Oklahoma DO May/June 2013 by Oklahoma Osteopathic Association

The Journal

of the

Oklahoma Osteopathic Association

Oklahoma D.O. May/June 2013

Volume 78, No. 1

Oklahoma D.O.

2013 - 2014 OOA President Oklahoma D.O. | May / June 2013

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Bret S. Langerman, DO

AUGUST 9-10, 2013 Renaissance Hotel and Cox Convention Center, Downtown Oklahoma City

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Oklahoma D.O. PAGE 2

• Showcase of new technologies and the future of medicine • CME and CEU Credits will be awarded (hours and types of credit, as well as professional affiliations, TBA) • Network with as many as 400 top physicians and other practitioners from throughout the State of Oklahoma—the largest single gathering of the healthcare community! The host, PLICO (Physicians Liability Insurance Company), is an informed industry leader providing comprehensive insurance services and products to Oklahoma healthcare providers.

Oklahoma D.O. | May / June 2013

The Journal

of the

Oklahoma Osteopathic Association

Oklahoma D.O. May/June 2012 May/June 2013

Volume 78, No. 1

January 2012

November 2012

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 Lany Milner, Director of Operations and Education Matt Harney, Advocacy and Legislative Director Marie Kadavy, Director of Communications and Membership

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. | May / June 2013

“Inaugural Address” provided by Bret S. Langerman, DO, 2013-2014 President

2013 Doctor of the Year Award Recipient

2013 Outstanding and Distinguished Service Award Recipient

10-12

Convention Award Recipients

Foundation Update

15-20

Convention Recap

“Alumni Luncheon Address” provided by Andy Lester, JD, Chair OSU A&M Board of Regents

“Inaugural Address from the AOOA President” provided by Vicki Stevens, 2013-2014 AOOA President

“OSU Medical Center’s Cath Lab Brings Improvements in Patient Care” provided by Jamie Calkins, Marketing/Media Coordinator

“Analysis of the Side Effect Profile in HIV Patients Converting from Lopinavir/Ritonavir to Darunavir/Ritonavir”

“Professionals into Action” provided by Stanley E. Grogg, DO

30-31

2013 Summer CME Seminar Program & Registration

“Putting Us On The Map” provided by Chad E. Landgraf, MS

“What Does a 3 Year Old Have In Common With Simon Sinke, John G. Miller and Rural DO’s?” provided by Vicki Pace, Director of Rural Medical Education

What DO’s Need To Know

“The Final Push” provided by Val Schott, MPH, Chief Executive Offiver

By the Way

2013-2014 OOA Bureaus and Committee

Classifieds & Calendar of Events

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The OOA Website is located at www.okosteo.org

Oklahoma D.O.

For more information: 405.528.4848 or 800.522.8379 Fax: 405.528.6102 E-mail: ooa@okosteo.org

Lynette C. McLain, Editor Lany Milner, Associate Editor

MAKING a

DIFFERENCE Dr. Milner was confirmed by the Education Committee and by the Senate on May 13, 2013, to the unexpired term. Dr. Milner is replacing Jay Helm’s position.

Trudy J. Milner, DO (Tulsa) was on her way to making osteopathic history when she answered her cell phone early one morning between seeing patients. On the phone was Oklahoma’s Governor Mary Fallin. A dream and goal was about to be realized. Dr. Milner was being asked to serve on the esteemed Oklahoma State University Agriculture and Mechanical Board of Regents. Dr. Milner is the FIRST osteopathic member to be appointed to this board.

Dr. Milner is a graduate of the AOA’s Health Policy Fellowship program and practices as a primary care physician and Assistant Medical Director of OMNI Medical Group with St. John’s Health Care System in Tulsa, OK. She is a member of the Oklahoma State University Medical Center Trust and a member of the Oklahoma State University Foundation Board of Governors. Dr. Milner is a past president of the Oklahoma Osteopathic Association and the OSU College of Osteopathic Medicine Alumni Association. She received her Bachelor of Science Degree from William Woods College in Fulton, MO, in 1973 and her nursing degree from Baylor University College of Nursing in Dallas, TX, in 1974. After working as a nurse, she applied to and was accepted into the Oklahoma State University College of Osteopathic Medicine where she earned her osteopathic medicine degree in 1988. Upon graduation she completed her internship at OSU Medical Center and a family medicine residency at the University of Oklahoma College of Medicine in Tulsa.

The late Bob E. Jones, CAE, executive director of the OOA, and Terry L. Nickels, DO, recognized the benefits and the importance of having an osteopathic physician serve at the OSU Regent Board level, since 1998. Throughout the past 25 years, attempts have been made but did not work out. LeRoy E. Young, DO, OOA past president and OOA Legislative chair, shared this belief and goals of these leaders and made a special effort to see an osteopathic physician be placed on the OSU A&M Board of Regents. The OOA is grateful to all our past leaders for their vision and the tenacity of our current leaders to see this effort to fruition.

OSU Medical Center Saved On May 20, 2013, Governor Mary Fallin signed the general appropriations bill that divides $7.1 billion among the state’s various agencies.

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Once again, the profession faced a significant goal this legislative session requesting permanent longterm funding for OSU Medical Center in Tulsa, OK. In an effort to save the OSU-MC, the DO IT! Campaign was created to build excitement and support a unified voice for the profession. Buttons, stickers and t-shirts were designed to help market this campaign. The Tulsa Osteopathic Medical Society (TOMS) joined forces and went to the membership requesting donations to this campaign in the Tulsa area. Through the efforts of Layne E. Subera, DO; Janice Bratzler, executive director of TOMS; Kenneth E. Calabrese, DO; David F. Hitzeman, DO, and countless others, over $25,000 was raised to save the hospital. Thank you to the Gooden Group and Karen Wicker of Candor PR who assisted with the DO IT! Campaign and the requesting of funds. Thank you to our lobbyists, Gary Bastin and Mark Snyder for your countless hours dedicated to the osteopathic causes, and finally thank you to all the physicians who took action and contacted their legislators asking for support of the $18.25 million for the hospital. You are the ones that make the difference.

Lobbyists were successful in gaining support and getting $13 million included in the bill directed to the OSU Medical Authority for OSU Medical Center.

Facts About OSU Medical Center

• In the last decade, OSU Medical Center has contributed $136 million to the state’s economy and created more than 2,500 jobs. • More than 80% of OSU medical residents remain in Oklahoma to practice medicine, many locating in rural Oklahoma. • Last year alone, 45,000 patients sought medical care in the OSU emergency room. • OSU Medical Center employs more than 900 people. • OSU Medical Center is home to more than 150 medical residencies. • OSU Medical Center provides training for 185 medical students. Oklahoma D.O. | May / June 2013

Inaugural Address by Bret S. Langerman, DO Presented during the Silver Buckle Banquet

“Thank you and welcome. We have the IJ Ganem Band in the house tonight for our entertainment. I somehow feel that we would all rather listen to the band than me so I am going to keep my remarks brief. As you can see, we have tried to do some things a little bit different at convention this year. I was allowed to wear jeans to the formal banquet. I’m not sure that this has ever been done before, and I am certainly not expecting to get away with it again. I rode in on horseback. Now having several horses myself, you would think this isn’t a big deal. The problem is, over the last few years it seems as though I have only had time to feed and clean up after them and not actually ride them. You have a tendency to get out of shape for that, and I have some real concerns about my ability to walk tomorrow. In all seriousness, we have changed the program this year offering several specialty tracks where you can obtain hours that will apply to your specialty certifications. I would like to give a special thank you to Dr. Michael Cooper for his hard work in putting this program together. This was quite a task and has worked out well. We have also embarked on a technology whirlwind trying to offer a more interactive electronic experience. I hope you had a chance to try out the new convention module that is available online. I would like to thank Rachael Prince for her hard work on this endeavor. As an association, we continue to strive to advance our technology to keep up with these changing times. None of this would be possible without the hard work of the OOA staff. My heartfelt thanks go out to Lynette McLain, Lany Milner, and Allison Rathgeber. They work tirelessly on our behalf on a daily basis. Nineteen years ago and some 235 miles up the turnpike in a place called Shangri-La, my late father, Richard Langerman, DO, stood on a stage much like this to accept his nomination to the presidency of this great association. There is no doubt in my mind that it was my exposure to the OOA through his tenure that I started down my path to serve. Now, I stand before you very humbled and appreciative for the opportunity to carry on in the great traditions of the leaders before me. I took a few minutes to look back at his inaugural speech and he spoke of osteopathic unity. It’s interesting to me how his theme is still important to our profession today. Medicine is rapidly changing and I’m not convinced that it’s for the better. It is only through our unity as an osteopathic profession that we can steer medicine down the path that is right, not only for our patients, but for us as physicians. I urge you to get involved in the OOA by serving on bureaus and perhaps even this board. It is only with your help that we can stay strong and influential on your behalf. Speaking of advocacy, the OOA Board and Bureau on Legislation have continued to be a force to reckon with at the state Capitol. We started out this legislative session tracking over 300 bills which affect what we do as physicians. Some of the legislation this session includes the nurse anesthetists who once again want to advance their scope of practice to work without the supervision of physicians. Physical therapists want the ability to evaluate, diagnose and treat patients without an

Oklahoma D.O. PAGE 5 article continues on page 6... Oklahoma D.O. | May / June 2013

order from a physician. Last year we assisted with and were successful with legislative efforts to secure funding for the OSU Center for Health Sciences to start primary care residencies in rural areas. This year, we continue to work diligently with the medical school to lobby and secure funding to save OSU Medical Center which is on the brink of closure. Workers’ compensation reform continues to be contentious and we continue to work to protect the interests of our patients and our physicians in that regard. We have also seen a big push legislatively to enact statutes to curb prescription drug abuse and diversion. The problem is, currently this legislation puts the onus on the physician to police the system. We will continue to work with the legislature to enact meaningful legislation in this area that does not place the burden on us as physicians. These are just a few of the larger issues that we have been dealing with during this legislative session. I would like to recognize and thank Dr. LeRoy Young for his leadership with the legislative bureau. I would also like to recognize and show our appreciation to our lobbyists Gary Bastin and Mark Snyder who work tirelessly to benefit the majority of the association. We will continue to make it a priority to protect our practice rights and be a presence at the capital. Briefly on the national scene, the American Osteopathic Association has announced that they are currently involved in negotiations that would place all postgraduate residency training programs under ACGME control. As you can imagine, this is a very controversial move and we will continue to follow the negotiations. If you have not yet been advised by your specialty board about Osteopathic Continuous Certification (OCC), please take the time to research this as the requirements do vary from board to board. Whether or not we like or agree, OCC is upon us and will affect your ability to maintain your specialty certification. Stay informed and do not let this sneak up on you. I would like to close by thanking our national leadership, AOA President Dr. Ray and Peggy Stowers, AOA President-Elect Dr. Norman and Marsha Vinn for being here this evening. Thank you to Dr. Layne Subera for his leadership over the last year and to this board for their hard work. I would like to welcome our newest board members Dr. Melissa Gastorf and Dr.Timothy Moser. I look forward to working with you in the years to come. Also, I would like to give a special thanks to Dr. Young for agreeing to emcee the banquet tonight. He has been an asset to this association and my mentor and friend for the last 10 years. I certainly will miss his presence. I would be remiss if I didn’t recognize and thank Dr. Terry Nickels for his advice and mentorship over the years. He continues to work very hard and is making great strides in his recovery. I would like to recognize my brother RJ Langerman, DO, his wife, Melissa, and kids Ryan and Rylee. Ryan, I thank you for delivering the invocation this evening. Your kind and caring heart touches my soul. You make me very proud to be your uncle. Also here tonight are my brother and sister-in-law Kyle Hrdlicka, DO, and Charlotte, with their kids Nicholas, Paige and Brooke.

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I have some other special guests this evening who have been a support to my family over the years. Please welcome Rick and Carol Blaske, Cary and Karen Barger, and Joe and Christy Windle. You know, when you make a commitment to serve on this board it’s a 10 plus year process, and it’s not something that you can do alone. It takes a lot of family support and understanding. To my girls Callie and Kynlie, you were born during my tenure on this board and have not known a time when the OOA was not part of our lives. Thinking back, I can recall maybe two vacations that we took as a family that were not related to OOA business or CME. I thank you for your patience and your willingness to share me with the OOA and this profession. Your daddy loves you. And of course, I saved the best for last. To my beautiful wife and soul mate DeLaine. You have been putting up with me, this profession and this association for over 15 years now. All three of those things can be a challenge though I would like to think that I’m the lesser in that group. I thank you and love you for your continued support, friendship and love. You are going to make one great first lady, or since this is a country evening, one great first cowgirl. Again, thank you for your trust and this honor to serve. Please stay and enjoy IJ and the band. And as those before me have said, “Lets pray for a quiet year!” okDO Oklahoma D.O. | May / June 2013

2013-2014 OOA Board of Trustees & Special Guest Back row (L-R): LeRoy E. Young, DO; Kenneth E. Calabrese, DO, FACOI, trustee; C. Michael Ogle, DO, newly elected OOA Vice President; Gabriel M. Pitman, DO, trustee; Christopher A. Shearer, DO, trustee; Dale Derby, DO, trustee; Timothy J. Moser, DO, newly elected trustee. Front row (L-R): Kayse M. Shrum, DO, FACOP, trustee, dean of OSU-COM; Bret S. Langerman, DO, newly elected OOA President; Jeffrey S. Grove, DO, FACOFP, President of the American College of Osteopathic Family Physicians (ACOFP); Ray E. Stowers, DO, FACOFP, President of the American Osteopathic Association (AOA); Norman E. Vinn, DO, FACOFP, President-Elect of the AOA; Layne E. Subera, DO, FACOFP; Michael K. Cooper, DO, FACOFP, newly elected OOA President-Elect.

Oklahoma Osteopathic Association Inducts Bret S. Langerman, DO, as 2013-2014 President The Oklahoma Osteopathic Association (OOA) inducted Bret S. Langerman, DO, board-certified emergency medicine

Dr. Langerman is a graduate of Oklahoma State University College of Osteopathic Medicine. He completed postgraduate training at Southwest Medical Center, Oklahoma City, and currently practices in Oklahoma City.

Oklahoma D.O. | May / June 2013

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Attendees highlighting the 113th Annual Convention were Ray E. Stowers, DO, FACOFP, President of the American Osteopathic Association (AOA); Norman E. Vinn, DO, FACOFP, President-Elect of the AOA; Jeffrey S. Grove, DO, FACOFP, President of the American College of Osteopathic Family Physicians (ACOFP), and Nancy Granowicz, President of the Advocates to the American Osteopathic Association.

Oklahoma D.O.

and family practice physician from Oklahoma City, OK, as the 2013-2014 president during the OOA’s 113th Annual Convention. This year’s convention, with the theme “Spurring Down the Specialty Track: Individualizing a Program for Your Specialty Needs,” was held April 18-21, 2013, at the Embassy Suites Norman Hotel & Conference Center, Norman, OK. The induction ceremonies were Saturday evening, April 20, during the “Silver Buckle Banquet.” Master of ceremonies for the evening was LeRoy E. Young, DO, FAOCOPM, board certified occupational and preventive medicine physician from Oklahoma City.

113th Annual Convention

special presentations & awards

Thomas H. Conklin, JR., DO “

2013 OOA Doctor of the Year The Oklahoma Osteopathic Association (OOA) presented Thomas H. Conklin Jr., DO, from Stigler, Okla., with the “2013 OOA Doctor of the Year.” This award is given to the osteopathic physician who has shown exemplary leadership qualities in the profession, demonstrates high moral characteristics, and is highly respected among their colleagues and peers.

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Dr. Conklin graduated from Northeastern State College with a degree in biology. He graduated from Kirksville College of Osteopathic Medicine and married his wife, Flo, shortly after graduation. The couple moved to Columbus, Ohio where he completed a rotating internship at Doctor’s Hospital. Upon completion of an internship, he returned home to practice with his father and continued in that practice, becoming board certified in Family Practice. He is a former Chief of Staff of the Haskell County Hospital and continues to serve as medical director for the Haskell County Health Department, the Haskell County Nursing Center and the Quinton Nursing Home. He has served several terms as a trustee, as well as, President of the Oklahoma Educational Foundation for Osteopathic Medicine (OEFOM) over the past 25 years. He serves on the continuing education and the nominating committees for the OOA and on the OSU College Advisory Council. He functioned for many years as the president of the Eastern District of the OOA and is a past president of the Kirksville College of Osteopathic Medicine Alumni Board. He has served the people of Haskell County for the past 43 years, still making house calls when needed. For relaxation, Dr. Conklin enjoys overseeing his cattle operation, racing thoroughbred horses and reading books on US history. He is an active member of the Stigler United Methodist Church, where he has taught Sunday School, serves as head usher and chair of the Capital Funds committee. Married to his wife, Flo, for 43 years, they have been blessed with three incredible children, Kelly who is a third-generation graduate from KCOM and is currently a hospitalist in Columbus, Ohio; son Thomas H. III (Trey) who practices law in Stigler, Okla.; and daughter Tara who is a tax attorney living in New Orleans, La. He has a daughter-in-law named Jill and a son-in-law named Ken, and a special granddaughter, Olivia.

Oklahoma D.O. | May / June 2013

WILLIAM J. PETTIT, DO “

2013 OUTSTANDING & DISTINGUISHED SERVICE AWARD

The Oklahoma Osteopathic Association (OOA) presented William J. Pettit, DO, Tulsa, Okla., with the “Outstanding & Distinguished Service Award.” This award is given to an osteopathic physician who is an outstanding asset to patients, physicians, hospitals, medical students, and professional organizations. The award was given Saturday evening, April 20, during the “Silver Buckle Banquet.” Dr. Pettit was recognized for his outstanding leadership and guidance within the profession and for his dedication to promoting the education of students in osteopathic medicine.

Oklahoma D.O. | May / June 2013

And then there are his girls, Miss Marnie, Allison and Emilly. They are the loves of his life. He is fiercely protective of them and proud of the women they are. After being surrounded at home by females for 20+ years, he was delighted to get two sons-in-law, Ainslie and Jeff, and three grandsons, Ainslie III, Owen and William. In fact, Owen William and William Smith are both named after him. His fourth grandchild, Henley, a sweet baby girl, arrived last year. His grandkids call him “Pa” and love nothing more than playing with his tools, riding on the boat and playing catch.

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This young family was relocated to Lawton/Ft. Sill, Oklahoma, where he worked as a Staff Physician at the Reynolds Army Community Hospital and also at the Comanche County Health Department Family Planning Clinic. He was honorably discharged as a Major from the Army.

His influence and work on behalf of the OOA and the office of rural health was demonstrated during his presidential term with the OOA by initiating and executing visits to 52 towns across Oklahoma. He wanted to visit face to face with members and hospital administrators to find ways the OOA and College could support the rural areas.

Oklahoma D.O.

Dr. Pettit was born in northern Iowa and was the youngest of five children and was the first child delivered in a hospital. He attended Whittemore High School, and it was his junior year of high school when his life would change forever and he would meet the love of his life. He continued his education at Luther College where he received a Bachelor of Arts in Psychology. After that, he studied Special Education at the University of Northern Colorado and received a Master of Arts. For the next five years, he worked as a vocational rehabilitation counselor. It was during that period his mentor, Burt Routman, encouraged him to pursue a career in medicine. He and his high school sweetheart got married and shortly thereafter, he was inducted into the United States Army as a captain and started medical school at Des Moines University College of Osteopathy. He began his medical career with the United States Army as a resident at the Womack Army Hospital in Fort Bragg, North Carolina. It was also in Ft. Bragg, where he received, what he would say, is one of the greatest gifts of his life-his twin girls.

For the next 19 years he served as Medical Director for the AM+PM Clinic and as the Medical Director for the Center of Occupational Health. He has been a member of the OOA since 1983. He is truly a man that believes in serving others. He continues to be actively involved in his professional and academic organizations. He was appointed by former Governor Brad Henry, to the professional subcommittee on responsibility tribunal; a committee for Oklahoma comprehensive cancer network; and he is stakeholder for the health insurance exchange. Dr. Pettit lives his life with great passion believing it is important to continue learning and be involved in the community while helping others. He is also passionate about rural health and the quality of education at Oklahoma State University Center for Health Sciences. Since his career began at OSU-CHS in 2002, he has worked hard to make a difference knowing medical students at OSU-CHS are the future of osteopathic medicine.

Convention Award Recipients

During the ONE Leadership Luncheon on Friday, April 19 and the Alumni Luncheon on Saturday, April 20 the “Awards of Appreciation” were presented on behalf of the Association.

Janice Bratzler Tulsa, OK

Gary L. Patzkowsky, DO Enid, OK

Mary Shaw Tulsa, OK

James I. Graham, DO Fairfax, OK

You are being recognized for your leadership and organizational guidance to the osteopathic physicians in the Tulsa Osteopathic Medical Society. Healthy districts are key to strong state associations. We applaud your dedication.

You are being recognized for your dedication to educating the future leaders within the realm of osteopathic medicine; and setting an exemplary example for students and residents you teach and mentor. Your service is greatly appreciated.

You are being honored for your years of volunteer service to the Oklahoma Educational Foundation for Osteopathic Medicine (OEFOM); and for your positive impact and fundraising talents benefiting organizations within the osteopathic profession.

For your dedication and commitment to serving the rural population of Oklahoma; and for your exceptional service and attention to patient care. We are privileged to call you a colleague and friend.

Rookie Physicians

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The OOA presented three physicians with the “Rookie of the Year” designation during the Saturday Alumni Luncheon. Physicians in their first two years of practice qualify for the “Rookie Physician of the Year Award.”

Scott T. Shepherd, DO Tulsa, OK Internal Medicine

Zachary A. Fowler, DO Mannford, OK Family Practice

Nicole M. Willis, DO Vinita, OK Pediatrics

Oklahoma D.O. | May / June 2013

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Oklahoma D.O.

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Convention Award Recipients

2013 Life Members

Congratulations to the following physicians who received their life membership to the OOA

In picture (l-r) David S. Krug, DO; Thomas H. Conklin, Jr., DO; A. John Geiger, DO.

Thomas H. Conklin, Jr., DO Herbert R. Littleton, DO Jerry D. Patton, DO David L. Bradshaw, DO John D. DeWitt, DO A. John Geiger, DO Edward A. Huber, DO David S. Krug, DO

scholarship OEFOMrecipients

Congratulations to the following students who received the OEFOM scholarships. $16,000 in scholarship monies were awarded Matthew L. Sullivan, OMS III-$4,000 Larry L. Johnston, OMS II-$3,000 Balli B. Barnes, OMS II-$3,000 Jennifer L. Duroy, OMS III-$2,000 Stephanie E. Letney, OMS II-$2,000 Brock D. Wilson, OMS III-$2,000 In picture (l-r) Larry L. Johnston; Balli B. Barnes; Stephanie E. Letney; Jennifer L. Duroy; Mary Shaw; Brock D. Wilson.

2013 ROGME

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This is the 5th year for the Research in Osteopathic Graduate Medical Education (ROGME) Poster Symposium, sponsored by the OOA as a project of the Bureau on Postgraduate Education. 1st place winner: Jarrod Mueggenborg, DO-$1,500 4th year emergency medicine resident at Integris SW Medical Center

“Clinical Cues of Mortality in Early Sepsis”

1st place winner: Kelly Koenig, DO-$1,500 3rd year emergency medicine resident at Integris SW Medical Center

“Patient Satisfaction Scores and Physician Prescribing Practices”

In picture (l-r) Jarrod Mueggenborg, DO; Kelly Koenig, DO; Brandon Wilson, DO; and Sean D. Boone, DO.

2nd Place winner: Brandon Wilson, DO-$1,000 4th year OB/GYN surgery resident at OSU Medical Center “Posterior Reversible Encephalopathy Syndrome (PRES) in Pregnancy: A Difficult Diagnosis” Oklahoma D.O. | May / June 2013

OEFOM Update 2013 A.T. Still Award Recipient You are being recognized for exemplifying and preserving the philosophy and teachings of A.T. Still, DO; and for your dedication to the students at the OSU Center for Health Sciences College of Osteopathic Medicine; and for furthering the skills of Osteopathic Manipulative Medicine (OMM) and continuing a fair appreciation of his work and beliefs.

Robin R. Dyer, DO

The OEFOM would like to congratulate Dr. Dyer for receiving this coveted award.

The Oklahoma Educational Foundation for Osteopathic Medicine (OEFOM) would like to present this article of thanks to Robin R. Dyer, DO, the newest President of the Foundation for 2013-2014. She is certified by the American Osteopathic Board of Family Physicians and American Osteopathic Board of Neuromusculoskeletal Medicine. Dr. Dyer is a professor and the Chair of the Department of Osteopathic Manipulative Medicine (OMM) at the Oklahoma State University College of Osteopathic Medicine (OSU-COM). She is also the coordinator of Osteopathic Manipulative Medicine I and II for OSU-COM. Dr. Dyer provides a wealth of knowledge on OMM treatment and practices and has spoken on the subject at many OOA and OSU-COM seminars and CME events. Before she began her career as an osteopathic physician, Dr. Dyer studied music and received her Bachelor of Music Education degree from Southeast Missouri State University in Cape Girardeau, MO, and her Masters of Music Education Degree from the University of Oklahoma in Norman, OK.

Oklahoma D.O. | May / June 2013

n OEFOM Memorials n Contributing

In Memory of

Dr. Thomas and Flo Conklin

Marvin A. Martin

Oklahoma Osteopathic Association

John A. Voorhees, DO

Dr. Thomas and Glenda Carlile

John A. Voorhees, DO

Drs. Barney and Mary Blue

John A. Voorhees, DO

Dr. Harvey and Barbara Drapkin

John A. Voorhees, DO

Dr. Terry and Connie Nickels

John A. Voorhees, DO

Oklahoma Osteopathic Association

Carla D. Waller, DO

Oklahoma Osteopathic Association

William S. Agent, DO

Dr. Ralph and Margaret Coffman

William S. Agent, DO

Dr. Harvey and Mrs. Barbara Drapkin Thelma Marie Simpson Dorothea Rosdahl

Hallie Baker

Dr. William and Marnie Pettit

Doris Benjamin

Dr. Dennis and Sheri Carter

Betty Gillson

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During her service to the osteopathic profession, Dr. Dyer has served on many boards and committees including the Osteopathic Founders Foundation and the OSU Regent’s Teaching Award Committee, which she is currently serving as the chair and she is a past president of the Tulsa Osteopathic Medical Society and the OSU-COM Alumni Association. Dr. Dyer has also volunteered her time yearly as a student mentor for the Oklahoma Osteopathic Association since 2004.

The OEFOM is grateful for Dr. Dyer’s years of tireless service to her profession. We hope that the year as President is filled with many blessings and positive experiences.

Oklahoma D.O.

Dr. Dyer returned to school to study chemistry and then attended OSU-COM and graduated as a Doctor of Osteopathic Medicine in 1992. Following graduation, she completed an internship at the Tulsa Regional Medical Center and then became the Medical Director at the Tulsa County Social Services office. Dr. Dyer has been a professor at OSU-COM since 1994.

Dr. Dyer has received numerous awards over the years, the most recent of which was received at the 2013 OOA Annual Convention. Dr. Dyer was the recipient of the “A. T. Still Award” which is presented to the osteopathic physician who most exemplifies and helps to preserve the teachings and philosophy of osteopathic medicine. She has been recognized twice as the Clinical Professor of the Year from OSU-COM, as well as, an Outstanding Clinical Faculty Member, and is a recipient of the Regent’s Distinguished Teaching Award for Clinical Sciences.

in memorium William S. Agent, DO February 2, 1940 April 2, 2013

Dr. Bill Agent of Cookson, Oklahoma, passed away April 2, 2013 in Tulsa, Oklahoma. He was born February 2, 1940, in Ft. Smith, Arkansas, the son of William Seth Agent, Sr., and Sally Gallohan Bahr Agent. He married Jacquelyn Daugherty on July 1, 1978, in Tulsa. Dr. Agent was a graduate of Sallisaw High School and participated in high school athletics where he was the Captain of the Football Team and voted Best All Around in his senior class. He was a graduate of Kansas City University of Medicine and Biosciences College of Osteopathic Medicine in 1966. He served his internship at Tulsa Regional Medical Center and was chairman of his intern class. He did his general surgery residency at Tulsa Regional Medical.

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Dr. Agent was trained in general abdominal, gynecological and C-section, urological, minor and major orthopedic, skin and integumentary, and endoscopic and laproscopic procedures. He was the past president of the Sallisaw Lions Club, past board member of the Sallisaw Chamber of Commerce, past Rotary Club member and Randolph County Chamber of Commerce in Pocahontas, Arkansas. Dr. Agent recently retired from Stilwell General Hospital and was a lifetime fellow of American College of Osteopathic Surgeons.

Carla D. Waller, DO August 4, 1972April 4, 2013

Dr. Carla Deanne Waller-Schauberger, 40, of Bartlesville, went to be with the Lord April 4, 2013, at the Jane Phillips Medical Center following a sudden illness. Dr. Waller was born on Aug. 4, 1972, in Winfield, Kansas, to Carl Dean and Patricia Margaret (Andrews) Waller. She received her education in Cedar Vale where she graduated from high school in 1990. She attended college for her undergraduate work at Southwestern College in Winfield where she graduated in 1994 with a major in biology and a minor in music. She then attended the Kansas City University of Medicine and Bioscieinces College of Osteopathic Medicine and received her Doctorate in Osteopathic Medicine in 1998. She did her residency in the University of Oklahoma Rural Medicine program at the Caney Valley Clinic in Ramona. Following her residency, she worked for the Mayo Clinic at Waukon, Iowa, for five years. She returned to Ramona where she was the assistant director of the Caney Valley Medical Clinic. She worked as a hospitalist with the Jane Phillips Medical Center in Bartlesville and then as a family medicine doctor with the Gemini Medical Clinic/Jane Phillips Medical Center. She loved to travel and explore new places, and she loved being a mom. She was also a mentor through the Big Brothers Big Sisters program to two children, Alex, in Waukon, and Angie, in Bartlesville. Her patients were her life, and she provided the best medical care possible for them. She will be missed by all who knew her. Her home church was the Grenola Christian Church, and she was a member of the First Wesleyan Church in Bartlesville.

John A. Voorhees, DO December 28, 1928 April 12, 2013

Dr. John Voorhees was born Dec. 28, 1928, in Mound City, Missouri to John & Eunice (Price) Voorhees. He suffered with polio as a teenager but overcame this illness and graduated from Lafayette High School in 1946. After his pre-med studies at St Joseph Jr. College and being placed in the accelerated program, he graduated from Des Moines University College of Osteopathic Medicine in 1951. Following internship, he married Marjorie Schoenfelder in 1953. Dr. Voorhees began his practice in Lamont, Oklahoma. In 1956, he began his practice in Oklahoma City, retiring in 1993. For over 20 years, he served as director of medical education at Hillcrest Health Center, where he supervised the training of medical students, interns and residents. Dr. Voorhees was certified by the American Board of Quality Assurance & Utilization. Throughout his career, he served as consultant to Medicare, HFAP and the Oklahoma Foundation For Medical Quality, where he served as interim medical director. For almost 38 years, Dr. Voorhees was a director of Friendly National Bank, later Bank One; at the time of his death, he was a Community Director for BancFirst Oklahoma City. After retiring from private practice, he went back to school and became a paralegal. He was currently working for O.F.M.Q. & APS Healthcare. Dr. Voorhees was a lifetime member of the AOA, OOA, and a Fellow of the Academy of Directors & Medical Educators and belonged to St. James Catholic Church, where he served as eucharist minister, served in the Stephen Ministry and Knights of Columbus. He truly enjoyed the fellowship of others, his physician friends, family and close friends, tennis pals, SOKCCC friends, church friends and BancFirst associates. Oklahoma D.O. | May / June 2013

Convention Exhibitors

The 113TH OOA Annual Convention Exhibitor Hall

The OOA sends many thanks to all of the exhibitors for their time, energy, support, and dedication to the success of the OOA Convention Hall. We ask all Oklahoma physicians to take another look at the many companies listed below and please utilize their services to show your appreciation!

113TH Convention Exhibitors

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Oklahoma D.O. | May / June 2013

OCOM Imaging OFMQ Oklahoma Academy of Physician Assistants Oklahoma Beef Council Oklahoma CyberKnife Oklahoma Health Care Authority OMT OOC Locum Tenens & Permanent Placement OSU College of Osteopathic Medicine-Alumni Association OSU Medical Center PDRX Pharmaceuticals Pfizer Physician Manpower Training Commission PLICO ProAssurance / American Physicians Insurance Procure Proton Therapy Center Regional Medical Laboratory Revert Rich & Cartmill Inc. Roger Hicks and Associates Group Insurance, Inc. SAA/IRAA Sooner Relief Sunovion Pharmaceuticals TEVA Pharmaceuticals The Apothecary Shoppe Travel Leaders - Bentley Hedges Travel US Morningstar, LLC Xymogen

Oklahoma D.O.

A+ Computer Solutions Advanced Ultrasound Electronics, LLC Advocates to the OOA All Star X-Ray, Inc. American Express Open Amgen Astra Zeneca AXIS Practice Solutions - Management Blue Cross Blue Shield of Oklahoma Boston Heart Diagnostics Cancer Treatment Centers of America Chickasaw Nation Division Of Health Choctaw Nation Health Services Authority Clinical Pathology Laboratory Community Health Systems Concord Medical Group Cook Children's Health Care System Diagnostic Laboratory of Oklahoma Eli Lilly-Neuroscience e-MDs Grifols Health Diagnostic Laboratory, Inc. HealthChoice Ideal Protein Innovative Healthcare Systems Insurica Integris Health Physician Recruitment Janssen Pharmaceuticals JD McCarty Center John Hancock Insurance Liberty Mutual Insurance Lilly Diabetes MC - Imaging Merck Mercy Physician Recruitment Midwest Medical Books MyHealth Access Network Mylan Specialty LP (Dey Pharma, LP) NE Tribal Health System Northwestern Mutual Novartis Vaccines & Diagnostics Novitas Solutions Novo Nordisk

OOA Golf Classic Wednesday, April 17, 2013

The Oklahoma Osteopathic Association (OOA) hosted the Annual Golf Classic at Willow Creek Country Club in Oklahoma City, Okla. Although the day was a bit cold & windy, the dedicated golfers and supporters of the OOA enjoyed a great day of golf and healthy competition.

special thanks to our

event partners

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Rich and Cartmill/MedPro for being this yearâ&#x20AC;&#x2122;s t-shirt sponsor and to Cosmetic Surgery Center for sponsoring the luncheon.

Oklahoma D.O. | May / June 2013

thanks to

our sponsoring partners

PLICO OSU-COM Alumni Association Dr. Richard and Beverly Schafer Norman Embassy Suites-Hotel & Conference Center Dr. Dennis and Sheri Carter Osteopathic Founders Foundation Family Medical Care Clinic-Rebecca Biorato, DO Cory's AV Regional Medical Laboratory Dr. Bobby and Walli Daniel Drs. Duane and Tammie Koehler

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Oklahoma D.O. | May / June 2013

113th Convention Photo Gallery

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Thursday, April 18, 2013 The first official day of convention began with opening session speakers, J.D. Polk, DO, MS, MMM, CPE, FACOEP (certified emergency medicine, Haymarket, Virginia) who is the Principal Deputy Assistant Secretary for Health Affairs and Deputy Chief Medical Officer of the Department of Homeland Security (DHS). The day featured: a variety of educational lectures, AOOA Silent Auction, OMT Treatment Clinic, ROGME Poster Symposium, OOA Annual Business Meeting, ACOFP Annual Business Meeting, an AOOA Annual Business Meeting and Educational Program, the i-Pad mini give-a-way and the $100 exhibitor drawing.

Oklahoma D.O. | May / June 2013

Friday, April 19, 2013

Minds were challenged, leaders were acknowledged, endurance was tested and luck was played

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Saturday, April 20, 2013

Oklahoma D.O. | May / June 2013

Saturday Alumni Luncheon During the Saturday Alumni Luncheon, OSU Board Regent, Andy Lester, JD, made the following remarks “Thank you, Dr. Young, for that kind introduction. I’m pleased to be with you today and to bring greetings from the Board of Regents for the Oklahoma Agricultural & Mechanical Colleges. Our Board and University are proud to have the College of Osteopathic Medicine as a part of our research institution. With its mission of producing primary care doctors for rural and underserved Oklahoma, it is a perfect complement to Oklahoma State University’s land grant mission. You know, I come here with some trepidation, and that’s because I am a lawyer coming into a room filled with a class of people who are not known for their love of lawyers. And in that regard, I do recognize that there is an entire category of quips called “lawyer jokes” (I also realize there is no similar category called “physician jokes”). But I’m not going to tell one, because there is an old adage among attorneys that lawyers shouldn’t tell lawyer jokes. Lawyers don’t find them funny, and non-lawyers don’t know they are jokes. As someone who majored in history and is a lifelong student of history, it seems appropriate to me that we briefly review how we have arrived where we are today.

Since its creation, the College of Osteopathic Medicine has produced more than 2,600 doctors. Imagine where our state would be today without those doctors.

Since joining the OSU system, and with the support of the OOA, the College of Osteopathic Medicine has thrived and expanded. In 2001, the Oklahoma Legislature created OSU Center for Health Sciences, setting the medical school in an academic health center. The Oklahoma Legislature created the Center for Rural Health at CHS to promote rural health care through education, research, telemedicine and health policy. And, speaking of telemedicine, OSU is a leader in telemedicine technology. When voters approved a legislative referendum in 2004 to increase cigarette and tobacco taxes, a portion of those revenues was dedicated to the College. OSU used the funds to develop telemedicine resources statewide and to expand clinical care, patient visits, research, training opportunities and practice plan income. As a result, the University experienced growth in overall size, quality, faculty, medical school class size and financial health at every level. We have steadily increased our enrollment by 30 percent since 2009, and that has expanded the number of students in the pipeline of physicians. This fall, we celebrated our largest first-year class ever with 115 students. Our total osteopathic medicine enrollment this year is 385, and 91 percent of those students come from Oklahoma. We recognize the effect a physician has on a rural community, not only in terms of health care, but also the economic impact. According to the National Center for Rural Health Works, one primary care physician in a rural community creates about 23 jobs annually, generates $1 million in wages, salaries and benefits, and produces $1.8 million in revenue each year. In the last few years, we have implemented a number of efforts to recruit talented high school students from rural areas of the state article continues on page 22...

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The University has racked up accolades for its success in providing doctors for rural and underserved areas. It has been among

the top-ranked medical schools by U.S. News and World Report for the primary care, rural and family medicine programs.

Oklahoma D.O.

The Legislature was very concerned that there were not enough primary care doctors and not enough in practice in rural areas, and some areas in the cities. They saw a physician manpower problem and, after years of study, created the Oklahoma College of Osteopathic Medicine in 1972, with the specific aim of focusing on primary care and rural and underserved areas. No hospital funding was needed at the time. In related actions, the Legislature also created the Physician Manpower Training Commission (PMTC) to encourage education, training, residency and doctor placement in rural areas, and established a clinical branch campus of OU in Tulsa, to focus on primary care residencies. We all know that a variety of rankings of physician manpower in the U.S. show that we have a shortage of doctors in the country today, and forecasts for an alarming shortage in the future. By every ranking — primary care, doctors per capita, or other measures – Oklahoma is near the bottom.

“Together we can seize this opportunity and continue to fulfill our purpose in medicine—to improve the public health of Oklahoma and to treat the sick—no matter where in Oklahoma they may reside.”

to careers in medicine. We have actively partnered with FFA chapters across the state to locate students who are interested in becoming physicians. Dean Kayse Shrum and our medical students have traveled the state visiting these rural communities and spreading the word about careers in osteopathic medicine. In June, we will be launching Operation Orange, a series of summer camps for high school students to give them an opportunity to experience a day in the life of an OSU medical student. These camps will be hosted at regional universities in Ada, Lawton, Tahlequah, and my former hometown, Enid. We have also visited with students through 4-H, maintained a presence at the Oklahoma Youth Expo, and worked with the Oklahoma Farm Bureau and other rural organizations to identify and recruit these outstanding future doctors. Starting last fall, we implemented a rural health track into the medical curriculum for students interested in serving as primary care physicians in rural Oklahoma. The track takes third and fourth-year students to rural areas of the state to complete rotations and has established internships and externships in rural hospitals and clinics across the state. We have also begun implementing a Rural and Underserved Primary Care Early Admissions Program so that undergraduates can cut a year out of their training.

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In the last legislative session, our Oklahoma Legislature and Governor Mary Fallin provided $3 million for the Oklahoma Hospital Residency Training Program Act, to establish new residency programs in rural Oklahoma hospitals and clinics. The University, in partnership with the Oklahoma Health Care Authority and the Osteopathic Medical Education Consortium of Oklahoma, has established the first residency programs in internal medicine and family practice at the McAlester Regional Health Center. OSU-CHS has established residency programs in Tulsa, Oklahoma City, Durant, Enid, Muskogee, Tahlequah and Talihina, as well as in Joplin, Missouri, and Pine Bluff, Arkansas. OSU Medical Center serves as our primary teaching hospital, offering 11 residency programs and eight fellowship programs, and training more than 150 osteopathic physicians each year. There are also 185 third and fourth-year medical students learning and working at OSU Medical Center, making it the largest osteopathic teaching hospital in the nation. The medical center handles 45,000 emergency room visits, 7,000 inpatient visits and 23,000 outpatient visits annually, more than double the patient volume in 2009.

The OSU Medical Center trust has contracted with a nationally recognized hospital consulting firm, Alvarez and Marsal, to conduct an exhaustive study of the condition of the hospital. They have concluded that OSU Medical Center must have a public subsidy, just like every other public teaching hospital in the nation. Many of you are aware that the leadership of the University, the medical school and your association are, once again, in the process of seeking the necessary state support to assure that our teaching hospital is the kind of experience our medical students, our residents and our state deserve. We are asking the Legislature and Governor Fallin to appropriate $18.25 million in recurring annual appropriations to subsidize the cost of teaching. Every public teaching hospital in this country requires a subsidy from some source—city, county or state—to go along federal matching funds to allow us to teach and train while treating patients. We want a private partner to manage the hospital and augment our resources. A public-private partnership will bring additional resources, service lines for teaching and patient care, financial stability and an overall improvement in the learning experience for our medical students and training experience for the residencies located there. This is absolutely necessary for the survival of the teaching hospital and medical school. From the State Capitol, one only has to look down the street to see the success that a public-private partnership has afforded to the OU College of Medicine. It is a good model, and five years ago, the Legislature created the OSU Medical Authority, patterned after the University Hospital Authority. You are our partners and the Board of Regents believes we have a marriage that has worked extremely well. We know that you will help us and you would like more information. As that information becomes available, be assured that President Hargis, President Barnett and Dean Shrum will work with your leadership to keep you apprised. We cannot succeed without you. Together we can seize this opportunity and continue to fulfill our purpose in medicine—to improve the public health of Oklahoma and to treat the sick—no matter where in Oklahoma they may reside. It has been a great honor to share this day with you and to celebrate the achievements of the osteopathic profession and this organization. Thank you and Go Pokes!”

okDO

As many of you probably remember, there was a huge effort in 2008 to prevent OSU Medical Center, then known as Tulsa Regional Medical Center, from closing. Many city and state leaders came together to create a plan to address the medical center’s needs, and the Legislature and Governor Brad Henry approved funds to keep the historic teaching hospital site open, committing to five years of funding. In addition, authority over the medical center was transferred from corporate ownership to a Tulsa public trust. Well, if you do the math, you know this is the final year of that agreement.

Oklahoma D.O. | May / June 2013

inaugural address

Provided by Vicki Stevens, 2013-2014 AOOA President

What an honor to accept the gavel and the leadership position of President of the Advocates of the Oklahoma Osteopathic Association. And what a way to start the year – such a great convention. The AOOA is so very appreciative of the support it has received from the Oklahoma Osteopathic Association, both the central office (special thanks to you Lynette and Lany) as well as the OOA leadership (special thanks to you Dr. Subera and Dr. Langerman and the OOA Board of Trustees). I believe the AOOA has made great strides under the magnificent performance of the 2012 – 2013 President Walli Daniel. I believe I inherit a Board that has shown itself to be dedicated and capable of hard work, and I look forward to our confronting the challenges that still remain. I have been asked what my theme for this year will be, and how, I believe, this ADVOCACY organization should proceed. At the recent Oklahoma State University Student Advocate Association Board Officer's Installation, I presented each of the SAA Board Members with a picture frame and asked that they visualize the pictures that would occupy those frames as they continued their journey in advocacy for the osteopathic profession. Another technique to visualize inside each of us is a MRI and it is these letters that represent my goals for the AOOA this year. M - Maintain the forward momentum this organization has experienced this year, under the leadership of Walli Daniel, with a concentration on increasing membership (a vital fiscal and physical need especially with the change in how AOOA dues are collected).

In closing, I am excited, humbled and truly honored to be the 2013-2014 President of the Advocates for the Oklahoma Osteopathic Association. I ask for your prayers, support and ideas. I see an even brighter future ahead.

2013-2014 AOOA Board of Trustees Vicki Stevens President Donna Cannon President-elect Bavette Miller Vice-President Walli Daniel Past President Maghin Abernathy Recording Secretary Andy Ting Treasurer Apryl Pritchett Corresponding Secretary

Orpha Harnish Parliamentarian

Ryan Miller Public Relations and Manvocate Program

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Oklahoma D.O. | May / June 2013

What I pledge to our AOOA membership and to the Oklahoma Osteopathic Association is Principled Leadership. All opinions are encouraged and will be given respect. I will lead focusing on issues and processes, not personalities. I do not believe in the “ABC” solution to issues (Assess fault, Blame, then Criticize). I will seek solutions through structured processes that are focused on a vision of a vibrant organization where every member is respected for the unique contributions they each are capable of and bring to this organization.

Oklahoma D.O.

R - Relationships. I believe relationships, built on respect, honesty, and guided by a united purpose, are the keys to an organization's success. I mean ALL relationships: relationships between individuals (both within and outside the AOOA); between the individuals and their state districts; between the state districts and the state organization; between the state organization and the national organization; and between the advocacy organization and the organization it advocates for (AOOA-OOA). Osteopathic medicine, to me, is about relationships. It is a family. In order to strengthen membership, our members have the right to expect something in return for their dues. I believe one of the greatest things we have to offer is relationships to others (spouse/family member/supporter) who understand the many challenges and opportunities that being an advocate for an osteopathic physician presents.

I - Information. With the current state of technology, there is no reason for AOOA members to not be fully informed of the activities, issues and direction of the AOOA. We have made some achievements in this area with the opening of our Facebook page and a hard copy Newsletter. I would like to build on these positive accomplishments by further using technology to bring us closer together and increase our efficiency by using such things as Go To Meetings and other ideas which I am counting on our membership to suggest.

OSU MEDICAL CENTER’S CATH LAB BRINGS IMPROVEMENTS IN PATIENT CARE Provided by: Jamie Calkins, Marketing/Media Coordinator

medical center

Oklahoma State University Medical Center continues to enhance the services of its Cath Lab to effectively treat a variety of cardiovascular conditions. In addition to remodeling two labs, constructing a new stress lab and providing residents and cardiology fellows with work and educational areas in closer proximity to the Cath Lab, an ACIST CVi and a SonoSite Ultrasound were recently acquired. The ACIST CVi is a leading-edge technology that simplifies Cath Lab procedures and is used for controlled infusion of angiographs. The device is used to deliver controlled, precise doses of contrast during cardiac catheterization procedures. This ensures a higher level of patient safety by reducing contrast usage and fluoroscopy time.

Oklahoma D.O. PAGE 24

A much needed SonoSite Ultrasound was also introduced. “Previously physicians would have to palpitate the femoral artery and then obtain access. With the SonoSite technology the physician can visualize the artery, allowing for optimal vascular access. It’s almost like a 6th sense for our cardiologists,” said Manager of Cardiovascular Services, Connie Ryan, MBA, RN-BC. The increased ease and accuracy of access for interventional procedures is significant.

Pictured from left to Right: Matt Wilkett, DO (Cardiologist); Chad Broughton, (CV Specialist Coordinator) & Gary Badzinski, DO (Cardiologist). Among other cardiologists practicing at OSU Medical Center are Robert L. Archer, DO; David L. Brewer, MD; Michael P. Carney, DO; Larry J. Dullye, DO, and Wilbert W. Stoever, DO.

Among other great things happening at OSU Medical Center is the privilege of being a GE Centricity Show Site. “The implementation has occurred in stages with the first ‘Go Live’

ACIST CVi is one of the new additions to OSUMC Cath Lab

date in August 2012. We were one of the first sites to utilize the new product, and the success of the rollout is due to the great sense of teamwork we have here at OSUMC. Our IT department is phenomenal and has given us unrivaled support.” said Ryan. The integrated solutions of Centricity enhance the clinical and financial productivity of OSU Medical Center as well as enhancing productivity for physicians. Michael P. Carney, D.O. stated, “With Centricity Cardio Enterprise I have the same level of access to patient images in my office and at home that I have in front of a workstation in the lab. The speed of image retrieval is great and having access to diagnostic images with measurement tools has improved our efficiency and our response time to patient care needs.” While having updated equipment that ensures better care for patients is a priority it is also important that staff be advanced in the care that they provide. By the end of June the entire staff of Cardiac Cath Lab technologists will be certified RCIS (Registered Cardiovascular Invasive Specialist). Certification provides validation of the knowledge base and skill level of each of the staff members. According to Ryan, “Certification also demonstrates a commitment to excellence in practice and continuing education, both of which are vital to an academic medical center. We are dedicated to having the best and brightest individuals to serve our patients.” The addition of equipment sets forth our mission of providing high quality health services, delivered with compassion for patients and their families. For more information about OSU Medical Center visit: www.osumc.net. okDO Oklahoma D.O. | May / June 2013

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Oklahoma D.O.

Let us examine your insurance and risk management program.

CENTER FOR HEALTH SCIENCES David F. Hitzeman, DO, FACOI, Editor Professor of Medicine Department of Internal Medicine

Analysis of the Side Effect Profile in HIV Patients Converting from Lopinavir/Ritonavir to Darunavir/ Ritonavir

Jeffrey S. Stroup, PharmD, BCPS Associate Professor of Medicine Oklahoma State University Center for Health Sciences 717 S Houston Ave Tulsa, OK, 74127 Phone: 918-382-3534 Fax: 918-382-3559 Email: Jeffrey.Stroup@okstate.edu Lindsey Keeley, PharmD PGY1 Pharmacy Resident Oklahoma State University Medical Center Tulsa, OK Nathan Voise, DO Gastroenterology Fellow Oklahoma State University Medical Center Tulsa, OK

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Johnny Stephens, PharmD, AAHIVE Associate Professor of Medicine Oklahoma State University Center for Health Sciences

Abstract Protease inhibitors (PI) are common components of anti-retroviral therapy because they have a higher barrier to resistance than regimens that contain non-nucleoside reverse transcriptase inhibitors (NNRTI). There are numerous PIs to choose from based on pill burden, side-effect profile and drug interactions. Kaletra® (lopinavir/ritonavir) is the only PI that is co-formulated with ritonavir making it advantageous for patients because it decreases pill burden; however,

Oklahoma State University Center for Health Sciences College of Osteopathic Medicine 1111 West 17th Street Tulsa, Oklahoma 74107-1998

common side effects such as diarrhea and cholesterol abnormalities can limit its use. The POWER 1 and POWER 2 trials showed that darunavir/ritonavir is effective at sustaining viral suppression as well as having a favorable safety profile. The ARTEMIS trial directly compared darunavir/ritonavir to lopinavir/ritonavir which showed darunavir to be superior in virologic response as well as having a smaller side effect profile (diarrhea, triglycerides, cholesterol). Our goal was to evaluate our clinic population to determine if we could replicate the outcomes from the ARTEMIS trial. After reviewing and assessing the data from the charts of eighteen patients that had been transitioned from lopinavir/ ritonavir to darunavir/ritonavir we did not find a statistical difference between glucose and metabolic abnormalities. Gastrointestinal side effects were more difficult to assess due to a lack of documentation. Introduction Protease inhibitors (PI) are common components of anti-retroviral therapy because they have a higher barrier to resistance than regimens that contain non-nucleoside reverse transcriptase inhibitors (NNRTI) (1,2). Initial therapy for antiretroviral-naïve patients with human immunodeficiency virus (HIV) infection typically includes two nucleoside reverse-transcriptase inhibitors (NRTI) and either a NNRTI, a PI, or an integrase inhibitor (1). Therapy selection is dependent upon virologic resistance, pill burden, side-effect profile, comorbidities, drug-drug interactions, drug-disease interactions, and if the patient is a female of child-bearing poten-

tial (3). Commonly, therapy including an NNRTI is initiated along with two NRTIs as first line therapy. The NNRTI typically utilized is efavirenz, which is included in a once daily combination tablet (Atripla®) along with tenofovir and emtricitabine. Patients who do not tolerate or develop virologic resistance to Atripla® are commonly changed to a regimen that includes a PI. In addition, a previous hypothesis was that patients with a high viral load burden should be initiated on a PI as compared to a NNRTI because of increased virologic potency (4). This hypothesis has been refuted by studies demonstrating that NNRTIs provide virologic potency at a similar and in some cases greater level than PIs (5,6). PIs have demonstrated a higher barrier to resistance than NNRTI regimens because they require multiple mutations to confer resistance whereas resistance to NNRTIs can occur after a single mutation (1,4). There are several PIs to choose from based on drug interactions, pill burden, and side-effect profile. Kaletra® (lopinavir/ritonavir) is the only PI that is co-formulated with ritonavir making it advantageous for patients because it decreases pill burden. It can be administered once or twice daily and the common side effects are diarrhea and cholesterol abnormalities (7). Until the end of 2009, lopinavir/ritonavir was the preferred PI based on national treatment guidelines (8). In the last few years, lopinavir/ritonavir has been compared to other PIs since the unfavorable side effects of this agent have often forced clinicians to change the PI of the antiretroviral regimen (9,10). Oklahoma D.O. | May / June 2013

In the POWER 1 and 2 trials, Prezista速 (darunavir), another PI boosted with ritonavir, was shown to be effective at sustaining undetectable viral loads as well as having a favorable safety profile (11). In the ARTEMIS trial, treatmentna誰ve patients were randomized to receive either boosted darunavir or boosted lopinavir (12). After 96 weeks of treatment, darunavir/ritonavir was shown to be superior in virologic response compared to lopinavir/ritonavir (12). During this trial it was also noted that darunavir had a very favorable side effect profile as compared to lopinavir (12). Only 4% of patients taking darunavir had diarrhea as compared to 11% of lopinavir patients (12). Darunavir also had a statistically significant difference in increases in triglycerides and total cholesterol compared to lopinavir (12). The POWER trials and the ARTEMIS trial have observed that darunavir/ ritonavir had a favorable side effect profile as compare to other PIs, specifically studied was lopinavir/ritonavir. The positive effects observed by utilizing darunavir/ritonavir as compared to lopinavir/ritonavir on metabolic parameters has been demonstrated in several recent publications (13,14). With HIV treatment becoming more advanced, the current problems encountered are adverse effects from the HIV therapies and chronic disease complications, such as myocardial infarction, stroke, and diabetes (15-18).

Discussion Prior to analyzing the data, it was hypothesized that patients who were converted from lopinavir/ritonavir to darunavir/ritonavir would experience an improvement in metabolic abnormali-

The clinical implications of HIV therapy effects are important to evaluate because of the effects of HIV itself on CVD. The SMART study identified that inadequately treated viral infection itself increase the risk of CVD (23). In addition, a recent meta-analysis identified that the relative risk of CVD among patients with HIV not on therapy compared to HIV-uninfected individuals was 1.61 (24). Some HIV infected patients have traditional risk factors as identified through the Framingham Risk Score. Yet, a recent study that evaluated arterial inflammation in HIV patients identified that patients with controlled HIV (HIV-RNA <48 copies/mL) and comparable risk scores had higher arterial inflammation, identified by positron emission tomography, compared to a non-HIV control group (25). Therefore, several mechanisms are involved in this inflammation process that leads to CVD. These mechanisms include: HIV replication, T-cell depletion, T-cell activation, T-cell senescence, cytomegalovirus coinfection, microbial translocation, and monocyte activation (25-27). The implication that arterial inflammation occurs in HIV patients despite adequate management complicates the scenario.

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Oklahoma D.O. | May / June 2013

Results A total of thirty-nine charts were reviewed for conversion from lopinavir/ ritonavir to darunavir/ritonavir. Twentyone patients were excluded due to loss of follow-up, lack of laboratory data, or use of other regimens in between converting from lopinavir/ritonavir to darunavir/ritonavir. The average age for the eighteen patients included in the study was 45 years old and 83% (15/18) patients were male. The baseline and follow-up laboratory values are listed in Table 1. Hemoglobin A1C was not recorded for every patient, therefore, it was not included in the statistical analysis. The number of loose stools per day was difficult to assess due to poor documentation by the providers prior to and after conversion to darunavir/ ritonavir.

ties, glucose levels, and gastrointestinal side effects. After assessing the data, we did not find a statistical difference between glucose and metabolic abnormalities. A positive trend on all lipid parameters was identified. This data was limited due to the sample size of 18 patients. In the ARTEMIS trial, over 340 patients in each treatment arm were evaluated (10,12,19). Boosted darunavir has also been evaluated to boosted atazanavir. In that analysis, there was no difference identified between the treatment groups in regards to lipid or glucose parameters (20). A hypothesis for the positive metabolic effects of darunavir as compared to other PIs is the effects on adipocytes (21). A recent study on murine and human adipocytes revealed that darunavir did not affect adipocyte function as compared to lopinavir or atazanavir (22).

Oklahoma D.O.

We proposed a retrospective study, through medical record review, to be performed at the OSU Internal Medicine Specialty Clinic to determine if the conversion from lopinavir to darunavir is in fact accompanied by a significant decrease in side effects that include metabolic abnormalities (lipid abnormalities [low-density lipoprotein, highdensity lipoprotein, total cholesterol, and triglycerides], glucose abnormalities [fasting glucose and hemoglobin A1C]) and gastrointestinal side effects in our clinic population.

Methods A computer generated list of patients seen in the OSU Internal Medicine Specialty Services Clinic was generated for patients receiving darunavir from January 1, 2006 to August 30, 2011. Utilizing this list, the medical records were assessed to identify patients converted from lopinavir/ritonavir to darunavir/ ritonavir. Patients that met the criteria were included in the analysis. The evaluation of included patients identified a baseline visit (when lopinavir/ ritonavir was switched to darunavir) and a follow-up visit (a minimum of 90 days while on darunavir). The retrospective evaluation included a review of home medications (including HIV regimen), current and previous medical illnesses, age, gender, race/ethnicity, HIV viral load, CD4 count, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, blood glucose level, hemoglobin A1C, and side effects (diarrhea, gastrointestinal complaints).

Therefore it is important to avoid additional metabolic complications with the addition of HIV therapy. Conclusion CVD risk in patients with HIV has been identified to be caused by HIV itself and also HIV therapy. PIs are effective therapy options for patients with HIV. They can complicate the metabolic profile of patients. Darunavir has been shown to be effective and also more metabolically friendly as compared to lopinavir. Research needs to continue to identify how to decrease the CVD event okDO rates in patients with HIV.

Table 1. CD4 (cells/µL) Viral Load (copies/mL) Total cholesterol (mg/dL) LDL (mg/dL) HDL (mg/dL) Triglycerides (mg/dL) Blood Glucose (mg/dL)

Baseline 246±233 69,952±101,469 200±41 120±37 46±19 172±69 90±10

Follow-up 234±164 5577±12,568 183±33 109±29 48±12 130±65 94±14

P-value 0.56 0.056 0.49 0.69 0.19 0.49 0.40

n=18

References

Oklahoma D.O. PAGE 28

1.)

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. January 10, 2011; 1-166. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed August 26, 2011.

2.)

Flexner C. HIV-protease inhibitors. N Engl J Med. 1998; 338:1281.

3.)

Thompson MA, Aberg JA, Cahn P, et al. Antiretroviral treatment of adult HIV infection. JAMA. 2010; 304: 321-333.

4.)

McKeage K, Perry CM, Keam SJ. Darunavir: a review of its use in the management of HIV infection in adults. Drugs. 2009; 69: 477-503.

5.)

Riddler SA, Haubrich R, DiRienzo AG, et al. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med. 2008; 358: 2095-2106.

6.)

Hirschel B, Calmy A. Initial treatment for HIV infection-an embarrassment of riches. N Engl J Med. 2008; 358: 2170-2172.

7.)

Croxtall JD, Perry CM. Lopinavir/Ritonavir: A review of its use in the management of HIV-1 infection. Drugs. 2010; 70: 1885-1915.

8.)

9.)

Chaix ML, Sahali S, Pallier C, et al. Switching to darunavir/ritonavir achieves viral suppression in patients with persistent low replication on first-line lopinavir/ritonavir.AIDS. 2008; 22: 2405-2407.

10.)

Ortiz R, Dejesus E, Khanlou H, et al. Efficacy and safety of once-daily darunavir/ritonavir versus lopinavir/ritonavir in treatment-naïve HIV-1 infected patients at week 48. AIDS. 2008; 22: 1389-1397.

11.)

Clotet B, Bellos N, Molina JM, et al. Efficacy and safety of darunavir-ritonavir at week 48 in treatment-experienced patients with HIV-1 infection in POWER 1 and 2: a pooled subgroup analysis of data from two randomized trials. Lancet. 2007; 369: 1169-1178.

12.)

Mills AM, Nelson M, Jayaweera D, et al. Once-daily darunavir/ritonavir vs. lopinavir/ritonavir in treatment-naïve, HIV-1-infected patients: 96-week analysis. AIDS. 2009; 23: 1679-1688.

13.)

Currier JS, Martorell C, Osiyemi O, et al. Effects of darunavir/ritonavir-based therapy on metabolic and anthropometric parameters in women and men over 48 weeks. AIDS Patient Care STDS. 2011; 25: 333-340.

14.)

Tomaka F, Lefebvre E, Sekar V, et al. Effects of ritonavir-boosted darunavir vs. ritonavir-boosted atazanavir on lipid and glucose parameters in HIV-negative, healthy volunteers. HIV Medicine. 2009; 10: 318-327.

15.)

Giannarelli C, Klein RS, Badimon JJ. Cardiovascular implications of HIV-induced dyslipidemia. Atherosclerosis. 2011; 219: 384-389.

16.)

Feeney ER, Mallon PW. HIV and HAART-associated dyslipidemia. Open Cardiovasc Med J. 2011; 5: 49-63.

17.)

Estrada V, Portilla J. Dyslipidemia related to antiretroviral therapy. AIDS Rev. 2011; 13: 49-56.

18.)

Lo J. Dyslipidemia and lipid management in HIV-infected patients. Curr Opin Endocrinol Diabetes and Obes. 2011; 18: 144-147.

19.)

Lascar RM, Benn P. Role of darunavir in the management of HIV infection. HIV AIDS (Auckl). 2009; 1: 31-39.

20.)

Aberg JA, Tebas P, Overton ET, et al. Metabolic effects of darunavir/ritonavir versus atazanavir/ritonavir in treatment-naïve, HIV type-1 infected subjects over 48 weeks. AIDS Res Hum Retroviruses. 2012 Apr 2. [Epub ahead of print].

21.)

Zanni MV, Grinspoon SK. HIV-specific immune dysregulation and atherosclerosis. Curr HIV/AIDS Rep. 2012; 9: 200-205.

22.)

Capel E, Auclair M, Caron-Debarle M, Capeau J. Effects of ritonavir-boosted darunavir, atazanavir, and lopinavir on adipose functions and insulin sensitivity in murine and human adipocytes. Antivir Ther. 2012; 17: 549-556.

23.)

Post WS. Predicting and preventing cardiovascular disease in HIV-infected patients. Top Antivir Med. 2011; 19: 169-173.

24.)

Islam FM, Wu J, Jansson J, Wilson DP. Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis. HIV Med. 2012; 13: 453-368.

25.)

Subramanian S, Tawakol A, Burdo TH, et al. Arterial inflammation in patients with HIV. JAMA. 2012; 308: 379-386.

26.)

Hsue PY, Deeks SG, Hunt PW. Immunologic basis of cardiovascular disease in HIV-infected adults. J Infect Dis. 2012; 205: S375-S382.

27.)

Pandrea I, Cornell E, Wilson C, et al. Coagulation biomarkers predict disease progression in SIV-infected nonhuman primates. Blood. 2012; 120: 1357-1366.

Oklahoma D.O. | May / June 2013

PROFESSIONALS INTO

ACTION

Submitted by Stanley E. Grogg, DO, FACOP

A group of 21 professionals from several areas of the US traveled to Uganda from March 9-22, 2013, to medically evaluate underserved individuals in Uganda.

Sister’s Rosemary’s Saint Monica School for Girls

The group, led by Stanley E. Grogg, DO, medical director and professor of pediatrics at the OSU-College of Osteopathic Medicine, and his wife, Barbara Grogg, NP, in charge of logistics, was a collaboration of Pros-for-Africa (http://prosforafrica.com) and DOCARE International (www.docareintl. org). The professionals included 3-pediatricians, 1-ENT, 1- musculoskeletal specialist, 1-dermatologist, 1-radiologist, 1- pediatric resident, 7-osteopathic medical students, 1-dental hygienist, 1-family practice nurse practitioner, a former CFO, 1 former restaurant entrepreneur, a school teacher and 1 video-photographer.

Oklahoma D.O. | May / June 2013

PAGE 29

Uganda has been a country of much strife and conflict including the atrocities of Joseph Kony and his Lord’s Resistance Army (LRA). (http://www.state.gov/r/pa/prs/ ps/2012/03/186734.htm) Many scars are still present from his actions from 1986 to 2007. Facilities visted were Sister’s Rosemary’s Saint Monica School for Girls, Blessings of Joy, Hope North, and Mercy’s Village.

Close to 1,200 persons received medical care and oral health instruction with the distribution of nine hundred fifty tooth brushes and toothpaste samples. We plan to return to Uganda in one year. okDO

Oklahoma D.O.

We were met at the Entebbe airport by NFL star, Tommy Harris. Several professional NFL players were just completing a trip to Sister’s Rosemary’s Saint Monica School for Girls.

Oklahoma Osteopathic Association 2013 Summer CME Seminar

Sports

Medicine

Aug.9-11, 2013

Oklahoma D.O. PAGE 30

Friday – August 9, 2013 12:00 – 6:00 pm Registration

10:00 am – Noon

“Cast and Splint Lab” Steven Sands, DO (Orthopedic Surgery, Oklahoma City, OK) Glenn L. Smith, DO, FAOAO, FACOS (Certified Orthopedic Surgery, Oklahoma City, OK) Ryan A. Pitts, DO (Certified Sports Medicine, Tulsa, OK) www.med.uottawa.ca/procedures/cast/

Noon – 2:00 pm

OOA Luncheon: “Legislative Update” LeRoy E. Young, DO, FAOCOPM (Certified Occupational & Preventive Medicine, Oklahoma City, OK) www.okosteo.org

2:00 – 3:00 pm

“Opioid Abuse/Withdrawal…The Missed Diagnosis” Proper Prescribing Lecture – Sign-In Required for Credit Melinda R. Allen, DO, FACOI (Certified Internal Medicine, Blackwell, OK) www.emedicinehealth.com/narcotic_abuse/article_em.htm “The Risk of Prescribing Controlled Substances to Athletes” Risk Management Course – Sign-In Required for Credit Theodore L. Passineau, JD, HRM, RPLU, Senior Risk Management Consultant www.medpro.com President’s Reception

2:00 – 6:00 pm

Exhibits Open

2:00 – 3:00 pm

“Sports Injuries” M. Sean O’Brien, DO (Certified Orthopedic Surgery, Oklahoma City, OK) www.nlm.nih.gov/medlineplus/sportsinjuries.html

3:00 – 4:00 pm

“Concussion Management” Ryan K. Hakimi, DO (Certified Neurology, Oklahoma City, OK) www.concussiontreatment.com/

4:00 – 5:00 pm

“Drug Abuse in Sports and the Consequences” Gregory J. Zeiders, DO, FAOBOS (Certified Orthopedic Surgery, Edmond, OK) http://www.medscape.org/viewarticle/518418

5:00 – 6:00 pm

“Skin Disease in Sports Medicine” Peter Knabel, DO (Dermatology, Kirksville, MO) www.ncbi.nlm.nih.gov/pmc/articles/PMC2902037/

6:00 –7:00 pm

OOA Past Presidents & District Presidents Meeting

3:00 – 5:00 pm

6:00 – 7:00 pm

OOA New Physicians Meeting

5:00 – 6:30 pm

Saturday – August 10, 2013 7:00 am Registration

Sunday – August 11, 2013 7:00 am Registration & Continental Breakfast – Sequoyah Foyer

7:00 am

Continental Breakfast

8:00 – 9:30 am

Bureau on CME Meeting

8:00 – 9:00 am

“Sideline Sports Emergencies” Keri D. Smith, DO (Emergency Medicine, Oklahoma City, OK) http://sidelinesportsdoc.com/

8:00 am – Noon

Exhibits Open

8:00 – 9:00 am

“Fracture Evaluation and Treatment” Steven Sands, DO (Orthopedic Surgery, Oklahoma City, OK) www.aapsm.org/ct0398.html

9:00 – 10:00 am

“Sports Physicals” Melissa A. Gastorf, DO (Certified Family Practice, Durant, OK) http://emedicine.medscape.com/article/88972-overview

9:00 – 10:00 am

“Sprains, Strains of the Foot and Ankle” Ryan A. Pitts, DO (Certified Sports Medicine, Tulsa, OK) http://emedicine.medscape.com/article/85639-overview

10:00 – 11:00 am

“Spine Injuries in the Young Athlete” C. Shane Hume, DO (Certified Orthopedic Surgery, Oklahoma City, OK) www.uptodate.com/contents/approach-to-the-young- athlete-with-neck-pain-or-injury

11:00 am – Noon

"Sports Injuries of the Hand & Wrist" Kristopher R. Avant, DO (Orthopedic Surgery, Oklahoma City, OK) www.bidmc.org/YourHealth/BIDMCInteractive/HealthIs/ BoneandJoints/HandWrist/MostCommonInjuries.aspx Oklahoma D.O. | May / June 2013

Oklahoma Osteopathic Association

Summer CME Seminar

Sports Medicine

Registration Form

q *DO Member Registration q DO Registration for Saturday afternoon “Proper Prescribing” & “Risk Management” Courses only (3 Credit Hours) q*Retired DO Member Registration q*DO Nonmember Registration q Nonmember Saturday Only Registration q *MD/Non-Physician Clinician Registration q Student, Intern, Resident, Spouse, Guest Registration

On or Before 7/26/13 $340 $180 $80 $840 $680 $340 $0

After 7/26/13 $365

$205 $105 $865 $705 $365 $0

Mail Registration Form & Payment to: OOA, 4848 North Lincoln Boulevard, Oklahoma City, OK 73105-3335 or Fax to 405.528.6102. DO Name (please print): ________________________________________________________________________________ Guest/Professional/Guest: _______________________________________________________________________________ Resident/Intern: _______________________________________________________________________________________ Student: _____________________________________________________________________________________________ q OMS-I q OMS-II q OMS-III q OMS-IV

Payment: q Check Enclosed q VISA/MASTERCARD q DISCOVER

q AMERICAN EXPRESS

Credit Card No.: _________________________________________________________________ Card Exp. Date: ________ Signature: ____________________________________________________________________________________________ Name (as it appears on card - please print): _________________________________________________________________

City: ________________________________________________ State: _____________ Zip: ________________________ Office Telephone: (_______)_____________________________ E-Mail address: ___________________________________

*Includes: Proper Prescribing Course, 2 Continental Breakfasts, Saturday Luncheon, & Evening Reception.

Requests for Refunds Must Be Received Before August 2, 2013 and a $25 Service Fee Will Be Charged.

Oklahoma D.O. | May / June 2013

PAGE 31

Please indicate: q Printed syllabus OR q DVD syllabus PLEASE NOTE: requested print syllabus cannot be guaranteed after July 12th

Oklahoma D.O.

Billing Address: ________________________________________________________________________________________

putting us on the map Provided by Chad E. Landgraf, M.S., GIS Specialist & Chair of the OSU Center for Rural Health Marketing Committee OSU Center for Rural Health, Tulsa, Oklahoma

Oklahoma D.O. PAGE 32

I titled this article, “Putting Us On the Map” because that is what I do. As the geographic information systems (GIS) specialist at the OSU Center for Rural Health, my job is to create maps. However, over the past year my duties have expanded. I am now the chairperson of the OSU Center for Rural Health Marketing Committee. The purpose of this article is not to brag. Rather, I want to introduce the Center’s Marketing Committee and review some of our most prominent accomplishments over the past 2+ years. While this is not a “how to” type article on marketing, some approaches mentioned below might be applicable to your practice. Background The OSU Center for Rural Health’s dedication to its marketing efforts began in earnest at our 2010 staff retreat. The general consensus among the group was that our message or story was not being told. The Center sat on a wealth of data, had developed novel approaches to rural medical education, and provided unique services to rural Oklahoma. Little, if any, word of these accomplishments reached beyond our office. As a result, the OSU Center for a Rural Health Marketing Committee was formed. The Marketing Committee consists of representatives from each of the major functional departments in the OSU Center for Rural Health: Rural Medical Education, Research & Grants; the Oklahoma Office of Rural Health; and TeleHealth. Jeff Hackler, J.D., M.B.A., Assistant to the Dean for Rural Service Programs, served as the inaugural chair of the committee. My tenure as chair began approximately a year later. Currently, the Marketing Committee consists of Corie Kaiser, M.S., Director of the Oklahoma Office of Rural Health; Robert Sammons, M.A., Northwest Regional Coordinator; Debbie Martin, TeleHealth Manager; and Mr. Hackler. The Center’s Marketing Committee works closely with the OSU Center for Health Sciences Marketing and Communications Services team led by Mary Bea Drummond, Ed.D. Websites The Center Marketing Committee realized immediately that enhancing our web presence was the easiest and most efficient way to increase our visibility. The Center has long maintained a website, but it was little more than an electronic brochure. The website’s navigation was not intuitive and the content was

CENTER FOR HEALTH SCIENCES

haphazardly arranged and difficult to update. In March 2011, we implemented a blog-format website that permitted us to categorize and regularly update content. Now, we can offer interactive content, publish longform articles, and solicit feedback from our users. The blog-format website averages 725 pageviews per month (March 2011 through February 2013) while our former website averaged around 770 pageviews per month prior to March 2011. We eclipsed 1,000 monthly pageviews on the blog-format website in February 2012 and January 2013. Currently, our total pageviews exceed 17,000. While it appears that our former website performed better, with respect to average monthly pageviews, deeper analysis of website traffic utilization patterns reveals that visitors spend more time on the blog-format website and view more pages. Our former website will continue to remain an important part of our web strategy. It is still our “official” website and drives a significant amount of traffic to our blog-format website. The Center’s Marketing Committee is currently assessing ways to further enhance all of our web-based content. We want to leverage the best assets of each platform to create a complete information resource for the citizens of Oklahoma. You can visit both websites via the following links: http://www.healthsciences.okstate.edu/ruralhealth/index.cfm and http://osururalhealth.blogspot.com. Newsletter One of the more significant accomplishments of the Marketing Committee is our quarterly newsletter. Identified as another relatively easy and efficient method to tell our story, the Center’s quarterly newsletter has become a key tool to reach our audience on an individual basis. First published in June 2011, the newsletter typically contains at least one story from each department at the Center for Rural Health. Other content typically featured in each edition includes recognition of an OSU CHS student, a calendar of events, and a listing of recent publications by Center’s staff. The newsletter is delivered via email in March, June, September, and December. The newsletter offers feature rich content with links to our Internet-based resources. The current subscription list exceeds 1,400 individuals. On average, the newsletter is opened by 31% of the recipients. Content within in the newsletter is “clicked-on” or accessed by 15% of those who open it. The newsletter is a vital conduit that directs traffic to our websites. View our newsletter archive online: http:// osururalhealth.blogspot.com/p/newsletter-archive.html.

Oklahoma D.O. | May / June 2013

Social Media Love it or hate it, social media is here to stay. The OSU Center for Rural Health is an active user and promoter of social media. While the term, “social media” is broad and encompasses a number of platforms or applications, Facebook and Twitter are arguably at the pinnacle of the social media universe. The Marketing Committee’s strategy for Facebook is to feature content that does not lend itself to a formal blog post or a standalone webpage. This primarily includes photo albums and event promotion. Since our first status update in May 2009, our Facebook page has garnered 119 total “Likes” split between 75 individuals and 44 organizations. Currently, we have a weekly reach of over 700 unique individuals. Photos are the most popular content on our Facebook page. We also utilize Facebook to share timely rural health news or status updates from the members of our own social network. We aim to keep most of our status updates Oklahoma-centric. Lastly, Facebook plays a key role in driving traffic to our websites. Find us on Facebook: http://www.facebook.com/osururalhealth. The OSU Center for Rural Health sent its first tweet on April 23, 2010. As of March 2013, our total number of tweets exceeds 3,000. The Marketing Committee’s initial strategy for Twitter was to drive visitors to our websites. That strategy matured and has now evolved into more news and information dissemination. We try to keep our tweets relevant to rural health and Oklahoma. To date, the Center’s Twitter account has 570 followers from around the world. Follow us on Twitter: http://www.twitter.com/osururalhealth.

Day. National Rural Health Day is celebrated nationwide on the third Thursday in November. Beginning with the inaugural National Rural Health Day in 2011, the OSU Center for Rural Health has hosted an open house each year with a catered BBQ lunch. The event is our way of giving back to our campus family and celebrating the joys of rural Oklahoma. The Center has also sponsored a rural Oklahoma photo contest each year in conjunction with National Rural Health Day. The public’s response to the contest has been tremendous. We have garnered entries from across the state with subjects ranging from people to landscapes. Oklahoma Governor Mary Fallin has twice issued gubernatorial proclamations honoring the people and healthcare providers of rural Oklahoma on National Rural Health Day. Conclusion The OSU Center for Rural Health Marketing Committee will mark its third year of existence this June. While it is fun to look back at where we have been and what we have accomplished, it is just as important that we look forward. The relationships that we have kindled through our various efforts described above (and some not listed) must continue to grow. We exist to serve the people of rural Oklahoma. Part of that service is to keep them informed of our activities. The Marketing Committee is doing just that. I encourage you to visit the resources listed in this article. Let us know if we are missing something or if there is something that we can do to help tell your story. Ultimately, our success will be measured not by pageviews or tweets, but how we tell the story of rural Oklahoma. okDO

National Rural Health Day One of the larger undertakings of the Marketing Committee has been to organize a celebration marking National Rural Health

Oklahoma D.O.

Winner of the 2012 Rural Oklahoma Photo Contest. “Ol' Silo on Highway 45” by Tony Khalaf. Taken near Carmen, OK.

PAGE 33

Oklahoma D.O. | May / June 2013

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We have received higher ratings from A.M. Best and S&P than any other carrier in the healthcare liability industry.

Oklahoma D.O. PAGE 34

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Oklahoma D.O. | May / June 2013

3/28/11 11:05 AM

what does a 3 year old have in common with simon sinek, john g. miller and rural DO’s? Provided by Vicki Pace, Director of Rural Medical Education

Asking “why” as simple as it sounds, is a great tool and we learn to use it at the early age of three. As any parent will tell you, it also makes the parent think. Maybe you can think of no reason other than “because I told you to” but as a parent if you continue to ask yourself “why,” it may be because you are trying to “teach” (cleanliness, responsibility, etc.) As we get older, do we lose that curiosity, forget how powerful the word “why” is, get trained not to ask to avoid upsetting others or learn to answer our own “whys”? Simon Sinek in his book, Start with Why, brings back how important it is for businesses, organizations or leaders to know why they do what they do. Knowing why the business, organization or leader does what they do, can make a big difference in the image your company or organization portrays. Examples he used in his book were Apple, Southwest Airlines, Sam Walton, and Martin Luther King, Jr., a few well know companies and leaders that clearly knew why they were doing what they were doing.

CENTER FOR HEALTH SCIENCES

role in medical education, today. When the “why” is for the wrong reason that unprofessional behavior comes into play. We can usually answer the “what or how” of what we are doing, but inspiring others into action requires knowing “why” we are doing what we do and everything we do relates back to our “why.” Andrew Taylor Still, DO, certainly knew “why.” His lifelong driving force to make medicine more effective and humane led to the founding of osteopathic medicine and contributed to people living happier and more productive lives. In a recent online conversation about professionalism in the medical field, those in medical education felt like medicine should always start with the patient. Is the “why” in osteopathic medical education and the osteopathic medical profession all about the patient? According to the students at rural rotation sites, the answer is yes!

In John Miller’s book, QBQ or Question behind the Question, he discussed asking “why” to get at the real reason a person does what they do. No matter how many times you have to ask “why”, each time you’ll get a little closer to the real reason. He related it back to people being held accountable for their actions.

William J. Pettit, DO, Interim Senior Associate Dean and Associate Dean for Rural Health with OSU-CHS, inspires others because his “why” is very clear. Students that completed the Rural Health Option, took the Perspectives in Rural Health Elective, or are part of the Rural Medical Track demonstrate the power of “why” in their commitment to make a difference in rural Oklahoma.

Accountability has always been a big part of the medical profession. The medical profession self-regulates professionals holding them accountable for unprofessional behavior. It is so important to the profession that it plays a big

Regardless of what your position in medical education or the medical profession is, ask yourself “why” you are investing your time, education, energy, leadership, or heart in what you do each and every day. Ask enough times and you may be surprised by your answer.

Legend has it that Earnest Hemmingway was challenged to tell a story using only 6 words. He won the bet with “For Sale: Baby shoes, never worn.” Whether the story is true or not, it has gained a lot of attention in the Twitter world. Take the challenge and discover your “why” using only six words. We asked medical students and others at the school to try this six-word method to tell their story and answer the questions “Why D.O.?” and “Why Rural?” Six well-chosen words tell a story! Why DO? Focus on entire patient. Why rural? Lifelong commitment and impact. -Dustin Little, OMSIII, Rural Medical Track Student Why DO? Complete, compassionate patient care. Why rural? Defining rural, defines me. -J.T. Ball, OMSII, Rural Medical Track Student

Data analysis and interpretation provides insight. -Denna Wheeler, Ph.D., Director of Research OSU-CHS Center for Rural Health I am needed. I can help. -Alisha Murrow, OMSI

Rural, underserved need healthcare. Answer? D.O.! Improving rural healthcare, making a difference! -Vicky Pace, Director of Rural Medical Education, OSU-CHS Center for Rural Health Caring D.O! Patient-centered: Mind, Body, Spirit Oklahoma D.O. | May / June 2013

PAGE 35

Right things. Right time. Right results. -Dave Peyok, OMSI

Oklahoma D.O.

Steady job, good pay, help people. Familiarity, small town leader. Country living. -Josh Priddle, OMSIII, Rural Medical Track Student

What DO’s Need To

KNOW

Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program – Registration & Attestation Stage 1 Wednesday, June 12, 12:30 – 1:30 CDT/11:30 – 12:30 MDT Register now at: http://www.eventbrite.com/event/6587486349 CMS Regions VI, VII and VIII are pleased to announce a new EHR webinar focused on the EHR Incentive Payment Program – Attestation and Registration – Stage 1 for Eligible Professionals (EPs) and Eligible Hospitals (EHs) who have met meaningful use for a 90 day period plus at least one, one-year period, Stage 2 requirements will be effective in 2014. Agenda • EHR Certification Requirements - Michael Lipinski, Office of the National Coordinator (ONC) • Beacon Community Program - Janhavi Kirtane, Acting Director for the Beacon Communities • Q and A Session – Led by Travis Broome, CMS What You Need To Do Now 1. Register for the webinar at: http://www.eventbrite.com/event/6587486349 After registering, you will receive an appointment which will include information on how to connect to the live webinar. 2. View the prerecorded presentations posted at the following links prior to June 12th. We won’t present this information on the live webinar. Medicare & Medicaid Registration & Attestation for Eligible Professionals: http://www.cms.gov/ Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/060712-EHRIncentive.html EHR: Medicare Incentive Program Attestation Webinar for Eligible Hospitals: http://www.youtube.com/kNOCV6A&list=UUhH TRPxz8awulGaTMh3SAkA&index=187 Medicare and Medicaid EHR Incentive Program Registration Webinar for Eligible Hospitals: http://www.youtube.com/ watch?v=ExOQOaYwie4&feature=mhum&lr=1

3. Make a list of your questions to ask during the Q&A session of the live webinar. You may also submit questions to Adra May- berry at adra.mayberry@cms.hhs.gov by COB June 11th. Please use “June 12th EHR Webinar” in the subject line of your email.

Oklahoma D.O. PAGE 36

What You Need To Do On June 12th: Join the live webinar by following the instructions in your Eventbrite appointment. We have 500 lines that are available on a first-come first-served basis. If several people are calling from one location please use one line if possible. Presentation materials will be available for viewing upon your entrance into the webinar.

National Provider Call: Getting Started with PQRS Reporting: Implications for the Value-based Payment Modifier — Continuing education credit may be awarded for participation in certain CMS National Provider Calls. Visit the Continuing Education Credit Notification web page to learn more. National Provider Calls: Medicare Shared Savings Program Application Process — Register Now

Thursday, June 20; 12:30-2pm CT— Application Review Thursday, July 18; 12-1:30pm CT— Application Question and Answer Session On October 20, 2011, CMS issued a final rule under the Affordable Care Act to establish the Medicare Shared Savings Program (Shared Savings Program). This initiative will help providers participate in Accountable Care Organizations (ACOs) to improve quality of care for Medicare patients. CMS will host two National Provider Calls on the Shared Savings Program application process. Oklahoma D.O. | May / June 2013

On Thursday, June 20, CMS subject matter experts will provide an overview and updates to the Shared Savings Program application process for the January 1, 2014 start date. A question and answer session will follow the presentations. On Thursday, July 18, CMS subject matter experts will be available to answer questions about the Shared Savings Program and application process for the January 1, 2014 start date. The Shared Savings Program Application web page has important information, dates, and materials on the application process. Call participants are encouraged to review the application and materials prior to the call. Target Audience: Medicare FFS providers Registration Information: In order to receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls registration website. Registration will close at 11am on the day of the call or when available space has been filled; no exceptions will be made, so please register early. Presentation: The presentation for this call will be posted on the FFS National Provider Calls web page. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call. Continuing education credit may be awarded for participation in certain CMS National Provider Calls. Visit the Continuing Education Credit Notification web page to learn more.

Information You Need: New Medicare Equipment and Supplies Program In Your Community If you help people with Original Medicare get certain durable medical equipment and supplies, such as oxygen, walkers, or wheelchairs, you should know about a Medicare program, called the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program, that saves money for taxpayers and people with Medicare and may change the suppliers people with Medicare will need to use. The first round of the program went into effect in nine areas of the country on January 1, 2011, reducing money spent for equipment included in the program by over 42 percent in its first year of operation while maintaining access to quality equipment and supplies. Now the programâ&#x20AC;&#x2122;s benefits are coming to people with Original Medicare near you, and there is some important information you need to know. Round 2 of the program is scheduled to begin on July 1, 2013, and expands it to 91 additional areas across the country. These areas can be found in the fact sheet at http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/DMEPOSBeneFactSheetMarch2013.pdf. When the program starts, people with Original Medicare who live in or travel to one of these areas and need the items listed below will likely need to get these items from contract suppliers if they want Medicare to help pay, unless their current suppliers decide to become grandfathered suppliers (non-contract suppliers that choose to continue to provide certain rented medical equipment or oxygen under the terms of the program). So people will need to find out which suppliers are Medicare contract suppliers to make sure Medicare can help pay for their medical equipment or supplies. You can find out if a supplier is a contract supplier for the program by visiting http://www.medicare.gov/supplierdirectory/search.html or by calling 1-800-MEDICARE (1-800-633-4227).

Oklahoma D.O. | May / June 2013

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In addition to the categories of items listed, Medicare will be starting a national mail-order program for diabetic testing supplies at the same time as Round 2. The national mail-order program will include all parts of the United States, including the 50 States, the District of Columbia, Puerto Rico, the US Virgin Islands, Guam, and American Samoa. When the national mail-order program starts, people with Original Medicare will need to use a contract supplier for diabetic testing supplies delivered to their homes. Starting May 13, 2013, Medicare is mailing information to people with Medicare in the 91 Round 2 areas who use the items included in

Oklahoma D.O.

The 8 product categories that are included in Round 2 of the program are: 1. Oxygen, oxygen equipment, and supplies; 2. Standard (power and manual) wheelchairs, scooters, and related accessories; 3. Enteral nutrients, equipment, and supplies; 4. Continuous Positive Airway Pressure (CPAP) devices, Respiratory Assist Devices (RADs) and related supplies and accessories; 5. Hospital beds and related accessories; 6. Walkers and related accessories; 7. Support surfaces (Group 2 mattresses and overlays); and 8. Negative Pressure Wound Therapy pumps and related supplies and accessories.

the program, in addition to those who use diabetic testing supplies across the country. Approximately 5.7 million people with Medicare will get a letter and information. You can review the letters, introductory brochure, national mail-order program fact sheet and other program education materials by visiting http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/DMEPOS_Toolkit.html If you help people with Original Medicare who live in or travel to one of the Round 2 areas and who need one of the items included in the program or who use diabetic testing supplies, please make this information available to them.

DMEPOS Competitive Bidding Program: Grandfathering Requirements and Fact Sheet CMS would like to remind all non-contract suppliers furnishing rented durable medical equipment or oxygen and oxygen equipment in a Round 2 competitive bidding area that they must decide if they will elect to become grandfathered suppliers and notify beneficiaries of their grandfathering decisions at least 30 business days before July 1, 2013. For more information about grandfathering requirements, please review the â&#x20AC;&#x153;DMEPOS Competitive Bidding Program: Grandfathering Requirements for Non-Contract Suppliersâ&#x20AC;? Fact Sheet (ICN 900923). This fact sheet is available in downloadable format and includes a definition of grandfathered suppliers, beneficiary notification requirements, and rules and policies related to grandfathering.

DMEPOS Competitive Bidding Program: Beneficiary and Provider Mailings The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (the Program) was successfully implemented in nine areas on January 1, 2011. Round 2 of the Program is scheduled to go into effect in 91 Metropolitan Statistical Areas (MSAs) on July 1, 2013. Medicare will implement a national mail-order program for diabetic testing supplies at the same time as Round 2. The national mail-order program will include all parts of the United States, including the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa. As part of the ongoing education and outreach efforts for the Program, CMS will begin mailing information to approximately 5.7 million people with Medicare about The Program. Recipients include Medicare beneficiaries in the 91 Round 2 bid areas who use the items included in The Program (letter 1) as well as those who use diabetic testing supplies across the country (letter 2). Health care providers who order and refer DMEPOS Competitive Bidding Program items for beneficiaries residing in or traveling to a competitive bidding area will be receiving a letter from CMS with more information on The Program. Review the referral agent letter which also includes a fact sheet for referral agents.

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For information about The Program and to view additional educational resources, visit the CMS website. If you refer Medicare beneficiaries for DMEPOS, subscribe to the Referral Agent Electronic Mailing List.

HQRP Paperwork Reduction Act Package and Proposed Rule Available for Public Comment Comment period will end on June 28 Hospice providers can review the Hospice Quality Reporting Program (HQRP)-related proposed rule [CMS-1449-P] and Deep Penetrating the Paperwork Reduction Act (PRA) Package. Section III(B1Soothing Herbal Relief: B7) of the Proposed Rule outlines current HQRP requirements Sooner Relief is specially formulated with and proposes future HQRP requirements for Payment Year medicinal herbs. Bringing long lasting and (PY) 2016 and PY 2017. The PRA package includes details about the Hospice Item Set (HIS), a hospice patient-level data relaxing relief to sore muscles and aching set designed to collect and submit standardized data about each inflamed joints. patient admitted to hospice. The HIS is proposed for use in the Doctor recommended: Arthritis, Sore HQRP beginning in PY 2016.

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The public has the opportunity to comment on proposals in the rule and/or the PRA package. The public comment period for the proposed rule and the PRA package will end on June 28, 2013. The process for submitting comments on either the proposed rule or the PRA package is outlined within the proposed rule. After the comment period ends, CMS will respond to comments and finalize HQRP requirements in the Final Rule. Oklahoma D.O. | May / June 2013

Guidance for EPs: How to Participate in Both the Medicare EHR Incentive Program and PQRS in 2013 and Beyond Providers who treat Medicare patients and bill for Part B services on the Medicare Physician Fee Schedule (PFS) may be eligible for two incentive programs at CMS: the Medicare EHR Incentive Program and the Physician Quality Reporting System (PQRS) program. CMS encourages you to read more to learn about the opportunity to participate in both. About EHR The Medicare EHR Incentive Program provides incentive payments to eligible professionals (EPs) that successfully demonstrate meaningful use of certified EHR technology. About PQRS PQRS is a reporting program that provides incentive payments to promote reporting of quality information by EPs. Participating in Both in 2013 EPs who successfully participate in PQRS and EHR can receive an incentive in 2013 and avoid the 2015 payment adjustment for both programs. To successfully demonstrate meaningful use for the Medicare EHR Incentive Program, EPs are required to report clinical quality measures (CQMs) as well as meaningful use measures. In 2013, EPs may satisfy the meaningful use objective to report CQMs to CMS by reporting them through: • Medicare and Medicaid EHR Incentive Programs’ web-based Registration and Attestation System o EPs who choose to report CQMs through the CMS Attestation system must still report information on individual quality measures or measure groups using one of the four reporting options in order to also participate in PQRS. • Participation in the PQRS-Medicare EHR Incentive Pilot, which utilizes the 2013 PQRS EHR Measure Specifications . o EPs who participate in the pilot may submit their meaningful use objectives through the CMS Attestation system, and then complete a single submission of CQMs to receive credit for both programs. Participating in Both in 2014 and Beyond In 2014, the PQRS and EHR programs have overlapping participation guidelines, including the same quality measures, the same reporting criteria, and the option to use the same reporting mechanism. The goal of this “alignment” is to simplify participation in both programs. Here are some key considerations for PQRS and EHR alignment in 2014: • PQRS and EHR programs will align on the same set of eCQMs (64 total) and the same electronic specifications • All Medicare-EPs beyond their first year of demonstrating meaningful use will be required to electronically report their CQM data to CMS for the EHR program • Submitting data electronically using 2014 certified EHR technology will meet the standards for both EHR and PQRS programs • Participating EPs will have the option to submit patient-level data (via QRDA I) or aggregate data (via QRDA III) using the same reporting mechanism for electronic reporting for both programs CMS hopes you will take action and participate in both programs this year. Learn more about PQRS and EHR on the eHealth website.

Adjustment of Certain Institutional Claims The Shared System Maintainer (SSM) for the Fiscal Intermediary Shared System (FISS) corrected an issue which went into production on April 14, 2013. Medicare Administrative Contractors (MACs) will adjust claims with “through dates” on or after April 1, 2013, that processed between April 1 and April 14, 2013, with the following criteria: • Value Code 73 • A deductible applied (A1, B1 or C1 Value Code) and • Negative reimbursement (at the line level for outpatient claims or negative reimbursement at the claim level for inpatient claims)

Although, AWV and IPPE are covered services for RHCs, the Fiscal Intermediary Shared System (FISS) is currently preventing the processing of these services at the all-inclusive payment rate. Oklahoma D.O. | May / June 2013

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Temporary Billing Guidelines for Annual Wellness Visits and Initial Preventive Physical Examinations for Rural Health Clinics CMS identified an issue with the January 2013 quarterly release that is impacting the payment to Rural Health Clinics (RHCs) for Annual Wellness Visits (AWV) and Initial Preventive Physical Examinations (IPPE) services.

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MACs will process the following claim types, as they were previously held and do not require adjustments: • Critical Access Hospital (CAH) claims: TOB 85X with a deductible applied (A1, B1 or C1 Value Code) • Rural Health Clinic RHC outpatient claims: TOB 71X with a deductible applied (A1, B1 or C1 Value Code) All adjustments will be completed by June 30, 2013. No further action by the provider is required.

Until system changes can be implemented in FISS, RHCs should follow the billing instructions outlined below to ensure there is no further delay in your Medicare payments: • AWV services should be submitted to the Medicare claims administration contractor with revenue code 052X and HCPCS code G0438 or G0439. Please ensure no other services are reported on the claim with the same line item date of service as the AWV. • IPPE services should be submitted by itself on a separate claim to the Medicare contractor. When billing for an encounter/visit on the same day as an IPPE service, submit the first claim with revenue code 052X and no HCPCS/CPT code. The second claim should be submitted with revenue code 052X and HCPCS code G0402. Your Medicare contractor may have been holding these claims waiting for a system fix. Therefore, in order to prevent further delay in payments, your contractor will soon begin to return these claims to you. Please resubmit the claims using the billing guidelines as described above. RHC providers should follow these billing guidelines until further instructions are given. Please contact your Medicare contractor if you have additional questions.

2014 ICD-10-PCS Files Now Available ICD-10 Code Updates The 2014 ICD-10-PCS (procedure) files are now available and posted on the 2014 ICD-10 PCS and GEMs web page. 2014 Version — What’s New describes the four new procedure codes created for new technologies. CMS will post the 2014 ICD-10-CM (diagnosis) files once we receive them from the Centers for Disease Control (CDC) in June. A 2014 ICD-10-CM and GEMs web page will be created on the ICD-10 website for these files. The ICD-10-PCS and ICD-10-CM 2014 General Equivalence Mappings (GEMs) and the 2014 Reimbursement Mappings will be posted on the 2014 ICD-10-PCS and GEMs and 2014 ICD-10-CM and GEMs web pages in October.

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FY 2014 ICD-9-CM Procedure Code Addendum Now Available The FY 2014 ICD-9-CM procedure code addendum is posted on the Updates and Revisions to ICD-9-CM Procedure Codes web page. There will not be a FY 2014 ICD-9-CM diagnosis addendum, as CDC is not updating ICD-9-CM diagnosis codes for FY 2014.

Clarification on the Use of External Cause and Unspecified Codes in ICD-10-CM External Cause Codes Just as with ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required. If a provider has not been reporting ICD-9-CM external cause codes, the provider will not be required to report ICD-10-CM codes in Chapter 20, unless a new state or payer-based requirement regarding the reporting of these codes is instituted. Such a requirement would be independent of ICD-10-CM implementation. In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies. Sign/Symptom/Unspecified Codes In both ICD-9-CM and ICD-10-CM, sign/symptom and “unspecified” codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter. If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code (e.g., a diagnosis of pneumonia has been determined, but not the specific type). In fact, unspecified codes should be reported when they are the codes that most accurately reflects what is known about the patient’s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code. Oklahoma D.O. | May / June 2013

Dates of Service: Is It ICD-9 or ICD-10? With the October 1, 2014, ICD-10 deadline approaching, you may be wondering how you will code a claim that you are submitting in October 2014 for a service that your practice provided in September 2014. Even if you submit your claim on or after the ICD-10 deadline, if the date of service was before the October 1, 2014, deadline, you will use ICD-9 to code the diagnosis. For dates of service on or after the October 1, 2014, deadline, you will use ICD-10. You may not be able to use ICD-9 and ICD-10 codes on the same claim based on your payers’ instructions. This may mean splitting services that would typically be captured on one claim into two claims: one claim with ICD-9 diagnosis codes for services provided before October 1, 2014, and another claim with ICD-10 diagnosis codes for services provided on or after October 1, 2014. Some trading partners may request that ICD-9 and ICD-10 codes be submitted on the same claim when dates of service span the compliance date. Trading partner agreements will determine the need for split claims. Here’s an example of a split claim: A patient has an appointment on September 27, 2014, and is diagnosed with bronchitis. He returns for a follow-up appointment on October 3, 2014. In this case, a practice will submit a claim with an ICD-9 diagnosis code for the first visit and another claim with an ICD-10 diagnosis code for the follow-up visit. Make sure that your systems, third-party vendors, billing services, and clearinghouses can handle both ICD-9 and ICD-10 codes depending on the dates of service in the months following October 1, 2014. Please note that future ICD-10 Email Updates will explore how Medicare will handle dates of service for inpatient settings (e.g., a hospital inpatient stay that begins before the transition date and ends after the transition date will be coded on a single claim with ICD-10). Stay tuned for details. Keep Up to Date on ICD-10 Visit the CMS ICD-10 website for the latest news and resources and the ICD-10 continuing medical education modules developed by CMS in partnership with Medscape to help you prepare for the October 1, 2014, deadline.

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Oklahoma D.O.

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Oklahoma D.O. | May / June 2013

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the final push Provided by Val Schott, MPH, Chief Executive Officer Oklahoma Health Information Exchange Trust

OHIET is the result of a remarkable grant made to Oklahoma in 2009. The grant, titled the State Health Information Exchange Cooperative Agreement Program or SHIECAP started an extended process in Oklahoma that recommended a state-beneficiary trust as the most acceptable (and least objectionable) format for state leadership in the advocacy, development and implementation of electronic health records and electronic data exchange for Oklahoma patients and providers.

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Oklahoma had taken on a previous groundbreaking effort to establish and enhance the confidentiality, privacy and security of Oklahomansâ&#x20AC;&#x2122; health information. Oklahoma was the recipient of assistance from the federal government through the Governorâ&#x20AC;&#x2122;s Office and the University of Oklahoma College of Public Health (OUCOPH), which developed into the Oklahoma Health Information Security and Privacy Collaborative. This was a two-year effort designed to identify processes and barriers to the appropriate sharing of personal health information electronically. Oklahoma involved several hundred people in this process including a wide variety of providers, payors and citizens in this effort, which was led by the OUCOPH and the Oklahoma State Department of Health where this was eventually housed. This collaborative resulted in the formation of the Oklahoma Health Information Security and Privacy Council (OHISPC), a representative group of health care providers, payors, and citizens appointed by the Governor. OHISPC continues to meet quarterly concerning privacy and security issues. This effort was a good starting place for the Oklahoma SHIECAP grant. Through a series of coordinated meetings centered on the grant requirements and building on the Collaborative discussions, this process resulted in the recommendation for the Oklahoma Health Information Exchange Trust (OHIET). Because of the application deadline, the Governor authorized the Oklahoma Health Care Authority to apply for and receive the SHIECAP grant as the State Designated Entity (SDE). The OHIET had to be created

by the 2010 Oklahoma Legislature. Then the Trust would have to be formed, Trustees appointed and staff hired and assembled. This all took place in the early fall after adjournment of the Legislature. Then we got started. OHIET established an Advisory Board (AB) that was created in the legislation authorizing the Trust. We set about designing programs that would benefit providers in Oklahoma. Our special emphasis was rural providers. The simple reason for this is that there was simply a dearth of resources to encourage adoption of electronic data exchange in the rural parts of our state. Problems with high speed Internet persist to this day although progress is being made. The AB debated and designed programs recommended to OHIET. These programs focused on rural hospitals and rural providers. OHIET also focused on e-prescribing and electronic lab reporting as part of national goals in those two areas. Additionally, OHIET set about the business of becoming a real business entity. Legal representation was already established. We contracted for an independent audit. OHIET developed a process allowing for certification of health information organizations (HIO) doing business in Oklahoma. While OHIET cannot prevent any organization doing business in Oklahoma, we can offer a certification process that gives credibility to the certified HIO. This process essentially looks at and requires that the HIO have substantial security and privacy policies to prevent the misuse of inappropriate disclosure of personal health information. We also required a representative governance structure that included providers in the decision making process for the HIO. Finally, we required a sustainability plan to demonstrate the HIO is an ongoing business entity. We have certified three HIOs in Oklahoma: MyHealth, SMRTNet, and NPHX. All three offer a broad range of services and all three operate statewide. This was an important, initial step in our work. No other state has three independently operating certified HIOs within their state. We developed and submitted a request for

proposal for business administration and management with the Oklahoma Purchasing Department; they were most helpful with this process. As a result we hired a management company. OHIET also went through the same process to hire the Oklahoma Foundation for Medical Quality to do education and marketing for OHIET programs to Oklahoma providers. With the advice and council of the AB, OHIET approved two voucher programs. These vouchers work like coupons. All are designed to help providers meet meaningful use of electronic health records. We have discussed these vouchers several times in these articles. All providers have to be located in areas defined as rural or mixed counties by the OSU Center for Rural Health. This means that all hospitals and primary care providers are eligible if they are in an Oklahoma county other than Oklahoma, Cleveland, Tulsa or Comanche counties. The vouchers are designed in two phases for both eligible hospitals and providers. The first level generally requires that the hospital or provider have an account with a certified HIO, have used that to look up a patient record and has sent and received a secure message via the certified HIOs secure messaging system. Generally but not always, this will use the Direct connection. The second level requires the hospital or provider to have a live data feed and is actively exchanging at least discharge summaries and ADTs to the HIO in the case of a hospital. An eligible provider is passing structured clinical data to the HIO in a standardized format in compliance with ONC accepted interoperability standards. The vouchers for Eligible Hospitals have an original value for services totaling $24,500 and for Eligible Providers the original service value was $2,306. For the Eligible Provider, OHIET also offered a connection fee through the HIO of up to $3,000 with a maximum of one connection to a unique database. If you had two physicians, a nurse practitioner and a PA in one practice, this would allow for only one $3,000 connection fee. These amounts were seen as suffiOklahoma D.O. | May / June 2013

cient to buy about a yearâ&#x20AC;&#x2122;s worth of service from an HIO depending on your individual negotiations with your chosen HIO.

Committee to meet during the May 16 through 24 time frame to finalize the details of these expanded voucher programs.

As we get closer to the ending of these grant programs, OHIET has examined our process to determine barriers to the adoption of electronic data exchange. For Eligible Hospitals, we find that cost is a significant barrier. This is especially true when we discuss the interface structure required by rural hospitals. To help solve this problem, OHIET has added another $25,500 in value to the Eligible Hospital voucher that now will total $50,000 in value to the Eligible hospital. This more than doubles the amount of the original voucher for Eligible Hospitals. If you are an Eligible Hospital and have a voucher award, there is no need to reapply. Simply check with your chosen HIO to determine how this increased voucher amount will work for you.

The Trustees also added some contingency planning that includes expanding the voucher program to specialists in any Oklahoma county if those specialists would, in addition to meeting the attestation requirements of the primary care provider, would attest that he or she was (1) treating a patient referred by a rural primary care provider, and (2) was treating and would continue to treat patients funded by Medicare and Medicaid. In addition, the Trustees added certain optometrists as eligible providers. To qualify, the optometrist would have to have an electronic health record installed and operational that is ONC approved and is capable of transmitting data to other primary care providers and is engaging in that transmission process. There are currently 47 optometrists in rural communities that would meet those criteria with a total universe of no more than 100 potentially eligible practitioners in this class. The Trustees also looked favorably on the development of a Master Person Index in conjunction with these efforts.

OHIET found similar barriers for Eligible Providers. This was especially true for providers in small rural practices. There was simply not enough capital to make the program successful. In response, OHIET has raised the value of the voucher to $5,000 per provider if that provider is a primary care provider in a practice of five or less practitioners. For example, a rural practice involving two physicians with two nurse practitioners and a PA would be eligible for a $25,000 voucher plus the one time maximum connection fee of up to $3,000. This five-practitioner rural practice would be eligible for up to $28,000 in value through their chosen HIO.

Oklahoma D.O. | May / June 2013

On a personal note, this is the last time I will address you as the CEO of OHIET. While I have enjoyed the challenge of this position, I have decided to take a different one. Effective June 1, I will become the Senior Vice President for Rural Community Hospitals of America. This is a company that owns and manages small rural hospitals in several different states. They have a commitment to quality health services for rural people and communities and are looking to grow. While it is always difficult to leave a job, I know OHIET will continue to make substantial progress and I am excited about the new prospects in front of me. Thank you for your help and friendship. Osteopathic medicine and osteopathic physicians will always have a special place in my heart and okDO mind.

PAGE 43

The OHIET Board of Trustees approved these expanded vouchers at their May 7, 2013 Board of Trustees meeting, with instructions to the OHIET Executive

For Eligible Providers and Eligible Hospitals, the time is now. As OHIET is nearing the culmination of its grant programs, the first who applied will be the first served. Once the funding has been expended, there will not be any additional funding or additional time extensions. You should make your application now! For Eligible Hospitals, email me directly at val.schott@okstate.edu for the simple application form. For Eligible Providers, simply go on line to OHIET. org. Look on the right side of the website under the Main Menu for the Eligible Pro-

To get more complete information including any modification that the Executive Committee might make, please check the OHIET.org website regularly.

Oklahoma D.O.

The major problem here is time. The SHIECAP funds must be totally expended and accounted for no later than February 7, 2014. This means that the last vouchers will be issued no later than September 30, 2013, with the last payment made no later than December 31, 2014. This is an extremely short time frame to accomplish the goals of the program. There will be no extension. Our program, funded through the American Recovery and Reinvestment Act was given a short extension already. The program was to end initially effective September 30, 2013. That would have meant that the final expenditures could have occurred no later than July 31, 2013. Thus, OHIET has been given one last extension.

The Trustees also gave approval to explore the process of funding a limited voucher program for pharmacists to help defray the costs of electronic prescribing; possible participation in a Federated Identify Management and Directory Service with other elements of Oklahoma state government including the Oklahoma Health Care Authority, the Oklahoma State Department of Health, the Department of Mental Health and Substance Abuse Services the Department of Human Services, the Corrections Department, and the Office of Management & Enterprise Services. Either of these last two expansions would have to come back to the Board of Trustees for final approval that would have to include a final budget.

vider Voucher and click on it. It will take you to the simple application form. It literally takes only about five minutes to make this application. But time is short and the time to apply is now. Any delay probably means you are leaving value on the table.

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Oklahoma D.O. | May / June 2013

BY THE WAY...

ACOFP Fellows Inducted Timothy J. Moser, DO, FACOFP (Midwest City) and Bobby N. Daniel, DO, FACOFP (Tulsa) were awarded with the prestigious fellow recognition of the American College of Osteopathic Family Physicians. Dr. Moser and Dr. Daniel joined the elite group during the 2013 Conclave of Fellows Awards Ceremony on Saturday, March 23, 2013. Members are named “Fellow of the American College of Osteopathic Family Physicians (FACOFP)” in recognition of individual experience, dedication, and contributions through teaching, authorship, research and professional leadership. It has been presented annually since 1976.

McAlester Named Regent of the Eastern Oklahoma State College Board Monte R. McAlester, DO (Wilburton) was appointed to the Eastern Oklahoma State College Board of Regents. Dr. McAlester is the medical director at Hastings Indian Medical Center in Tahlequah. He received a doctorate from the Oklahoma State Univeristy College of Osteopathic Medicine in Tulsa. Dr. McAlester is replacing Aud Balentine and will serve the remainder of a seven-year term on the board.

President Appoints the 2013-2014 Bureaus PMTC Appoints Newest Board Member H. Zane DeLaughter, DO (Duncan) was appointed to the Physician Manpower Training Commission (PMTC) on Monday, April 22, 2013. This is a five year term appointed by the Governor with the advice and consent of the Senate. The mission of the Physician Manpower Training Commission is to enhance medical care in rural and underserved areas of the state by administering residency, internship and scholarship incentive programs that encourage medical and nursing personnel to practice in rural and underserved areas. Further, PMTC’s purpose is to upgrade the availability of health care services by increasing the number of practicing physicians, nurses and physician assistants in rural and underserved areas of Oklahoma.

Congratulations to Scott S. Cyrus, DO (Tulsa) for his recent accolade. At the recent American College of Osteopathic Pediatrician (ACOP) Spring Conference, Dr. Cyrus was announced as the 2013-2014 ACOP President.

Jeremy R. Smola, DO (Family Practice) Sweetwater, TX

Oklahoma D.O. | May / June 2013

The Northeastern Tribal Health System is seeking a full-time Family Practice Physician that provides ambulatory health care to eligible Native American beneficiaries. The Health Care Center is located in close proximity to the Grand Lake area, as well as thirty- minute interstate access to Joplin, Missouri. The facility offers: • Expanded salaries • Excellent benefits • Loan repayment options • No weekends & No calls • Private office NTHS is a Tribal facility and Physicians are covered under the Federal Tort Claims Act. Applicants claiming Indian preference must submit proof with their resume. Applicants will be required to pass a preemployment drug screen and complete a background check. To apply please submit a current resume, certifications, & current state license to: Northeastern Tribal Health System attn: Human Resource Director P.O. Box 1498 Miami, Oklahoma 74355 Contact patricia.hecksher@ihs.gov for more information. (918) 675-2049 or fax (918) 540-1685 Please visit us at www.nthsclinic.com

PAGE 45

Bureau on Membership

The Northeastern Tribal Health System

Oklahoma D.O.

DO Named 2013-2014 ACOP President

The 2013-2014 OOA Bureau Appointments have been recommended by President Langerman and approved by the OOA Board of Trustees. The complete list can be found on page 46. If you wish to serve on a bureau, please contact the OOA Central Office at 405.528.4848 to express your interest.

OOA’s 2013-2014 Departments, Bureaus, Committees & Councils Executive Committee

President: Bret S. Langerman, DO President-Elect: Michael K. Cooper, DO Vice President: C. Michael Ogle, DO Past President: Layne E. Subera, DO Department of Professional Affairs Chief: Michael K. Cooper, DO, President-Elect

Bureau on Awards

5 Immediate Past Presidents Chair: Gilbert M. Rogers, DO Vice Chair: Duane G. Koehler, DO Staff: Lynette C. McLain Staff: Lany Milner Scott S. Cyrus, DO LeRoy E. Young, DO Layne E. Subera, DO

Bureau on Membership

Chair: Dale Derby, DO Vice Chair: Melissa A. Gastorf, DO Staff: Marie Kadavy Timothy J. Moser, DO Ronald S. Stevens, DO

Bureau on Physician Grievance Chair: Gabriel M. Pitman, DO Vice: Christopher A. Shearer, DO Staff: Matt Harney H. Zane DeLaughter, DO Carol A. Hanson, DO Valerie B. Manning, DO Timothy J. Moser, DO Gerald D. Rana, Jr., DO Richard W. Schafer, DO Jason W. Sims, DO Susan B. Young, DO

Physicians Health & Recovery Committee

Oklahoma D.O. PAGE 46

Director: Robert Westcott, MD Chair: Kayse M. Shrum, DO Vice Chair: Christopher A. Shearer, DO Lynette C. McLain, Executive Director Staff: Lany Milner Constance G. Honeycutt, DO Jennifer C. Scoufos, DO Michael F. Stratton, DO Susanne P. Thompson, DO Susan B. Young, DO

Bureau on Continuing Medical Education Chair: Layne E. Subera, DO Vice: Christopher A. Shearer, DO Staff: Lany Milner Melinda R. Allen, DO Lonette A. Bebensee, DO Shawnaree L. Beeson, DO William H. Bickell, MD Scott S. Cyrus, DO H. Zane DeLaughter, DO B. Baker, Fore, DO Jeff A. Gastorf, DO David E. Hogan, DO

Joseph R. Johnson, DO Walter E. Kelley, DO Duane G. Koehler, DO Tammie L. Koehler, DO Valerie B. Manning, DO Ryan W. Schafer, DO Caroline E. Merritt-Schiermeyer, DO

Bureau on Constitution & Bylaws Chair: Kayse M. Shrum, DO Vice Chair: Timothy J. Moser, DO Staff: Lany Milner C. Michael Ogle, DO Gabriel M. Pitman, DO Layne E. Subera, DO LeRoy E. Young, DO

Bureau on Postgraduate Education Chair: Melissa A. Gastorf, DO Vice Chair: Dale Derby, DO Staff: Marie Kadavy H. Zane DeLaughter, DO Kristopher K. Hart, DO David E. Hogan, DO Joseph R. Johnson, DO Duane G. Koehler, DO Jeffrey LeBoeuf, CAE Gary L. Patzkowsky, DO Hal H. Robbins, DO Gregory J. Zeiders, DO

Bureau of New Physicians Chair: Kenneth E. Calabrese, DO Vice Chair: Dale Derby, DO Staff: Marie Kadavy Zachary A. Fowler, DO Kenneth E. Hamilton, DO Scott T. Shepherd, DO Nicole M. Willis, DO

Department of Public Affairs Chief: C. Michael Ogle DO, Vice President

Bureau on Information Technology

Chair: Melissa A. Gastorf, DO Vice Chair: Timothy J. Moser, DO Staff: Marie Kadavy Gary K. Augter, DO Shawnaree L. Beeson, DO Joseph R. Johnson, DO Rajendra K. Motwani DO Ronald S. Stevens, DO

Bureau on Legislation

Chair: LeRoy E. Young, DO Vice Chair: C. Michael Ogle, DO Staff: Matt Harney Patrice A. Aston, DO Gary K. Augter, DO Kenneth E. Calabrese, DO Thomas J. Carlile, DO Michael K. Cooper, DO Scott S. Cyrus, DO Brent W. Davis, DO

Dale Derby, DO Melissa A. Gastorf, DO Greg Gray, DO David F. Hitzeman, DO M. Shane Hull, DO Stephanie J. Husen, DO Joseph R. Johnson, DO Duane G. Koehler, DO Bret S. Langerman, DO Timothy J. Moser, DO Terry L. Nickels, DO Gabriel M. Pitman, DO Gerald D. Rana, Jr., DO Christopher A. Shearer, DO Kayse M. Shrum, DO Roanld S. Stevens, DO Layne E. Subera, DO Sherri Wise

Bureau on Convention

General Convention Chair: Michael K. Cooper, DO Professional Program Chair: C. Michael Ogle, DO OOA Executive Director: Lynette C. McLain OOA Staff Members: Lany Milner

Bureau on Professional Liability Insurance Chair: Gabriel M. Pitman, DO Vice Chair: Kenneth E. Calabrese, DO Staff: Lany Milner Thomas J. Carlile, DO Timothy J. Moser, DO Richard W. Schafer, DO Sheila G. Simpson, DO

OOPAC Committee

Chair: LeRoy E. Young, DO Vice Chair: Bret S. Langerman, DO Treasurer: Lynette C. McLain Staff: Matt Harney Michael K. Cooper, DO David F. Hitzeman, DO Terry L. Nickels, DO Gabriel M. Pitman, DO

Bureau on Managed Care & Physician Reimbursement

Bureau on Public Awareness Chair: Ronald S. Stevens, DO Vice Chair: Melissa A. Gastorf, DO Staff: Matt Harney Gary K. Augter, DO Kenneth E. Calabrese, DO Jason W. Sims, DO

Past Presidents’ Council

Chair: LeRoy E. Young, DO Staff: Lany Milner and Matt Harney

District Presidents’ Council

Health Policy Task Force Chair: Michael K. Cooper, DO Vice Chair: Layne E. Subera, DO Staff: Matt Harney Melissa A. Gastorf, DO Duane G. Koehler, DO Trudy J. Milner, DO Ronald S. Stevens, DO

Department of Business Affairs Layne E. Subera, DO, Past President

Chair: Ronald S. Stevens, DO Thomas H. Conklin Jr., DO (Eastern) James I. Graham, DO (North Central) Vacant (Northeastern) Kelly McMurry, DO (Panhandle) Timothy J. Moser, DO(South Central) Thomas B. Leahey, DO (Southern) Melissa A. Gastorf, DO (Southeastern) Melvin L. Robison, DO (Southwestern) (Tulsa) Kenan L. Kirkendall, DO (Western) Keenan Ferguson, DO(Northwestern)

Nominating Committee

Bureau on Finance

Chair: Michael K. Cooper, DO Vice Chair: C. Michael Ogle, DO Staff: Lynette C. McLain, Exec. Dir. Bret S. Langerman, DO Gabriel M. Pitman, DO Layne E. Subera, DO

Bureau on Member Services Chair: C. Michael Ogle, DO Vice Chair: Dale Derby, DO Staff: Marie Kadavy Michael K. Cooper, DO Kenneth E. Hamilton, DO Gabriel M. Pitman, DO Richard W. Schafer, DO Sheila G. Simpson, DO Jason W. Sims, DO Layne E. Subera, DO

Chair: Christopher A. Shearer, DO Vice Chair: Kenneth E. Calabrese, DO Staff: Lany Milner Thomas J. Carlile, DO Melissa A. Gastorf, DO Sheila G. Simpson, DO Dianna M. Willis, DO Susan B. Young, DO

Eastern Representative North Central Representative Northeastern Representative Panhandle Representative South Central Representative Southern Representative Southeastern Representative Southwestern Representative Tulsa Representative Western Representative Northwestern Representative Gilbert M. Rogers, DO Duane G. Koehler, DO Scott S. Cyrus, DO LeRoy E. Young, DO Layne E. Subera, DO

Oklahoma D.O. | May / June 2013

Classified Advertising OFFICE FOR RENT: 1,500 square feet in an excellent area with high traffic count. Established location. Utilities are paid. Completely remodeled, very nice. Easy access from all areas of town, 7300 S Western, OKC. $1500 per month. Please call Dr. Buddy Shadid 405.833.4684 or 405.843.1709.

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.

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.

GOING OUT OF BUSINESS SALE: Quitting practice at year’s end! Great deals on exam tables, Universal X-ray unit with table, wall bucky and accessories, Hope processor, darkroom equipment, and general office equipment, etc. Also braces and other supplies. Please call 918-453-0023 if you are interested.

Calendar of Events 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.

IMMEDIATE NEED: for FP & ER (and more) Physicians, PAs and NPs: PT, FT and temp jobs. Bimonthly pay. Pd Malpractice and expenses. Call Sonja @ 877-377-3627 and send CV to sgentry@ oklahomaoncall.com Oklahoma D.O. | May / June 2013

August 1, 2013 OOA Board of Trustees Meeting

August 9-11, 2013 2013 OOA Summer CME Seminar:

PAGE 47

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.

July 18-21, 2013 2013 AOA House of Delegates Meeting

Oklahoma D.O.

OFFICE FOR LEASE: Great Location - Central to Norman Reg. Hospital & Healthplex! 2121 W. Main. Approx. 1700 s.f. available, incl. 5 rooms & 3 restrooms. Gas, Elec. & Water paid. Call (405) 3211497 or email adoverstr@yahoo.com. Also for Sale: 2 Hamilton Exam tables. Call (405)321-1497 or email adoverstr@yahoo.com.

June 30, 2013 2013-2014 Oklahoma License Renewal Deadline

Prsrt Std US Postage Paid Okla City OK Permit #209

OKLAHOMA OSTEOPATHIC ASSOCIATION 4848 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105-3335

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The Oklahoma Osteopathic Association has endorsed Rich & Cartmill, Inc. and Medical Protective since 1999

Oklahoma D.O. PAGE 48

Please support your OOA and consider Rich & Cartmill, Inc. for your Professional Liability Insurance needs. For more information contact Scott Selman at 918-809-1461 or sselman@rcins.com

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SPRINGFIELD, MO Oklahoma D.O. | May / June 2013