melissa A. Gastorf, DO Richard W. Schafer, DO Timothy J. Moser, DO Kenneth E. Calabrese, DO
2014 AOA House of Delegates (Delegates) 1. Michael K. Cooper, DO 2. C. Michael Ogle, DO 3. David F. Hitzeman, DO 4. Layne E. Subera, DO 5. Bret S. Langerman, DO 6. Stanley E. Grogg, DO 7. Gabriel M. Pitman, DO 8. Dennis J. Carter, DO
9. 10. 11. 12. 13. 14. 15. 16.
LeRoy E. Young, DO Duane G. Koehler, DO Scott S. Cyrus, DO Kayse M. Shrum, DO Melissa A. Gastorf, DO Timothy J. Moser, DO Christopher A. Shearer, DO Ronald S. Stevens, DO
2014 AOA House of Delegates (Alternates) 1. Kenneth E. Calabrese, DO 2. Thomas J. Carlile, DO 3. Joseph R. Schlecht, DO 4. William J. Pettit, DO 5. James P. Riemer, DO 6. Gordon P. Laird, DO 7. Trudy J. Milner, DO 8. Justin S. Sparkes, DO
9. 10. 11. 12. 13. 14. 15. 16.
Richard W. Schafer, DO Tammie L. Koehler, DO H. Zane DeLaughter, DO John F. Rice, DO Ray E. Stowers, DO Jonathan B. Stone, DO B. Eric Blackwell, DO Vacant
2014 Proposed OOA Bylaw Amendments
Oklahoma D.O. PAGE 16
The proposed Bylaws amendments will be voted on during the Association’s annual business meeting at 2:00 pm, Thursday, April 24, 2014 at the Norman Embassy Suites. During the December 5, 2013, meeting, the OOA Board of Trustees approved the following revisions 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... Article VII, Section 5: Charters must be renewed on an annual basis and may be revoked by the Oklahoma Osteopathic Association Board of Trustees for just cause. Revocation requires a three-fourths vote of the Board of Trustees favoring such action. Article VII, Section 6: Upon application from an organization for a charter as an affiliated organization, the Board of Trustees and the Executive Director shall investigate and, upon satisfactory proof of a general agreement in policy and governing rules with those of this Association, shall may proceed with the issuance of such a charter. The Association shall may not issue a charter to any organization which duplicates the function or prerogatives of any presently affiliated organization or the Association. All organizations, who have as their membership osteopathic physicians in good standing with the Oklahoma Osteopathic Association, whether holding a current charter or affiliation or not, shall have as a medium of communication all publications of the Oklahoma Osteopathic Association. Oklahoma D.O. | March 2014
Doctor of the Day Schedule Day & Date
Physician
Monday, March 3
State Senator
State Rep
Timothy J. Moser, DO
Sen. Cliff Aldridge
Rep. Charlie Joyner
Tuesday, March 4
Jay D. Cunningham, DO
Sen. Rob Johnson
Rep. Mike Turner
Wednesday, March 5
Kristopher K. Hart, DO
Sen. Clark Jolley
Rep. Lewis Moore
Thursday, March 6
Gordon P. Laird, DO
Sen. A.J. Griffin
Rep. Dennis Casey
Monday, March 10
Monica M. Woodall, DO
Sen. Josh Brecheen
Rep. Dustin Roberts
Tuesday, March 11
Lori Gore-Green, DO
Sen. Nathan Dahm
Rep. Weldon Watson
Wednesday, March 12
Scott S. Cyrus, DO
Sen. Gary Stanislawski
Rep. Fred Jordan
Stanley E. Grogg, DO
Sen. Gary Stanislawski
Rep. Ken Walker
Sen. Gary Stanislawski
Rep. Katie Henke
Thursday, March 13
Monday, March 17 Tuesday, March 18
VACANT
Wednesday, March 19
Debra L. Montgomery, DO VACANT
Thursday, March 20
Melissa A. Gastorf, DO
Sen. Josh Brechen
Rep. Dustin Roberts
Monday, March 24
Trudy J. Milner, DO
Sen. Brian Crain
Rep. Ken Walker
Tuesday, March 25
L. Janelle Whitt, DO
Sen. Gary Stanislawski
Wednesday, March 26
Linda M. Rodriguez, DO
Sen. Mark Allen
Rep. James Lockhart
Thursday, March 27
Michael F. Stratton, DO
Sen. Earl Garrison
Rep. Arthur Hulbert Rep. Doug Cox
Oklahoma D.O.
Monday, March 31 Aunna C. Herbst, DO Sen. Wayne Shaw
Rep. Jeannie McDaniel
PAGE 17
Oklahoma D.O. | March 2014
The Rural Clinic Rotation:
Bringing “Rural” Home Provided by: Duane G. Koehler, DO, FACOFP, Assistant to the Dean for Rural Education, OSU Center for Rural Health
Oklahoma D.O. PAGE 18
R
Returning osteopathic physicians to rural Oklahoma is one of the statutory charges for the Oklahoma State University Center for Health Sciences (OSU CHS). To this end, OSU CHS has, in recent years under the direction of Kayse M. Shrum, DO, President of the Center for Health Sciences and Dean of the College of Osteopathic Medicine, implemented a number of new initiatives to steer college and high school students from across the state into the profession. Even with these efforts, and others not specifically mentioned, the challenges of recruiting young physicians to rural Oklahoma can be daunting. Just ask anyone who has attempted to recruit into rural communities. Stories abound of young and eager physicians who practice only long enough (if the community is lucky) to repay an obligation and then they are gone. Physicians who practice in rural Oklahoma know this reality all too well. They are keenly aware of the challenges and rewards of practicing in rural communities. Many of the challenges facing rural physicians are not significantly different from those facing urban physicians. But lifestyle outside suburbia is different.
tion or statistical report of the challenges facing citizens in rural parts of the state. It is lived, felt, and experienced first-hand. Just as important are the shared experiences and relationships that develop between preceptor and student which forges a bond between two different generations of physicians.
An integral part of the medical education provided by OSU CHS is a series of required rural clinical rotations (see Figure 1). One of these rotations, Rural Clinic, provides the medical students direct involvement and experience in a rural practice, under the direct supervision of a primary care physician. This four week rotation exposes students to a deepened understanding of what life in rural Oklahoma is like. It is no longer a PowerPoint presenta-
Learn more about the OSU Center for Rural Health by visiting our website: http://ruralhealth.okstate.edu or follow us on Twitter: @osururalhealth.
To those who have touched and influenced the future of our profession by volunteering their time, energy, patients, and clinics, I want to say, “Thank You” on behalf of OSU CHS and the OSU Center for Rural Health. Your dedication to your patients and to the future is greatly appreciated. To those wishing to enrich your lives by interacting with young impressionable medical students you may contact OSU Center for Rural Health staff members, Duane Koehler, DO (duane.koehler@okstate.edu) and Vicky Pace, M.Ed. (vicky.pace@okstate.edu), to explore the possibilities of providing important educational opportunities to our students and yourself.
Oklahoma D.O. | March 2014
“
…my trip to rural Oklahoma immersed me in a small, yet proud community that was filled with many warm, welcoming people. I worked in a clinic that relied on experience and long-standing relationships to provide effective health care. The lessons that I’ve taken away from this rotation will always be with me through my career. I was shown how to be compassionate, yet thrifty, and perhaps even a bit resourceful in the care that I will one day provide.
”
OSU COM 3rd Year Medical Student after completing their Rural Clinic rotation Figure 1
Oklahoma D.O. PAGE 19
Oklahoma D.O. | March 2014
What DO’s Need To
KNOW
AOA and ACGME Agree to Single GME Accreditation System After months of discussion, the AOA, along with the Accreditation Council for Graduate Medical Education (ACGME) and the American Association of Colleges of Osteopathic Medicine (AACOM), have agreed to a single accreditation system for graduate medical education programs in the United States. A single graduate medical education (GME) accreditation system will evaluate and provide accountability for the competency of physician residents consistently across all GME programs. This ensures the quality and efficiency of postdoctoral education, while preserving the unique dimensions of the osteopathic medical profession and recognizing its contribution to health care in the U.S. Under the agreement: • From July 1, 2015 to June 30, 2020, AOA-accredited training programs will transition to ACGME recognition and accreditation.
• There will continue to be osteopathic-focused training programs under the ACGME accreditation system. Two osteo- pathic review committees will be developed to evaluate and set standards for the osteopathic aspects of training programs seeking osteopathic recognition.
• DOs and MDs would have access to all training programs. There will be prerequisite competencies and a recommended program of training for MD graduates who apply for entry into osteopathic-focused programs.
• AOA and AACOM will become ACGME member organizations, and each will have representation on ACGME’s board of directors.
The agreement provides the framework for the osteopathic and allopathic communities to prepare future generations of physicians with the highest quality graduate medical education and serve as a unified voice for graduate medical education resources to help mitigate the primary care physician shortage and better serve the public.
Oklahoma D.O. PAGE 20
As stated in the joint press release issued today, a single GME accreditation system ensures that all physicians have access to the primary and sub-specialty training they need for the patients they want to serve. For the osteopathic medical profession, the system recognizes the unique principles and practices of DOs and their contribution to the health and well-being of all Americans
ICD-10 eHealth University Resources CMS has launched eHealth University, a new go-to resource to help providers understand, implement, and successfully participate in CMS eHealth programs. eHealth University features a full curriculum of materials and information, all in one location. The education modules are organized by level, from beginner to advanced, and simplify complex information in a variety of formats, including fact sheets, guides, videos, checklists, webinar recordings, and more. As part of eHealth University, CMS is offering several resources to help you prepare for the October 1, 2014, ICD-10 compliance date. These include: • Introduction to ICD-10 – This fact sheet provides an introduction to ICD-10 and explains the key steps for switching to ICD-10. • Transition Checklist: Large Practices and Transition Checklist: Small and Medium Practices – These checklists outline
Oklahoma D.O. | March 2014
tasks and estimated timeframes for important ICD-10 transition activities for small, medium, and large practices. • Basics for Small and Rural Practices – This beginner-level fact sheet provides basics about the ICD-10 transition for small and rural practices, including background on ICD-10, important questions to answer about ICD-10 preparations, and resources to help prepare for the compliance date. • Introduction to ICD-10 for Providers - This in-depth guide for providers explains the background behind ICD-10, why the transition is important, how providers can prepare for ICD-10, and important resources to help transition. Once you have an understanding of the basics of ICD-10 through these beginner-level resources, check out the intermediate and advanced resources also available on the eHealth University website. By using these tools, you can better prepare for October 1, 2014, and help ensure a smooth transition to ICD-10. Keep Up to Date on ICD-10 Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, compliance date. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.
New EHR Attestation Deadline for Eligible Professionals: March 31, 2014 CMS is extending the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from 11:59 pm ET on February 28, 2014 to 11:59 pm ET March 31, 2014. In addition, CMS is offering assistance to eligible hospitals who may have experienced difficulty attesting to submit their attestation retroactively and avoid the 2015 payment adjustment. This extension will allow more time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment. This extension does not impact the deadlines for the Medicaid EHR Incentive Program or any other CMS program, including the electronic submission for the Physician Quality Reporting System EHR Incentive Program Pilot. How to attest? If you are an eligible professional, you may use the registration and attestation system to submit your attestation for meaningful use for the 2013 reporting year. You must attest prior by 11:59 pm ET on March 31, 2014 to meet the new 2013 program deadline. If you are an eligible hospital, you may contact CMS for assistance submitting your attestation retroactively. You must contact CMS by 11:59 pm on March 15, 2014 in order to participate for the 2013 program year.
Oklahoma D.O. | March 2014
PAGE 21
Tips In addition, there are some simple steps you can take which will help to make the process easier for you: • Ensure that your payment assignment and other relevant information is up to date in the Medicare payment system PE - COS • Make sure to include a valid email address in your EHR program registration • Consider logging on to use the attestation system during non-peak hours such as evenings and weekends • Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2013 data • If you experience attestation problems, call the EHR Incentive Program Help Desk and report the problem
Oklahoma D.O.
Resources If you are an eligible professional working on your attestation for the 2013 reporting period, there are resources available to help you with the registration and attestation process. • Stage 1 Meaningful Use Calculator • Registration and Attestation User Guides • EHR Incentive Program Website The EHR Information Center is open to assist you with all of your registration and attestation system inquiries. Please call, 1-888734-6433 (primary number) or 888-734-6563 (TTY number). The EHR Information Center is open Monday through Friday from 7:30 a.m. – 6:30 p.m. (Central Time), except federal holidays.
Quality Data Added to Physician Compare Website On February 21, CMS announced that for the first time, quality measures have been added to Physician Compare, a website that helps consumers search for information about hundreds of thousands of physicians and other health care professionals. The site helps consumers make informed choices about their care. In the first year, 66 group practices and 141 Accountable Care Organizations (ACO) now have quality data publicly reported on Physician Compare. The data are reported at the group practice and ACO level. The quality measures added include: • Controlling blood sugar levels in patients with diabetes. • Controlling blood pressure in patients with diabetes. • Prescribing aspirin to patients with diabetes and heart disease. • Patients with diabetes who do not use tobacco. • Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions. Physician Compare, created by the Affordable Care Act, already includes information about specialties offered by doctors and group practices; board certification; and affiliation with hospitals and other health care professionals. Full text of this excerpted CMS press release (issued February 21). Next Edition of Electronic Health Record Technology Certification Criteria Issued Progress by HHS increases interoperability and supports clinical and delivery reforms On February 21, the HHS Office of the National Coordinator for Health Information Technology (ONC) issued proposals for the next edition (the “2015 Edition”) of electronic health record (EHR) technology certification criteria. This proposed rule marks the first time ONC has proposed an edition of certification criteria separate from the CMS “meaningful use” regulations. The proposals represent ONC’s new regulatory approach that includes more incremental and frequent rulemaking. This approach allows ONC to update certification criteria more often to reference improved standards, continually improve regulatory clarity, and solicit comments on potential proposals as a way to signal ONC’s interest in a particular topic area. Compliance with the 2015 Edition would be voluntary – EHR developers that have certified EHR technology to the 2014 Edition would not need to recertify to the 2015 Edition for customers to participate in the Medicare and Medicaid EHR Incentive Programs. Similarly, health care providers eligible to participate in the Medicare and Medicaid EHR Incentive Programs would not need to “upgrade” to EHR technology certified to 2015 Edition to have EHR technology that meets the Certified EHR Technology definition. The proposed rule will be published in the Federal Register on February 26. ONC will accept comments on the proposed rule through April 28, 2014. The final rule is expected to be issued in summer 2014. Full text of this excerpted HSS press release (issued February 21).
Oklahoma D.O. PAGE 22
Adult Immunization: Are You Meeting the Standards for Patient Care? A Message from the CDC Vaccination is a critical preventive health measure. Making sure your patients are up-to-date on vaccines recommended by the Centers for Disease Control and Prevention (CDC) gives them the best protection available from several serious diseases. The National Vaccine Advisory Committee (NVAC) recently revised and updated the Standards for Adult Immunization Practice to reflect the important role that all healthcare professionals play in ensuring that adults are getting the vaccines they need. These new standards were drafted by the National Adult Immunization and Influenza Summit (NAIIS) of over 200 partners, including federal agencies, medical associations, state and local health departments, pharmacists associations, and other immunization stakeholders. What makes adult immunization a priority for leaders in medicine and public health? First and foremost, adult vaccination rates are very low (National Health Interview Survey, 2012). For example, rates for Tdap and zoster vaccination are 20% or less for adults who are recommended to get them. Even high risk groups are not getting the vaccines they need—only 20% of adults younger than 65 years old who are high risk for complications from pneumococcal disease are vaccinated. Each year, tens of thousands of adults needlessly suffer, are hospitalized, and even die as a result of diseases that could be prevented by vaccines. However, a recent national survey showed that most US adults are not even aware that they need vaccines throughout their lives to protect against diseases like shingles, pertussis, and hepatitis. Adults trust their healthcare professionals to advise them about important preventive measures. Most health insurance plans provide Oklahoma D.O. | March 2014
coverage for recommended adult vaccines. And, research indicates that most patients are willing to get vaccinated if recommended by their doctor. However, most patients report their healthcare providers are not talking with them about vaccines, missing opportunities to immunize. Incorporating vaccine assessments into routine clinical care is key to improving vaccination rates. CDC is calling on all healthcare professionals to make adult immunization a standard of patient care in their practice by integrating four key steps: 1. Assess immunization status of all your patients in every clinical encounter. This involves staying informed about the latest CDC recommendations for immunization of adults and implementing protocols to ensure that patients’ vaccination needs are routinely reviewed. 2. Share a strong recommendation with your patients for vaccines that they need. Key components of this include tailoring the recommendation for the patient, explaining the benefits of vaccination and potential costs of getting the diseases they protect against, and addressing patient questions and concerns in clear and understandable language. 3. Administer needed vaccines or refer your patients to a provider who can immunize them. It may not be possible to stock all vaccines in your office, so refer your patients to other immunization providers in the area to ensure that they get the vaccines they need to protect their health. 4. Document vaccines received by your patients. Help your office, your patient, and your patients’ other providers know which vaccines they have had by participating in your states’ immunization registry. And for the vaccines you don’t stock, follow up to confirm that patients received recommended vaccines. For more information and resources to improve adult immunization practice, visit the CDC Adult Vaccination Information for Healthcare and Public Health Professionals website. Note: CMS reminds all health care professionals that certain vaccines are covered by Medicare. For more information on Medicarecovered vaccines, please refer to the following CMS Medicare Learning Network® provider publications: • Preventive Immunizations Booklet • Quick Reference Information: Medicare Immunization Billing Quick Reference Chart • Vaccine Payments under Medicare Part D Fact Sheet • Mass Immunizers and Roster Billing Fact Sheet
Oklahoma D.O. | March 2014
PAGE 23
Want more information about the EHR Incentive Programs? Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
Oklahoma D.O.
New and Updated FAQs for the EHR Incentive Programs Now Available To keep you updated with information on the Medicare and Medicaid Electronic Health Record (HER) Incentive Programs, CMS has recently added four new FAQs and an updated FAQ to the CMS FAQ system. We encourage you to stay informed by taking a few minutes to review the new information below. New FAQs: • For some of the eligible professional (EP) clinical quality measures (CQMs), there are look back periods or look forward periods for which data was not available. How are these CQMs calculated for the reporting period? Read the answer. • Why does the result of the clinical quality measure for CMS140v2 not accurately reflect an accurate performance rate upon calculation according to the measure logic in the specification? Read the answer. • In calculating the meaningful use objectives requiring patient action, if a patient sends a message or accesses his/her health information made available by their EP, can the other EPs in the practice get credit for the patient’s action in meeting the objectives? Read the answer. • When reporting on the Summary of Care objective in the Electronic Health Records (EHR) Incentive Program, how is a transition of care defined and which transitions would count toward the numerator of the measures? Read the answer. Updated FAQ: A number of measures for Meaningful Use objectives for eligible hospitals and critical access hospitals (CAHs) include patients admitted to the Emergency Department (ED). Which ED patients should be included in the denominators of these measures for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
OSU-Medical Center
T
GI Program
Provided by: Jamie Calkins, Marketing/Media Coordinator, OSU Medical Center
Oklahoma D.O. PAGE 24
The medical professionals at Oklahoma State University Medical Center (OSUMC) Gastroenterology most commonly see their patients for colonoscopy screenings, reflux type symptoms, gastroesophageal reflux disease, abdominal pain and bowel changes. There are many exciting things happening in the GI department, but what sets them apart is the training program and the ability to work with the most knowledgeable doctors. Upon finishing their GI fellowship in December 2013, both Jeffrey M. Hunt, DO and Scott Hendrickson, DO joined David S. James, DO in practice at OSUMC. Dr. James has been has been the medical director of Gastroenterology at OSUMC for over 30 years. The service that OSUMC is able to provide within their GI program makes them unique. “We perform three-four Endoscopic ultrasounds a week, whereas other facilities may only perform them three to four times a year. Our doctors have access to cancer patients on a regular basis” said Dr. James. “With the celiac plexus block we are able to go in and block the celiac nerve for pancreatic cancer pain,” said Dr. Hunt. A celiac plexus block procedure is an injection performed to reduce abdominal pain caused by can-
intestines. It is safe and easy to perform and it provides a similar diagnostic and therapeutic yield when compared to a Double Balloon Enteroscopy. SBE is a viable technique for the management of small bowel disease and only one other facility has it in Tulsa.
cer, chronic pancreatitis or adhesions. The GI program at OSUMC is one of nine fellowships offered. OSUMC is always looking for ways to expand and further its mission of training the physicians of tomorrow. “All of the doctors that come through our GI program are internist. I am very pleased with the great doctors that I get to work with while they are in residency. It’s an honor that Dr. Hunt and Dr. Hendrickson have chosen to stay and practice with me here at OSUMC and it’s a privilege that I get to help train these individuals,” mentioned Dr. James. Some of the exciting things happening in the department of gastroenterology at OSUMC is the addition of two new pieces of equipment set to arrive in March 2014. The Single Balloon Enteroscopy (SBE) will allow for visualization of the small
The Endoscopic Ultrasound (EUS) will also be introduced. “EUS will allow us to see the organs on the outside of the GI tract that we have access to. That would include anything outside of the esophagus, the stomach and the first part of the small intestines,” said Dr. James Hunt. EUS allows for more accurate and more detailed images than the ones obtained from a traditional ultrasound. “We will be able to look at lymph nodes in the mediastinum and be able to biopsy those as well as pancreatic, liver, adrenal and renal masses and lymph nodes that are down in the abdominal region,” explains Dr. Hunt. The fellowship in gastroenterology offered at OSUMC has high hopes for expanding in the future as the need for GI specialists rises. OSUMC will remain at the forefront of medicine and continue its mission of exceptional health care, every patient, every time while training the physicians of tomorrow. DO OK
Oklahoma D.O. | March 2014
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Oklahoma D.O.
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Oklahoma D.O. | March 2014
OK_OsteoSoc_full_1c_7'375x9'75.indd 1
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Email: sselman@rcins.com Visit: www.rcins.com
3/28/11 11:05 AM
March Birthdays MarcH 1 Tobi N. Fried, DO Dennis R. Staggs, DO
March 7 Stanley K. Rogers, DO Karl F. Langkamp, DO
MarcH 2 Phillip A. Nokes, DO Daniel L. Nicoll, DO G. Lea Rollings, DO Tonya T. Suffridge, DO Larry L. Ruffin, DO
March 8 Henry W. Harnish, DO Stephen M. Treadwell, DO
MarcH 3 Shawn M. Ellis, DO
March 4 J. Cheree Fisher, DO Gary T. Dykstra, DO Tiffany D. Dupree, DO Kendal L. Mitchell, DO
Oklahoma D.O. PAGE 26
March 5 Fred C. LeMaster, DO M. Denise Speed, DO James R. Pletcher, DO James E. Meissen, DO
March 6 Donald L. Cooper, DO Connie L. Proskovec, DO Stacey D. Knapp, do
March 9 Robert T. McBratney, DO Trudy J. Milner, DO Laura L. Kilkenny, DO Sherry L. Roles, DO J. Todd Robinett, DO Michael W. Wilson, DO M. Scott Glover, DO
March 10 F. Steven Sanders, DO Michael R. Stafford, DO Lori C. Miller, DO Bryan J. Menges, DO
Christos E. Vassiliou, DO David Hopkins, DO Jonathan B. Stone, DO Tracy Burton, DO Lura S. Miller, DO
March 13 John S. Vogel, DO Gary Wayne Cole, DO
March 14 Terence M. Williams, DO Kalvin L. White, DO Richard J. Langerman, JR, DO. Tracy L. Thompson, DO Trisha L. Parks, DO Scott H. Gibson, DO
March 15 Charles F. Finnell, DO Gary D. Fine, DO Gretchen H. Jones, DO Tinuola Agbabiaka, DO
March 11 Dwayne L. Janzen, DO Trisza L. Ray, DO Russell D. Moneypenny, DO Damon L. Brooks, DO Bharat B. Mittal, DO
March 16 Douglas C. Nolan, DO Michael G. Gietzen, DO Jamie A. Akin, DO Matthew J. Comstock, DO
March 12 Brian K. Lepley, DO Robert L. Boyles, DO
March 17 Patricia A. Allen, DO Kirt E. Bierig, DO Oklahoma D.O. | March 2014
Rola E. Eid, DO Janet L. Kirk, DO
March 18 Bob R. Abernathy, DO Larry A. Bell, DO C. Thomas Woolard, DO Wendy F. Heller, DO Matthew R. Warren, DO C. Chris Glendenning, DO Nance D. Weddle, DO Brooke M. White, DO
March 19 Walter L. Wilson, DO Joseph C. Buendia, DO Shauna M. Kern, DO Peter J. Mostert, DO Stefanie Lynn Meredith, DO
March 20 Darci R. Hazelwood, DO Jamie L. Gore, DO Blake D. Christiansen, DO
Oklahoma D.O. | March 2014
March 24 T. H. Molskness, DO Dorian Randall Turner, DO Kerby W. Lamb, DO Timothy W. Teel, DO L. Brent Scott, DO Lori Arney, DO Carrie A. Gilstrap, DO
March 25 Philip J. Meyer, DO
March 26 Thomas H. Conklin Jr., DO Bryan K. Ledbetter, DO Aaron P. Wilbanks, DO Jeffrey L. Halford, DO Todd Thomas, DO
March 27 S. Addison Beeson, DO R. Michael Eimen, DO Mark W. Cotton, DO Paul D. Maitino, DO
March 28 Lewis J. Bamberl, DO Gregory S. Brooks, DO Kimberly J. Fletcher, DO John L. Halpin, DO Angela N. Farrar, DO
March 29 Albert K. Harvey, DO Lana G. Nelson, DO Sha-Rhonda M. Morton, DO
March 30 Mary K. Moore, DO Audra C. Scearce, DO Charles C. Henson, DO Sarah R. Elneser, DO Jacquelyn Desiree Boyd, DO
March 31 Patrice E. Mooney, DO Janet C. Matthews, DO Michell A. Cohn, DO Jonathan K. Bushman, DO
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MArch 22 James E. Little, DO Kim D. Floyd, DO
March 23 Fred D. Parman, DO Earl L. Uhland, DO Terry R. Gerard, DO Elizabeth A. McCutcheon, DO Kevin W. Hubbard, DO Ronald W. Holley, DO Ronald Kantola, DO Joe Tre’ Landrum, DO
Oksana I. Martsinkevich, DO
Oklahoma D.O.
March 21 C. Neal McCollum, DO Gordon M. Robson, DO James R. Sumner, DO Nathan Tillotson, DO Shawna R. Duncan, DO Zane E. Uhland, DO Heather D. Cribbs, DO Arash Karnama, DO
Pamela J. McCool, DO Stacy N. Taylor-Hunt, DO Kevin S. O’Neal, DO
Trace Heavener, OMS-II Student Government Association President 2013 – 2014 OSU-CHS STUDENT UPDATE
T
The 28 clubs, interest groups and other student organizations at OSU-CHS were very active during 2013. There were speakers invited on campus, events for the student body, events hosted in the community, representation at the national level, and fundraising that took place.
Oklahoma D.O. PAGE 28
A total of 65 speakers, many of whom read this journal, volunteered their time to educate the student body. Topics ranged from how to read an electrocardiogram by the Emergency Medicine Club, to what working in a war zone is like by the Wilderness Medicine Club, to the current status of the unified graduate medical education accreditation system by the Student Government Association. Also, 73 events were hosted for the student body and/ or their families. Some of these highlights include a New Student Survival Guide by the Sigma Sigma Phi Society, annual softball game by the Physical Medicine and Rehabilitation Club, residency tours by the Native American Association, and suture clinics by the Pros for Africa Club.
Forty-seven students attended national conventions, lobbying days in Washington D.C. or conferences. Students raised just shy of $20,000, the majority of which was donated to non-profit organizations such as St. Baldrick’s Foundation, Animal Alliance, and the Ronald McDonald House. Students applied for and received close to $20,000 in grants, most of which were from national parent organizations. The students could not have completed these accomplishments without the support, mentoring and guidance from physicians like you. We are all extremely grateful for the ways in which Oklahoma osteopathic physicians invest in the lives and nascent careers of OSU-COM students. OK
Eighteen events were hosted to benefit the community. For instance, the 34th Annual Osteopathic Scrub Run, organized by the Student Osteopathic Medical Association, benefits Lifeshare Transplant Donor Services of Oklahoma and the Sooner Chapter of the Cystic Fibrosis Foundation. Also, a Eugene Fields Health Fair was conducted by the Student National Medical Association, and a food drive for the Community Food Bank was organized by the Family Physicians Club.
Oklahoma D.O. | March 2014
DO
Oklahoma D.O. PAGE 29
Oklahoma D.O. | March 2014
CENTER FOR HEALTH SCIENCES Mousumi Som, DO, FACOI Assistant Professor of Medicine Department of Internal Medicine Assessment of Ticagrelor and Prasugrel Use at an Academic Medical Center Steve Kim, DO Cardiology Fellow Oklahoma State University Medical Center Patrick Henderson, DO Internal Medicine Resident Oklahoma State University Medical Center Jeffrey S. Stroup, PharmD, BCPS Associate Professor of Medicine Oklahoma State University Center for Health Sciences Matt Wilkett, DO Assistant Professor of Medicine Oklahoma State University Center for Health Sciences
Oklahoma D.O. PAGE 30
Background: Acute coronary syndrome (ACS) includes a spectrum of cardiac diseases, interventions, and outcomes. Antiplatelet therapy has long been essential in the treatment of ACS and dual antiplatelet therapy has become the standard of care for many ACS situations (1). These medications are not benign or without side effects and bleeding is often the major concern or contraindication. The newer antiplatelet medications work similarly as irreversible (prasugrel [Effient]) and reversible (ticagrelor [Brilinta]) P2Y12 inhibitors on platelet function. They have different mechanisms of action requiring conversion to active metabolites from prodrugs and different times for full activity or platelet inhibition. Clopidogrel (Plavix) has long been the standard of care for ACS with or without ST-segment elevation and after percutaneous intervention (PCI) procedures (2-4). There are a few disadvantages to clopidogrel. These include: its time of
Oklahoma State University Center for Health Sciences College of Osteopathic Medicine 1111 West 17th Street Tulsa, Oklahoma 74107-1998 onset with conversion to active metabolite and patients with a variable response to its platelet inhibition, ranging from 15-48% (5). The newer antiplatelets including prasugrel and ticagrelor have been developed and utilized in the ACS spectrum. When compared to clopidogrel, prasugrel had a faster onset and a greater inhibition of platelet function along with significantly reduced rates of ischemic events such as stent thrombosis. On a more negative side, they had more significant episodes of bleeding. Overall mortality was unchanged between prasugrel and clopidogrel but platelet inhibition and consistency was improved among a population of patients with diabetes (1). Ticagrelor is the first reversible oral P2Y12 receptor antagonist and was compared to clopidogrel for platelet inhibition during ACS. Ticagrelor proved to have a faster onset and more pronounced platelet inhibition along with a significant improvement in patients with ACS with or without ST-segment elevation in the rate of death from vascular causes, myocardial infarction, or stroke (5). These medications may appear superior for these events, but not without some side effects and specific contraindications. At our institution, these medications are classified as open formulary. This allows any provider to prescribe these medications. Currently there are contraindications for each of these new agents and our goal was to assess the utilization and safety of these medications at our institution. The contraindications/cautions for prasugrel include history of transient ischemic attack (TIA) or stroke, gastrointestinal (GI) bleeding, severe hepatic impairment, weight less than 60 kilograms (kg), or age greater than 75 years old. The contraindications/cautions for ticagrelor include a history of intracranial hemorrhage, severe hepatic impairment, and aspirin use in
doses greater than 100mg daily. The goal of this analysis was to help assess the utilization of these new agents at our institution. Methods: This study was a retrospective observational study that involved a chart review of patients admitted to our institution. The charts of patients admitted between January 1, 2009 until December 31, 2012 with use of ticagrelor or prasugrel, either during their admission or upon admission, were reviewed. Patients under the age of 18 were excluded from the analysis. The data collected were: baseline demographics (patient’s age, gender, weight), laboratory data (bilirubin, INR, and serum creatinine), and patient history (TIA, stroke, GI bleed, peptic ulcer disease, myocardial infarction or known coronary artery disease). The doses of aspirin, ticagrelor, and prasugrel were also identified. The inciting event for hospitalization or medication use was documented as well as any bleeding events in the hospital. Statistics: Only descriptive statistics of the patient population were utilized in this analysis, no comparative statistics were used. Results: 292 patients were evaluated in this study between the ages of 30 and 95 with an average of 62 years old and 181/292 (61.9%) were men. The average weight of the population was 88.7 kg with a range of 46.3 to 163.3. Of the 292 patients, 70 (23.9%) were prescribed ticagrelor and 222 (76%) were prescribed prasugrel. Forty four (15%) patients presented with ST elevation myocardial infarction (STEMI), 104 (35.6%) were diagnosed with unstable angina, and 73 (25%) were diagnosed with non ST elevation myocardial infarction (NSTEMI). The remaining reported discharge diagnoses included syncope, chest pain, ventricular arrhythmias, atrial fibrillation, congestive Oklahoma D.O. | March 2014
heart failure, chronic obstructive pulmonary disease, and deep vein thrombosis. The cardiology service evaluated 284/292 (97%) patients on these therapies during their hospital stay. In the prasugrel population, 22/222 (9.9%) patients were greater than 75 and 7/222 (3.15%) patients were less than 65 kg. One prasugrel patient received the 5mg dose but their weight was greater than 150 kg. Five (2.25%) patients were given prasugrel with a bilirubin greater than 1.5mg/dL (upper limit of normal for laboratory standard). 171 patients received 81mg of aspirin, 44 were prescribed 162mg, 70 received 325mg, and 7 were discharged without aspirin. Bleeding was identified in 13/292 (4.4%) cases. Four cases (1.37%) on ticagrelor and nine cases (3.1%) prescribed prasugrel had bleeding. All patients (n=70) prescribed ticagrelor had bilirubin levels less than 1.5mg/dL and all ticagrelor patients were prescribed less than 100mg of aspirin during discharge.
Of the 22 patients with an age greater than 75, eight patients were diagnosed with diabetes, two patients had a history of both diabetes and myocardial infarction (MI), and the remaining patient had only a history of MI. The high risk in these patients could allow the 10mg dose to be utilized. Eleven patients were prescribed prasugrel despite the age contraindication without an increased cardiovascular risk. This age risk contraindication is mechanistically the same as in low weight individuals regarding the active metabolite. In healthy populations of patients in clinical studies, the pharmacokinetics were not appreciably affected in those patients with an age between 20-80 years (14). The TRITONTIMI 38 trial did show a 19% increase in active metabolite in patients >75 years of age, but no effect on metabolite in patients with diabetes (11). This study resulted in a reduction in daily maintenance dose to 5mg daily (15). This dose was the same as the low weight subgroup, but still is cautioned due to an increased bleeding risk (15).
A review of a larger population of patients in our study would have been beneficial, along with specific subgroups between practitioners, patient demographics, and laboratory data. Notices of contraindications when prescribing electronically or simple check lists for order sets could also help our compliance and education to all prescribing physicians to identify contraindications. The mixed results in this review are impressive for the ticagrelor group, with excellent adherence to contraindications, while the prasugrel group left some areas for education and process reform. The percentages were small in the prasugrel group, with room for improvement, especially with electronic medical records advancement. Resources: 1. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2007; 357: 2001-15. 2. Bassand JP, Hamm CW, Ardissino D, et al. Guidelines for the Diagnosis and Treatment of non-ST-segment Elevation in Acute Coronary Syndromes. Eur Heart J 2007; 28: 1598660 3. Silber S, Albertsson P, Aviles FF, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Car diology. Eur Heart J 2005; 26: 804-07 4. Yusuf S, Zhao F, Mehta SR, et al. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-segment Elevation. N Engl J Med 2001; 345: 494-502 5. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009; 361: 1045-57. 6. Nawarskas JJ and Snowden SS. Critical Ap praisal of Ticagrelor in the Management of Acute Coronary Syndrome. Ther Clin Risk Manag. 2011; 7: 473-88. 7. DiNicolantonio JJ and Serebruany VL. Challenging the FDA black box warning for high aspirin dose with Ticagrelor in patient with diabetes. Diabetes. 2013; 62(3): 669-71.
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Oklahoma D.O. | March 2014
The number of patients prescribed prasugrel was much greater than ticagrelor, possibly accounting for the increased number of contraindications missed. Hepatic impairment is a caution when prescribing prasugrel and five patients were noted to have bilirubin levels greater than 1.5mg/ dL, but the lack of complete data did not allow a calculation of Child-Pugh scores. The history of TIA and stroke are contraindications, despite ten patients receiving prasugrel in our analysis with these diagnoses. The other black box warnings observed in this review included patient weight less than 60 kg and age greater than 75 years (10). The prasugrel 10mg dose in low body weight individuals caused increased bleeding in clinical trials due to the higher amounts of the metabolite (11). The alternative for patients with low body weight was a lower dose (5mg) of prasugrel (10). The active metabolite in the dose of 5mg for low body weight individuals was evaluated and compared to 10mg dose with body weight >60kg and showed similar systemic levels (12). Small studies have also compared the doses to patient weight in stable coronary artery disease with noninferiority (13).
Long term follow up for the few patients that received prasugrel, despite cautions, would be valuable to explore. In addition, an evaluation of the group of diabetes patients that received prasugrel with contraindications would be a future exploratory study. This population has been reported to have greater platelet inhibition and better response with both loading and maintenance doses of prasugrel while compared to clopidogrel (16).
Oklahoma D.O.
Discussion: The use of antiplatelet drug therapy in ACS has become part of the standard of care. These new antiplatelet medications have different risk factors and contraindications. With their benefits compared to clopidogrel and increased use, it is important to identify and adhere to the contraindications to therapy. In our analysis, there was complete adherence to the black box warning of ticagrelor with doses of aspirin greater than 100mg. This dose is important with regards to the effect of ticagrelor on platelet inhibition. In the Study of Platelet Inhibition and Patient Outcomes (PLATO) trial that compared ticagrelor to clopidogrel in ACS patients, this effect was identified (5). The drug was initially denied approval in the United States (US) in 2010, but retrospective evaluation of the regional differences for efficacy suggested aspirin as the biggest variable between the US and other countries. The median dose of aspirin in the US was >300mg compared to the rest of the world with lower doses. When the study was evaluated looking at lower doses of aspirin (<100mg), the benefit of ticagrelor over clopidogrel was confirmed across all regions (6). Future research is needed to better understand the dose relationship with aspirin and ticagrelor (7-9). In our analysis, prasugrel was prescribed three times as often as ticagrelor, but this warning was well
observed in the ticagrelor population despite the lower utilization.
American Osteopathic Association Health For the Whole Family
“The Dangers of Distracted Driving” Americans love their cars. And why shouldn’t they? Cars provide an unprecedented degree of mobility. Yet for all their advantages, deaths and injuries resulting from motor vehicle crashes are the leading cause of death for Americans age 30 and under, according to data from the National Highway Traffic Safety Administration. In fact, during 2011, one person died every 16 minutes in motor vehicle crashes. “Like most of the leading causes of death in the United States, motor vehicle collisions are a preventable cause of death,” says Samuel J. Garloff, DO, an osteopathic psychiatrist from Harrisburg, Pa. Distracted driving includes activities such as eating, putting on makeup, having passengers and pets in the vehicle, and using cellphones and other wireless or electronic devices. However, since cellphone use involves visual, manual and cognitive distraction, it’s especially dangerous, according to Distraction.gov. “The risk of serious injury and possible death is very high when it comes to vehicle collisions,” says Dr. Garloff. “While it’s still important to encourage people to wear seatbelts while driving, physicians and patients also need to address the increased dangers that technology in the car can pose to their health.”
Oklahoma D.O. PAGE 32
Cellphones and Crashes According to the National Safety Council, while other forms of distracted behavior may have greater and more severe consequences on driving behavior, cellphone use is the most common, and the one that contributes to the greatest crash involvement. In fact, according to the National Safety Council, an estimated 25% of crashes in 2011 resulted from using cellphones while driving. “Using a cellphone to engage in conversation or to send a text message presents two dangers,” warns Dr. Garloff. “First, drivers must take their eyes off the road while dialing or texting. Second, people can become so absorbed in their conversations that their ability to concentrate on the act of driving is severely impaired, jeopardizing the safety of vehicle occupants and pedestrians.” In addition, keep in mind that in some cities and states, it’s illegal to use a cellphone while driving unless you have a hands-free device. Cellphone Safety If it is absolutely necessary to use a cellphone or other wireless device while driving, Dr. Garloff recommends: Oklahoma D.O. | March 2014
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.
Waiting until you’ve reached your destination to send a text message. Ending your call if you find yourself in heavy traffic or driving in hazardous weather conditions. Learning how to use the speed dial, voice activation and redial features on your wireless device. This can greatly reduce the amount of time you are distracted. Keeping your phone within arm’s reach. Reaching into the backseat for something is a major distraction. Obeying the laws in your area. If there is a law that no hand-held cellphones are permitted while driving, wait until you get to your destination to make a call or invest in a hands-free device.
Refraining from taking notes or looking up phone numbers while driving. Both activities increase the amount of distraction and necessitate the use of at least one of your hands. Avoiding intense conversations, which can cause you to become so emotional you lose focus while driving. Informing the person you are speaking with that you are driving. They may encourage you to call them back at a better time. “Distractions are so commonplace that many don’t appreciate that it only takes a couple seconds for a distraction to turn into a collision, resulting in unnecessarily incurred medical expenses, loss of employment, damages to persons and property, and possible death,” adds Dr. Garloff.
When you need it. ProAssurance.com
Oklahoma D.O.
Medical professional liability insurance specialists providing a single-source solution
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Oklahoma D.O. | March 2014
LEGISLATIVE REPORT provided by Matt Harney, MBA
Oklahoma House Elects New SpeakerLegislative Priorities Change
On Feb. 10, House Republicans met behind closed doors to elect a new Speaker of the House. Speaker Pro Tempore Mike Jackson, R-Enid, faced off against Rep. Jeff Hickman, R-Fairview, to determine the new leader after T.W. Shannon stepped down as Speaker to focus on his U.S. Senate campaign. Rep. Hickman won the abbreviated contest by a reported margin of 39-30. “It is the most humbling experience of my life,” Hickman said following the caucus meeting. Hickman was sworn in by Oklahoma Supreme Court Justice Douglas L. Combs, surrounded by his wife and son. Hickman wasted no time in exercising his newfound authority. House Bill 1020, a carryover bill from the 2013 regular legislative session, was called to be heard by the House Calendar Committee on Thursday, Feb. 13. Speaker Hickman provided Calendar Committee Chair Rep. Pam Peterson, less than 24-hour notice the bill would be heard by her committee. The bill endangers public health by providing direct access to physical therapists.
Oklahoma D.O. PAGE 34
Bill Granting Direct Access to Physical Therapists Passes House, on to Senate
The vote took place the day after physical therapists rallied at the capitol. The bill would force patients into the unfortunate position of choosing between a PT and a qualified physician who is actually trained to evaluate all aspects of patient health. HB 1020 now moves on to the Senate. A sister bill in the Senate, SB 1778, has been laid over for now in the Health & Human Services Committee. Please understand your advocacy is crucial to our legislative outcomes. We ask for your continued support— through phone calls, emails, and even campaign contributions to your state legislators.
Sen. Sparks Elected to Serve as Senate Democratic Leader
On Feb. 17, Sen. John Sparks of Norman was elected Democratic Leader of the Senate during a Senate Democratic Caucus meeting. Sparks will succeed Sen. Sean Burrage of Claremore, who is not seeking re-election. Sparks will take the reins from Burrage at the close of this legislative session.
HB 1020, a bill granting direct access to physical therapists, passed the House on Feb. 19, Rep. Arthur Hulbert, R-Muskogee, authored the bill and is a physical therapist. Hulbert, along with physical therapist colleague Rep. Sean Roberts, R-Hominy, as well as medical doctor Rep. Doug Cox, R-Grove, debated in support of the bill. The OOA strongly opposes this measure.
“Although I am sad that this position became open due to Sen. Burrage’s departure from the Senate, I am ready and willing to step forward and lead our Caucus,” Sparks said. “The Democratic Caucus provides contrast where it is needed; we ask the hard questions; we shine light on the dark spaces; and we hold the Republicans accountable. I look forward to working with my fellow Democrats as we continue our efforts to create opportunity and promise for hard-working Oklahomans and their families.”
HB 1020 is a carryover bill from the 2013 regular legislative session. The bill started this legislative session dormant and was not anticipated to move forward to a full House vote. That is, until newly-elected Speaker of the House Jeff Hickman, R-Fairview, moved the bill by placing it on the Calendar Committee agenda.
Gov. Mary Fallin congratulated Sparks on his election to serve as the Democratic Leader of the Senate. “Republicans and Democrats alike want to make Oklahoma a stronger, more prosperous state for our citizens to live, work and raise a family. I look forward to working with Senator Sparks in support of that goal.” Oklahoma D.O. | March 2014
Board of Equalization Finalizes Figures, State Budget Picture Darkens
On Feb. 18, the State Board of Equalization finalized the budget picture for fiscal year 2015 showing a gap of $188.5 million short of the current year. This is an even larger gap than December’s projection of a $170 million shortfall. The current state budget is $6.9 billion. It appears some of the shortage is attributed to reduced corporate income tax collections—nearly $46 million short of projections. It is important to remember Gov. Mary Fallin’s proposal to cut state income taxes for the top bracket by .25%, erasing $136 million from state coffers. Therefore, more than 70% of the state’s current budget shortfall would be remedied by Fallin dropping her proposal.
Bill mandating PMP checks passes Senate Committee
A bill that requires medical practitioners or members of their medical or administrative staff to check information in the PMP before prescribing or re-filling any controlled substance passed in the Health & Human Services Committee this week. SB 1821, authored by Sen. A.J. Griffin, R-Guthrie, would also allow medical practitioners and their staff in Oklahoma who are employed by the federal government to have access to the state’s prescription monitoring program. The Committee passed the measure unanimously, 8-0, and will now move on to the full Senate.
Also opposed by the Bureau is SB 1495, authored by Sen. Kim David, R-Porter. SB 1495 would transition Oklahoma providers to a managed care delivery system for Medicaid patients. In a managed care delivery system, people get most or all of their Medicaid services from an organization under contract with the state. SB 1495 has passed the Senate Appropriations Committee.
Dr. Ritze named Chair of Public Safety Appropriations Committee
On Feb. 13, the only osteopathic physician in the Oklahoma legislature, Mike Ritze, DO, was appointed to serve as Chairman of the Public Safety Appropriations Committee. “It is an honor to have been selected for this position,” said Rep. Ritze, R-Broken Arrow. “It is a core function of government that we ensure our highways, roads, cities and towns are patrolled by highly trained and wellqualified law enforcement. To do their job professionally and effectively, this chamber must address the issue of proper and competitive compensation for those tasked with keeping our citizens safe and make sure they have access to modern equipment. It is time we begin to invest the taxpayers’ money in policies that will better protect the public and push for a safer Oklahoma.” The first official meeting of the House Public Safety Appropriations Committee was held Feb. 24.
OOA lobbyists are actively working to negotiate a lesser mandate for physicians.
Oklahoma D.O.
Bureau on Legislation Convenes, Opposes Medicaid Reforms
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This excessive regulatory requirement was applauded by Gov. Mary Fallin. “Currently, 81% of drug-related deaths in Oklahoma are caused by prescription drugs,” said Fallin. “One survey shows that nearly 8% of Oklahomans are abusing prescription painkillers. That is twice the national average, and it is unacceptable. The effects of statistics like these are tragic and when left unaddressed we see broken homes, higher incarceration rates, kids left without parents, poverty, child abuse, neglect and suicide.”
opposed two bills that would change the state’s Medicaid system. The first is HB 2384 and includes a cut for providers’ Medicaid-to-Medicare fee to 95%. The bill also decreases the number of covered monthly prescriptions for Medicaid recipients to five (eight for those in longterm care facilities) and reduces covered ER visits for Medicaid patients to six per year among other changes. HB 2384 is authored by Rep. Doug Cox, R-Grove, a medical doctor. HB 2384 has passed in the Public Health Committee.
The Bureau on Legislation met Feb. 26 and officially
Oklahoma D.O. | March 2014
Support OOPAC in 2014! DO your part To protect and promote osteopathic medicine in Oklahoma. 2014 OOPAC Investment _____ My personal check made payable to â&#x20AC;&#x153;OOPACâ&#x20AC;? is enclosed [ ] $100
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[ ] $2,500+ (Platinum PAC Partner) _____ Yes! I commit to monthly contributions to OOPAC. Please charge my credit card: [ ] $2,508 ($209 per month)
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Signature: ________________________________________________________________________________ I declare that this contribution is freely and voluntarily given from my personal property. I have not directly or indirectly been compensated or reimbursed for the contribution. This personal contribution is not deductible as a donation or business expense.
Please mail to: OOPAC, 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335.
Oklahoma D.O. | March 2014
Executive PAC Partner ($1000-$2500) Thomas H. Conklin, Jr., DO Scott S. Cyrus, DO Dale Derby, DO Greg Gray, DO Stanley E. Grogg, DO Robert R. Hunt, DO Trudy J. Milner, DO C. Michael Ogle, DO Gabriel M. Pitman, DO Ronald S. Stevens, DO American College of Osteopathic Family Physicians-Oklahoma Society
oklahoma osteopathic Political Action Committee
Premier PAC Partner ($501-$1001) Michael K. Cooper, DO David F. Hitzeman, DO Larry K. Hrdlicka, DO Duane G. Koehler, DO Tammie L. Koehler, DO Bret S. Langerman, DO John C. Loose, DO Timothy J. Moser, DO Christopher A. Shearer, DO James R. Turrentine, DO
Oklahoma D.O. | March 2014
committed to preserving osteopathic medicine
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support your OSTEOPATHIC pac today by filling out the form on page 36
Oklahoma D.O.
PAC Partner ($100-$500) Rod F. Linzman, DO Thomas H. Osborn, DO Candy Ting, DO
The J
2013-2014 Directory Order Form I would liked to order______ copies of the 2014 directory @ $55 per directory. Shipping and Handling is not included in the price, please call for pricing (405) 528-4848 or (800) 522-8379
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City: _____________________________________ State: _______ Zip: _________________ Phone: ___________________________________ Email: ____________________________
PLEASE RETURN FORM BY MAIL OR FAX MAIL: FAX TO: 4848 N. Lincoln Blvd. (405) 528-6102 Oklahoma City, OK 73105-3335 Oklahoma D.O. | March 2014
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. 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 IS NEGOTIABLE. Doctor prefers to sell, but would consider leasing. If interested, please call: Evelyn Francis at (405) 249-6945.
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. IMMEDIATE NEED: FP/ER/OB Physicians, FT,PT and Temp. Bimonthly pay. Paid malpractice and expenses including mileage. To join our fast growing team call Krystal @ 877-377-3627 or send CV to kernce@oklahomaoncall.com.
Oklahoma D.O.
IMMEDIATE OKLAHOMA OPPORTUNITY with largest family medicine clinic in Muskogee, Ok. Excellent opportunity to assume a practice that is up and running. Senior physician of four physician group leaving to pursue new career opportunities. 2,000 active patients need a physician. Two physicians currently practice OB. Surgical OB experience a plus. On site x-ray and CLIA certified lab. Nursing and support staff in place. Income guarantee. Be your own boss, work hard and practice family medicine in its historical tradition with respect and loyalty of small town patients. Contact Evan Cole, DO, 918-869-2456, ecoledo@yahoo.com, Brad McIntosh, MD, 918-869-7356, drbamc@yahoo.com Jason Dansby, MD, 918-869-7387, jasonddansby@yahoo.com or Judy Oliver, RN, practice administrator, 918-869-7357. (leave a message if temporarily unavailable) Find us on the web at www.mfpclinic.com.
STAFF PHYSICIAN NEEDED: The Oklahoma Department of Corrections is seeking applicants for Staff Physician at our correctional facilities statewide. The state of Oklahoma offers a competitive salary and benefits package which includes health, dental, life and disability insurance, vision care, retirement plan, paid vacation, sick days, holidays and malpractice insurance coverage. For more information and a complete application packet contact: Becky Raines 2901 N. Classen Blvd., Suite 200 Oklahoma City, OK 73106-5438 (405) 962-6185 FAX (405) 962-6170 e-mail: braines@doc.state.ok.us
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Oklahoma D.O. | March 2014
Prsrt Std US Postage Paid Okla City OK Permit #209
OKLAHOMA OSTEOPATHIC ASSOCIATION 4848 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105-3335
RELATIONSHIPS YOU CAN RELY ON PROTECTING YOUR MEDICAL PRACTICE FOR 83 YEARS
The Oklahoma Osteopathic Association has endorsed Rich & Cartmill, Inc. and Medical Protective since 1999 Please support your OOA and consider Rich & Cartmill, Inc. for your Professional Liability Insurance needs.
Oklahoma D.O. PAGE 40
For more information contact Scott Selman at 918-809-1461 or sselman@rcins.com
2738 E 51st Street, Suite 400 | Tulsa, OK 74105-6228 | 918.743.8811 | www.rcins.com
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SPRINGFIELD, MO Oklahoma D.O. | March 2014