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Volume 26, No. 2 The Journal of the Arizona Osteopathic Medical Association Summer 2011

Congratulations!

Jan D. Zieren, D.O., MPH, FACOFP, dist AOMA President 2011 - 2012


2011-2012 Board of Trustees President Jan Zieren, D.O., M.P.H. President Elect Thomas E. McWilliams, D.O. Immediate Past President Kelli M. Ward, D.O., M.P.H. Vice President Craig M. Phelps, D.O. Secretary/Treasurer Adam S. Nally, D.O. Executive Director Amanda L. Weaver, M.B.A. Trustees Craig R. Cassidy, D.O. Bradford Croft, D.O., M.B.A. Donald J. Curran, D.O. William H. Devine, D.O. Michelle E. Eyler, D.O. Charles A. Finch, D.O. Jonathon Kirsch, D.O. Christopher J. Labban, D.O. Lawrence R. LeBeau, D.O. Julie A. McCartan, D.O. Jeffrey Morgan, D.O., MA Laurel Mueller, D.O., MBA Kristin Nelson, D.O. Wendell B. Phillips, D.O. Paul M. Steingard, D.O. Anthony Will, D.O. Resident Trustee Danielle Barnett, D.O. Student Trustees Mathew Loesch, AZCOM

Contents

Volume 26 No. 2

S ummer 2011 Features 8 Patient Advocacy – A Myth or Reality? 11 Welcome new AOMA Members 13 Protecting Patients, Improving Care: The Medicare QIO Program 14 Medical Marijuana: Risk Management Strategies for Arizona Physicians 18 AOMA Business Partners 23 Just D.O. It 24 D.O. Day at the Legislature 26 89th Annual Convention Review 29 Student Clinical Case and Poster Competition Results Columns 4 President’s Message 8 From the Desk of the Executive Director 9 What We Have Done For You Lately 36 Practice Management 21 AzHeC Article Ost eopathic Community News 39 AzACOFP President’s Message 40 Midwestern University / AZCOM 42 A.T. Still University 46 Tucson Osteopathic Medical Foundation 49 Advertisers Index

Shaun Garff, SOMA Speaker of the House of Delegates John F. Manfredonia, D.O. Vice Speaker of the House James W. Cole, D.O.

AOMA Staff Listing Assistant Director & Managing Editor Flannery H. O’Neil, MPH Member Services Manager Sharon Daggett Administrative Assistant Teresa Roland

Opinions expressed in the AOMA Digest are those of authors and do not necessarily reflect viewpoints of the editors or official policy of the AOMA, or the institutions with which the authors are affiliated unless explicitly specified. AOMA Digest does not hold itself responsible for statements made by any contributor. We reserve the right to edit articles on the basis of content or length. Although all advertising is expected to conform to ethical medical standards, acceptance does not imply endorsement by this magazine. The appearance of advertising in the AOMA Digest is not an AOMA guarantee or endorsement of the product, service or claims made for the product or service by the advertiser. Copyright 2011

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AOMA Digest Summer 2011


President’s Report Winter 2011-2012

President’s Message

Ahoy Mateys!

Welcome to the USS AOMA… permission to board! We will be sailing the ocean of Healthcare.

A

s your new captain, I accept this duty with honor and will do my best to keep us afloat over the next 12 months. With storm clouds over head and rough waters beneath, our voyage could be pretty wild. However – with this crew (the Delegates) – and Quartermaster Jan D. Zieran, D.O. M. P. H. 2011-2012 AOMA President Weaver, I believe we can take our passengers (our members) on a successful tour over the seven “C”s…

The first “C” — CRISIS – Many label our present health care situation “in a crisis” – Others call it health reform… There is agreement that there is a physician shortage – especially the distribution of physicians over the nation – with decreased access to care for many patients. Several levels of discussion are on decreased funding for those who are uninsured –and there are issues involving residencies. Reimbursement concerns continue for physicians especially with the flawed SGR formula. Is quality now diminished? As it is now, we don’t have a good ranking among industrial nations including access to care, patient safety, timeliness of care and efficiency. Among the four reams of paper in “Obama Care” are attempts at correcting some of the issues.

The next C — CONCERNS – Primary care is dwindling – although there was a bit of an up tick in the primary care resident numbers

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this year. More physicians are needed for the expected increase in patient numbers… but some physicians are changing their practice to med spas or VIP/concierge style which decreases access for patients. Some are retiring earlier than expected – and others are coming back from retirement or a hiatus and have re-licensing issues. Physicians are switching from entrepreneurs to employees. Rural and remote areas could still use physicians. We have HIPAA issues – EMR issues – reimbursement issues – There are always concerns with scope of practice issues – from psychologists requesting prescribing rights – and Naturopaths/Chiropractors/NPs and PAs – Then there are patients who use or abuse the Emergency Rooms – who insist for many reasons on acute/intermittent care instead of an ongoing relationship with a physician for maintenance of care. Patients are not always compliant with life style changes, follow up, medications or other healthy activities. The onus is on the physician and much time is used for paper trails to document the patients’ presence or absence.

The adjacent C COSTS – expenses are up in practices… offices need more employees to keep going. Electronic Medical Records can be an expensive undertaking with software, hardware, IT, learning curve, and the slow down at going “live”. Membership fees in associations are higher. CME costs are still a lot with travel and time off work. With continuous certification there will be new and more expenses. For patients and insurances - End of life costs, hospitalizations, transplants, chemotherapy, anti-rejection meds, or Hep C meds – in fact – many medications have a high dollar price–and add in procedure costs – all of which can keep sick care expensive. About half of all Medicare costs in the last year of life are incurred in the last 60 days. President’s Message cont. page 10


2011-2012 Board of Trustees

2011-2012 Board

of

Trustees

Officers

Jan D. Zieren, D.O., M.P.H., FACOFP, dist. President

Thomas E. McWilliams, D.O., FACOFP President Elect

Kelli M. Ward, D.O., M.P.H., FACOFP Immediate Past President

Craig M. Phelps, D.O., FAOASM Vice President

Adam S. Nally, D.O. Secretary/Treasurer

Amanda L. Weaver, M.B.A. Executive Director

Craig R. Cassidy, D.O., FOCOO Specialists Representative

Bradford D. Croft, D.O., MBA, FACOFP Member at Large

Trustees

Photo not available

William H. Devine, D.O. District 1 Representative

Donald J. Curran, D.O. District 7 Representative

AOMA Digest Summer 2011

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Michelle E. Eyler, D.O. Member at Large

Charles A. Finch, D.O., FACOEP District 3 Representative


2011-2012 Board of Trustees

Jonathon Kirsch, D.O. Member at Large

Christopher J. Labban, D.O. District 4 Representative

Lawrence R. LeBeau, D.O. Member at Large

Julie A. McCartan, D.O. District 6 Representative

Jeffrey Morgan, D.O., MA, FACOI Member at Large

Laurel Mueller, D.O. Member at Large

Kristin Nelson, D.O. District 5 Representative

Wendell B. Phillips, D.O. Member at Large

Photo not available

Paul M. Steingard, D.O., FACOFP, FAOASM District 2 Representative

Anthony Will, D.O. New Physicians Representative

Shaun Garff, SOMA SOMA / A.T. Still University Representative

Danielle Barnett, D.O. Resident Representative

John F. Manfredonia, D.O., FACOFP Speaker of the House of Delegates

Mathew Loesch, PhD, AZCOM AZCOM Midwestern University Student Trustee

James W. Cole, D.O., FAODME Vice Speaker of the House of Delegates

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AOMA Digest Summer 2011


From the Desk of the Executive Director

Communicate… Educate… Advocate

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he summer issue of THE DIGEST is dedicated to the importance of osteopathic physicians in all specialties to be a “patient advocate.” Most physicians have fulfilled this function many times for relatives and friends by calling the treating doctor of a friend for a clarification, informally evaluating a relative’s care, and suggesting that they ask their physicians for a certain test.

First, communicate… The nature of a physician’s job is to be an advocate for your patients. In this health care environment, do you have the time to perform services to help your patients navigate the health care maze? Are you aware that many patients don’t : • have the skills or self confidence to communicate their needs • understand their diagnosis and treatment • know the medical language that the doctor is using • comprehend the results and implications of tests • know why they have been prescribed some medications and what they are taking Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

Next… educate You want to integrate patients as active participants in their own health and well being. Physicians refer to this as “patient compliance” which isn’t interactive. I am referring to “patient responsibility” which leads to “patient empowerment” and education is a key component. This is a partnership between individual patients, their physicians and the patients’ families. There are many websites that are great resources for patient education. Your staff also will need to be educated to provide these resources.

And… Advocate Let’s say you do a great job at communicating with and educating your patients. But have you had the time you need

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to effectively advocate? This could include a personal phone call to a specialist if the patient’s test results are delayed therefore delaying a diagnosis. Or… contacting the insurance company or managed care plan to reconsider a denial of a procedure that the patient needs. Or… spending the time needed to interact with Amanda L . Weaver, M. B.A. AOMA Executive Director family members who do not understand the treatment or even the diagnosis. Or… getting the information needed from the hospitalist and actually knowing that your patient was admitted to the hospital via the emergency room. One of the solutions is the Patient Centered Medical Home (PCMH) which is emerging as a model to provide comprehensive coordination of primary care to adults, youth and children. Please refer to the article on PCMH on page 13 with the Joint Principles of the Patient Centered Medical Home. AOMA’s 2011–2012 President Jan Zieren, D.O. has a goal for AOMA to develop a project which assists D.O.s in advocating for their patients. Dr. Zieren is also President of the Arizona Society of the American College of Osteopathic Physicians (AzACOFP). She has written an empathetic article about those geriatric patients who may not have family or their own health advocate. Her article is on page 39. “You Are Your Patients’ Advocate” was the theme of Past President Chip Finch, D.O. during his first term as AOMA President in 2007–2008. Dr. Finch has written an article on page 12. As you are advocating for your patients, remember that the AOMA leadership and staff are advocating for you and the osteopathic medical profession.


What We Have Done For You Lately

“What We Have Done For You Lately” This regular feature of the AOMA Digest provides members with a recent update of the Association’s activities. We are representing the profession as a healthcare stakeholder and are a voice and are “at the table.” This covers the period from January 15, 2011 – July 1, 2011.

Advocacy/Government Relations • Hosted a successful D.O. Day at the Legislature. See page 24 for more.

• Executive Director representing AOMA is on the board of Health Services Advisory Group (HSAG), Medicare’s Quality Improvement Organization (QIO).

• Testified several times at the Senate and House health committees opposing non-physician clinicians scope of practice expansions. • Lobbied successfully with other healthcare stakeholders for the passage of HB 2620 Medical Records; disclosure, release which allows for electronic exchange of health information.

American Osteopathic Association (AOA) • Executive Director serves on the Bureau of State Government Affairs (BSGA).

Membership/Member Services • Added 19 new members during this period. • Hosted an Office Manager Summit on electronic medical records for over 30 people. • Added new Business Partner: • Williams Real Estate – Sunbelt Realty

Students – the future of the osteopathic profession • Hosted a Student Clinical Case and Poster Competition for all third and fourth year osteopathic medical students in

Community Service • Arizona Osteopathic Charities donated $6,000 to Camp

Arizona. • Arizona Osteopathic Charities awarded $3,500 for

Paz/Stepping Stones of Hope, DOcare, Intl. for the clinic

scholarships and awards for Arizona’s osteopathic medical

in Guatemala, and TOPS free physicals program.

students • Gave a legislative advocacy presentation to the first year

Education • Provided over 30 hours of high quality AOA Category 1-A continuing medical education at the Annual Convention in Scottsdale with a discounted member rate. • Provided a half day of AOA Category 1-A CME in Flagstaff in June.

students at A.T. Still University’s (ATSU) School of Osteopathic Medicine – Arizona (SOMA). • Assistant Director working with students at Midwestern University’s Arizona College of Osteopathic Medicine (AzCOM) and A.T. Still University’s School of Osteopathic Medicine in Arizona (SOMA) to develop programs and increase participation.

Healthcare Community Leadership • Arizona Health-e Connection – Executive Director representing AOMA is a member of the Executive Committee and Board of Directors.

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AOMA Digest Summer 2011


President’s Report Summer 2011-2012

President’s Message cont. from page 4

Additionally, there are rising insurance premiums – CARE – If any group has demonstrated the ability to care, it’s the osteopathic physicians. From individual physicians who are team doctors, or those who serve on missions, or other endeavors… There are group efforts such as TOPS physicals – and more!… All experiences outside our offices are opportunities to educate the public about the difference a DO makes. Many of our physicians step out of their comfort zone and make a positive impact in the world. Even the students – in the osteopathic colleges – have lots of community involvement and projects…and win awards for their efforts. We reach out in many ways. COMMUNICATION – AOMA prides itself on effective communications – through emails, faxes, meetings, the journal, website, “e-letters”, DO Dashboard, mail, phone calls, conventions, committees – there are many avenues to exchange info! AOMA listens to the members. We physicians communicate with our patients – we listen – and we touch… and we teach…. But I miss the “good ole days” – when the physicians’ lounge at the hospital was where one would keep up on so much – from friendship to food – the latest on a case that involved several of the physicians to the political situation – or even a new best seller book… That was a wonderful place for communication doc to doc. I used to have phone calls to thank me for a referral and fill me in on the consult – and now I might – just might – get the records from the ER where a patient showed up. CONNECTION – Advocacy by the AOMA is one of our major functions. Through our lobbyist, Joe Abate, our executive director, Mandy Weaver, and many of our physicians who get involved on D.O. Day we connect with legislators and make our concerns known. We are creating alliances with the AOA and ArMA to

AOMA Digest Summer 2011

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increase our voice and visibility – an increased presence if you will – on mutual issues We also align with health care stake holders on appropriate bills to increase our effectiveness with legislators. The AOMA encourages and supports the physicians who become Health Policy Fellows. There is a list now of several here in Arizona, including our executive director, Mandy Weaver. This group helps in connecting with the legislators.

The final C— COMMITMENT – This is demonstrated in many ways – by many of us… From our loyal members, our delegates, committee members, Health Policy Fellows, our leaders and our staff – the continued service and involvement truly shows our commitment and dedication. So – what if…? What if…instead of concerns about how meaningful this organization is to the members….what if the members took the USS AOMA on a meaningful cruise?? Where would we go – and – what would we do??? With Quartermaster Weaver, the ambassadors (the staff), this captain, the crew (the delegates) and the passengers (our members)…we should be able to mobilize to achieve an admirable accomplishment. Perhaps we could increase access to health care… Or demonstrate improved quality of health care using our osteopathic care. In doing so, we could increase our presence in the health care ocean… We could educate the public about Osteopathic Medicine… And we could market ourselves in the process… Our first “port o call” as we set sail, to start off this tour right…is to christen this ship and celebrate on the quarterdeck around the corner. We will meet several of our legislators at the PAC reception there. This ship leaves port right after the close of the House of Delegates We can weather this crisis – by addressing the concerns, including the costs…and by showing we care. In communicating and making connections, our commitment to this year will make it the best one yet. Anchors aweigh! Bon Voyage…


Welcome New Members

Welcome New AOMA Members _________ First Year Members _________ Rafah Alsahlani, D.O Neurology Scottsdale, AZ Jennessa Hussey, D.O. Family Practice – Board Certified Phoenix, AZ (602) 249-4508 Susan Steffans, D.O. Family Practice – Board Certified Phoenix, AZ (602) 344-6600

Grant Padley, D.O. Orthopedic Surgery – Board Certified

Adriana Aguilera, D.O. Family Practice – Board Certified Laveen, AZ (602) 237-7373

Howard Linzer, D.O. Family Practice – Board Certified & Urgent Care Mesa, AZ (480) 807-0130

Michael Berman, D.O. Internal Medicine – Board Certified Scottsdale, AZ (480) 347-0844

Kathleen Marie Naegele, D.O., MBA, MIS, MPH Internal Medicine – Board Certified & Hematology/Oncology Kingman, AZ (928) 692-4665

Alfonso Castellucci, D.O. Emergency Medicine – Board Certified Laveen, AZ

_________ Third Year Members _________ Steven Nguyen, D.O. Internal Medicine – Board Certified & Pediatrics

____________________________ Full Membership ____________________________

Brian Porvin, D.O. Pulmonary – Board Certified Mesa, AZ (480) 834-0771

Angela DeRosa, D.O., MBA, CPE Internal Medicine – Board Certified Scottsdale, AZ (480) 619-4097

Zinzi Raymond, D.O. Psychiatry Phoenix, AZ (602) 252-7330

Jason Frye, D.O. Family Practice – Board Certified Mesa, AZ (480) 926-8000

Steven Reinhart, D.O. Emergency Medicine – Board Certified Phoenix, AZ

Dov Levine, D.O. Family Practice – Board Certified Surprise, AZ (928) 684-3031

Craig Rundbaken, D.O. Pulmonary – Board Certified Sun City West, AZ (623) 975-0500

Laura L’Heureux, D.O. Obstetrics & Gynecology – Board Certified Cave Creek, AZ

Aparna Sundaram, D.O. Preventive Medicine Scottsdale, AZ

In Memoriam

We are all diminished when one of our number leaves us. We will miss them and strive on for the betterment of our profession in their memory.

Karen J. Stepan, D.O.

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AOMA Digest Summer 2011


Features

Patient Advocacy – A Myth or Reality?

A

s Osteopathic Physicians, we find ourselves busy with

supposed to do, and his

our daily practice, seeing patients in the office and/or

response was “I am not

hospital settings, often finding little to no time to talk

sure – Nobody talked

to effectively communicate to our patients and their family

to me”. We all know

members. This is more of a common occurrence than we

that this is more likely a

would expect.

perception of a routine

Does care get better, or is it our communication that gets

visit, or is it a reality of

better?

what patient’s view as a

Often both go together to provide what it takes to serve

routine visit?

our patients and their families. Recently, a patient returned

Perception and

home from a visit to his physician still in pain from what he

reality often sets in, and

thought was a severely injured right ankle. He fell off his bike

what actually occurred

and “twisted his ankle” during the fall. Unable to walk, he was

Cha rles S. Finch, D.O., FACOEP

is not always what is

carried by his son to the local urgent care. After waiting several

Past President, AOMA

communicated hours

hours for assistance, he was fearful and scared. Eventually

after the visit. Taking

he was examined, and was told he mostly likely had a “bad

the extra 10 minutes of time to speak to each patient and

sprain” to his ankle and he would need x-rays for further

their family after a patient visit goes a long way. The extra

evaluation by their primary care provider or an orthopedic

burden that it takes often will complete the explanation for

surgeon. Appropriate written follow up instructions were

the patient. Understanding what is going on and what to do,

given by the medical assistant, and he was sent home with

generally make all the difference for the patient and

crutches and a script for motrin to take as needed.

their family.

His family asked him what was wrong when he arrived at home and he said “a bad sprain”. Asked what he was

Whether it’s in the hospital or clinic, it’s helpful to have someone at your bedside for explanation, to make sure overworked nurses notice if your vital signs are going downhill, or to ensure that the right medications are given at the right time. It’s good to have someone who can get on the Web and research your disease. It’s important to have someone to take notes during doctor visits and ask the questions you forget. Make time for your patient, and give extra to the families that are present. Often we are so busy that time is not always on our side. Make a difference in the lives of all and be an advocate for your patient. Rest assured that at the end of the day, you will feel refreshed that the extra effort went a long way. It does not require all that much effort. Charles Finch, D.O., FACOEP Past President, AOMA Emergency Physician, Scottsdale Emergency Associates

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Features

Protecting Patients, Improving Care: The Medicare QIO Program Howard Pitluk, MD, MPH, FACS

M

edicare is frequently in the news these days, and that news is often filled with financial concerns and dire warnings. But Medicare is much more than just a health care funding source (insurance company) for elderly, disabled, and ESRD patients. The roles it plays in protecting patients, assisting providers, and improving the U.S. health care system through programs that implement evidence-based health care improvement are frequently overshadowed. A core component of all of these efforts is Medicare’s Quality Improvement Organization (QIO) program. Soon after enactment of the Medicare program in 1965, concerns developed about the quality and cost of health care services provided to beneficiaries.1 In 1972, amendments to the Social Security Act authorized the establishment of what became the precursor to today’s QIO program, new state-based physiciansponsored organizations that could use only local physicians to determine the medical necessity of the services provided, based on local standards of care and practice patterns. The QIO program (Health Services Advisory Group is the QIO for Arizona) has evolved beyond simple review of medical necessity. QIOs are Medicare’s primary resource to help beneficiaries with complaints about care quality–including provider-based appeals, violations of the Emergency Medical Treatment and Labor Act (EMTALA), and other related responsibilities.2 Through those activities, the QIO can often help providers identify system-wide quality problems and provide expert assistance. However, QIOs also implement nationally endorsed evidence-based quality improvement activities that offer better individual patient care, better population health, and lower costs through quality improvement. In the next QIO contract cycle that begins August 1 (the 10th Scope of Work), QIOs will continue to implement national quality improvement projects for hospitals (reducing healthcare-associated

T

infections), nursing homes (reducing healthcare-associated conditions such as pressure ulcers), and physician offices (achieving meaningful use of electronic medical records to improve preventive care and early diagnosis). QIOs will also be working to reduce adverse drug events and improve care transitions across all care settings. If you are an Arizona-licensed physician in active practice who Howard Pitluk, MD, is board certified in your area of MPH, FACS specialty, we encourage you to become involved in the important work of quality improvement and beneficiary protection. If you would like to learn more about how you can begin working with HSAG and the QIO program, please contact the author at hpitluk@hsag.com. Howard Pitluk, MD, MPH, FACS, is Vice President and Chief Medical Officer, and Larry Cooper, MA, who assisted with is article, is Director, Health Education and Publications, at Health Services Advisory Group, Inc. This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-9SOW-XC-061211-01. References

1. Institute of Medicine. 2006. Medicare’s Quality Improvement Organization Program: Maximizing Potential. Washington, D.C.: The National Academies Press. 2. Centers for Medicare & Medicaid Services. Medicare’s Quality Improvement Organizations. Available online at http://www.cms.gov/QualityImprovementOrgs/.

Patient-Centered Medical Home Joint Principles

he physician leads the medical team to offer comfort, convenience and optimal health for their patients throughout their lifetimes. The American Osteopathic Association, American Academy of Family Physicians, American Academy of Pediatrics and the American College of Physicians developed the “Joint Principles of the Patient-Centered Medical Home.” • Personal physician: “each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.”

• Physician directed medical practice: “the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.” • Whole person orientation (hmm... A.T. Still would love this): “the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals.” • Care is coordinated and/or integrated

• Quality and safety are assured by a care planning process, evidence-based medicine, clinical decision-support tools, performance measurement, active participation of patients in decisionmaking, information technology, a voluntary recognition process, quality improvement activities and other measures. • Enhanced access to care is available • Payment must “appropriately recognize the added value provided to patients who have a patient-centered medical home.”

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AOMA Digest Summer 2011


Features

Medical Marijuana: Risk Management Strategies for Arizona Physicians

T

here are few issues in American healthcare that generate more heated discussion than the use of marijuana for medical reasons. The debate may, in part, stem from the strange dichotomy between data supporting cannabis’ benefits and evidence pointing to its adverse effects. Controversial or not, on November 2, 2010, just over 50 percent of Arizona voters (50.13 percent) approved Proposition 203 which resulted in the Arizona Medical Marijuana Act (I-04-2010). Simply put, the Act removes state-level criminal penalties on the use and possession of marijuana by patients who have “written certification” from their physician that marijuana may alleviate his or her condition. The Act allows a “qualifying patient” who has a “debilitating medical condition” to obtain an “allowable amount of marijuana” from a “nonprofit medical marijuana dispensary” and to possess and use the marijuana to treat or alleviate the debilitating medical condition or symptoms associated with the medical condition. The Act also requires the Arizona Department of Health Services (Department) to adopt and enforce a regulatory system for the distribution of marijuana for medical use, including a system for approving, renewing, and revoking the registration of qualifying patients, designated caregivers, nonprofit dispensaries, and dispensary agents. An individual applying for a qualifying patient registry identification card shall have a diagnosis from a physician of at least one of the following debilitating medical conditions: • Cancer; • Glaucoma; • Human immunodeficiency virus; • Acquired immune deficiency syndrome; • Hepatitis C; • Amyotrophic lateral sclerosis; • Crohn’s disease; • Agitation of Alzheimer’s disease; • A chronic or debilitating disease or medical condition or the treatment for a chronic or debilitating disease or medical condition that produces: a. cachexia or wasting syndrome; b. severe and chronic pain; c. severe nausea; d. seizures, including those characteristic of epilepsy; e. severe or persistent muscle spasms, including those characteristic of multiple sclerosis; or • A debilitating medical condition or treatment approved by the Department under ARS 36-2801.01 and R9-17-106. Does this new law mean marijuana is now considered a medication? An important clarification should be noted. This law is not about the use of medical marijuana; it is about the medical use of marijuana. Read that sentence again. It is not about approving a special grade of purified medical marijuana and prescribing it to patients.

AOMA Digest Summer 2011

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There is a synthetic version of THC called dronabinol available by prescription (trade name Marinol®). Dronabinol is approved by the FDA for the treatment of anorexia in AIDS patients and for nausea and vomiting in patients undergoing chemotherapy. It’s a Schedule III medicine, which means that doctors can prescribe it off label (e.g. for things other than nausea, vomiting, and Karen Connell, RN, BSN, MA Ed chemotherapy) and it can be refilled. It’s generally considered to be non-narcotic and to have a low risk of dependence. This drug is available for oral use and is being studied by researchers for suitability via other delivery methods such as an inhaler or patch. There are no FDAapproved medications that are smoked. However, the medical marijuana law is not about prescribing drugs such as dronabinol. Rather, the various medical marijuana acts and legislation allow for physicians to certify to a state agency that the patient may obtain from a state regulated dispensary an unspecified type or grade of marijuana for unspecified methods of administration by the patient to use in alleviating symptoms of various medical conditions specified in state statute. In certain circumstances the patient may even grow their own product. When can I prescribe medical marijuana? It should be noted that Marijuana is a Schedule I Narcotic according to federal law and thus cannot be prescribed by physicians. However in states such as Arizona, who have developed statutes or rules for the medical use of marijuana, a physician may certify that a patient meets state determined criteria for the medical use marijuana. The physician makes a medical determination, completes the documentation required by the state and transmits the documentation as required by statute. Under Arizona law, physician is defined as a Doctor of Medicine, Doctor of Osteopathic Medicine, a Naturopathic Physician or a Homeopathic Physician. A Physician Assistant or Nurse Practitioner is NOT able to certify a qualifying patient under Arizona law. Prop. 203 charged ADHS with creating rules and issuing approvals for medical marijuana cardholders, dispensaries and growers. The law also establishes a confidential state-run patient registry that issues identification cards to qualifying patients. Under the law, the Arizona Department of Health Services adopted rules ‘governing nonprofit dispensaries,’ which may produce and dispense marijuana to authorized patients on a


Features not-for-profit basis. Patients could start applying for medical marijuana cards as early as April 2011, but are not likely to be able to immediately buy legal marijuana, because July is when dispensaries could get approvals to grow marijuana and likely will not have available plants until fall or winter. Does the term “designated caregiver” mean a medical professional? It should be noted that the term does not refer to a healthcare professional but rather a designated person registered by the state who is at least 21 years of age, has agreed to assist with a patient’s medical use of marijuana and has not been convicted of an excluded felony offense. The designated caregiver may not be paid any fee or compensation for his service as caregiver. Some state laws specifically exclude the physician from this role. Arizona law is silent on that point. Can patients from other states obtain medical marijuana in Arizona? No. However, the medical use provisions in Arizona do include reciprocity provisions protecting visitors from other medical use states to use or possess marijuana in Arizona. The act defines a ‘visiting qualifying patient’ as a person ‘who has been diagnosed with a debilitating medical condition by a person who is licensed with authority to prescribe drugs to humans in the state of the person’s residence.’ What are the physicians’ main responsibilities under Arizona law? A physician may provide “written certification” which includes the use of a specific ADHS developed form dated and signed by a physician demonstrating that in the physician’s professional opinion the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient’s debilitating medical condition or symptoms associated with the debilitating medical condition. The physician must: • Specify the qualifying patient’s debilitating medical condition in the detailed, written ADHS developed certification, answering and initialing all questions, as well as explaining the potential risks and benefits of the medical use of marijuana to the qualifying patient. • Sign and date the written certification after the physician has completed a full assessment of the qualifying patient’s medical history and performed an in-person physical examination within the previous 90 calendar days appropriate to the patient’s presenting symptoms and qualifying debilitating medical condition. • Review the qualifying patient’s medical records, including medical records from other treating physicians from the previous 12 months, the qualifying patient’s responses to conventional medications and medical therapies, and the qualifying patient’s profile on the Arizona Board of Pharmacy Controlled Substances Prescription Monitoring Program database. • Attest that, in the physician’s professional opinion, the qualifying patient is likely to receive therapeutic or palliative benefit from the qualifying patient’s medical use of marijuana to treat or alleviate the qualifying patient’s debilitating medical condition. • The physician must disclose to the qualifying patient any personal or professional relationship the physician has with the dispensary.

• The medical director of a dispensary may not provide a written certification for medical marijuana for a qualifying patient obtaining medical marijuana from the dispensary. But isn’t marijuana still illegal under federal law? Yes, however a number of federal rulings have supported physician rights and protection to recommend medical marijuana in states having supporting statutes. On October 19, 2009, Attorney General Eric H. Holder, Jr. issued a memorandum to federal prosecutors in states that allowed for the use of medical marijuana stating: “Federal resources should not be focused on ‘individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of medical marijuana.’” In a statement accompanying the memo he went on to add: “but we will not tolerate drug traffickers who hide behind claims of compliance with state law to mask activities that are clearly illegal.” However a May, 2010 comment by U.S. Attorney for the District of Arizona, Dennis Burke should give pause. Burke reiterated his office’s commitment, under the Controlled Substances Act, to the prosecution of “individuals and organizations that participate in unlawful manufacturing, distribution and marketing activity involving marijuana, even if such activities are permitted under state law” [emphasis added]. The warnings contained in Mr. Burke’s letter are primarily of note for individuals and organizations involved in the commercial aspects of obtaining and distributing the drug. However, physicians making “recommendations” of medical marijuana to their patients and particularly medical directors of dispensaries should take heed. Despite the implementation of the Medical Marijuana Act in Arizona, the substance is a Schedule I drug for which growing, distribution and possession remains a federal offense and punishable under federal law. What about problems from my Medical Board? ADHS will periodically review the demographics of qualifying patients. If

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AOMA Digest Summer 2011


Features ADHS determines that a physician providing written certifications may be engaging in unprofessional conduct, ADHS will provide information to the physician’s licensing board. The new Arizona law states: “A physician shall not be subject to arrest, prosecution or penalty in any manner or denied any right or privilege, including but not limited to civil penalty or disciplinary action by the Arizona Board of Medical Examiners or by any other business, occupational or professional licensing board or bureau, based solely on providing written certifications or for otherwise stating that, in the physician’s professional opinion, a patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient’s debilitating medical condition or symptoms associated with the debilitating medical condition, but nothing in this chapter prevents a professional licensing board from sanctioning a physician for failing to properly evaluate a patient’s medical condition, or otherwise violating the standard of care for evaluating medical conditions. What are the duties of becoming a Medical Director of a Dispensary? The duties of a dispensary’s medical director are substantial and detailed in the Act. They include providing guidance to both staff and clients of the dispensary. The primary responsibility includes the responsibility to develop and provide training to the dispensary’s dispensary agents at least once every 12 months from the initial date of the dispensary’s registration certificate on a number of subjects such as: • Guidelines for providing information to qualifying patients related to risks, benefits, and side effects associated with medical marijuana; • Guidelines for providing support to qualifying patients related to the qualifying patient’s self-assessment of the qualifying patient’s symptoms, including a rating scale for pain, cachexia or wasting syndrome, nausea, seizures, muscle spasms, and agitation; • Recognizing signs and symptoms for substance abuse; and • Guidelines for refusing to provide medical marijuana to an individual who appears to be impaired or abusing medical marijuana; and also • Assist in the development and implementation of review and improvement processes for patient education and support provided by the dispensary. A medical director also has the responsibility to provide oversight for the development and dissemination of educational materials for qualifying patients and designated caregivers that include: • Alternative medical options for the qualifying patient’s debilitating medical condition; • Information about possible side effects of and contrain­ dications for medical marijuana including possible impairment with use and operation of a motor vehicle or heavy machinery, when caring for children, or of job performance; • Guidelines for notifying the physician who provided the written certification for medical marijuana if side effects or contraindications occur; • A description of the potential for differing strengths of medical marijuana strains and products; • Information about potential drug-drug interactions,

AOMA Digest Summer 2011

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including interactions with alcohol, prescription drugs, nonprescription drugs, and supplements; • Techniques for the use of medical marijuana and marijuana paraphernalia; • Information about different methods, forms, and routes of medical marijuana administration; • Signs and symptoms of substance abuse, including tolerance, dependency, and withdrawal; and • A listing of substance abuse programs and referral information; A Medical Director is also responsible for developing and maintaining a system for a qualifying patient or the qualifying patient’s designated caregiver to document the qualifying patient’s pain, cachexia or wasting syndrome, nausea, seizures, muscle spasms, or agitation that includes: • A log book, maintained by the qualifying patient and or the qualifying patient’s designated caregiver, in which the qualifying patient or the qualifying patient’s designated caregiver may track the use and effects of specific medical marijuana strains and products; • A rating scale for pain, cachexia or wasting syndrome, nausea, seizures, muscles spasms, and agitation; • Guidelines for the qualifying patient’s self-assessment or, if applicable, assessment of the qualifying patient by the qualifying patient’s designated caregiver; and • Guidelines for reporting usage and symptoms to the physician providing the written certification for medical marijuana and any other treating physicians; and A Medical Director is also responsible to develop policies and procedures for refusing to provide medical marijuana to an individual who appears to be impaired or abusing medical marijuana, and a medical director for a dispensary shall not pro­vide a written certification for medical marijuana for a qualifying patient obtaining medical marijuana from the dispensary. That’s a lot of responsibility! How can I reduce my Risks? A risk/benefit analysis is the starting point for physicians considering this new practice. As medical marijuana is now a reality, physicians and others authorized by the law should begin obtaining the knowledge necessary to determine if they will include such treatment in their practice. Now is the time for education and careful, knowledgeable deliberation of whether you should or should not certify your patients for medical marijuana use. It should be noted that physicians and other healthcare providers with prescribing authority under Arizona law are not required to meet a patient’s request for a recommendation to the medical marijuana program. You should develop a well thought out policy in your practice for whether or not you want to enter these uncharted waters of medicine. It is not appropriate for every physician or even every specialty, for example, to recommend medical marijuana. It remains primarily for those who treat patients with chronic debilitating diseases. Considering the patients at highest risk of complications for marijuana use are those for whom it allegedly has benefit, physicians should carefully evaluate the risks involved before recommending marijuana use. If you decide your patient population may benefit from this therapy and you are willing


Features to make that recommendation, it is important that you become knowledgeable in several areas and be willing to take the following steps. Physicians who plan to provide certification to qualifying patients for medical marijuana, in addition to careful completion of state required documents SHOULD: • Inform your medical liability carrier of this new area of your practice. • Be knowledgeable about your role and responsibilities under state law. • Acquire knowledge, training or even certification in addiction medicine. • Have a demonstrable knowledge of the physiologic effects of marijuana, its side effects and its interaction with other drugs before prescribing it. • Recommend marijuana only in the context of an ongoing physician patient relationship. • The examination for the condition for which medical marijuana is being recommended must be in-person and have occurred in the last 90 days. • Document that the patient has failed to respond to other conventional medications to treat his/her ailment. • Document a treatment plan with goals and objectives for the use of medical marijuana. • Determine if the patient has misused marijuana or other psychoactive and addictive drugs before recommending the patient for medical marijuana. • Document (including a signed informed consent form) that the patient was counseled regarding the medical risks of the use of marijuana – at a minimum to include infection, pulmonary complications, suppression of immunity, impairment of driving skills, and habituation. • Periodic reviews should occur and be documented at least annually or more frequently as warranted. • If marijuana is to be directed at helping pain control issues, consider utilizing pain scales, pain diaries, and any other patient centered data collection devices that might assist in evaluating the drug’s effectiveness. Be sure to document thoroughly. • Take steps to determine that medical marijuana use is not masking an acute or treatable progressive condition, or that such use will lead to a worsening of the patient’s condition and document your findings. • If a physician recommends or approves the use of medical marijuana for a minor, the parents or legal guardians must be fully informed of the risks and benefits of such use and must consent to that use. This should only be done in a very narrow context and is beyond the scope of this article. • Physicians should NOT: • Assist patients in obtaining marijuana. • Dispense marijuana. • Cultivate or possess marijuana for patient use. • Profit in any way from a dispensary which provides medical marijuana. • Physically assist patients in using marijuana. • Recommend marijuana without a justifiable medical cause. To reduce risks, as a prospective Medical Director you

SHOULD: • Be knowledgeable about your role and responsibilities under state law. • Acquire knowledge, training or even certification in addiction medicine. • Obtain knowledge of the physiologic effects of various strains and forms of administration of marijuana, possible side effects and interaction with other drugs in order to evaluate and educate dispensary patients, caregivers and staff. • Carefully follow all provisions of the law concerning effective oversight of the dispensary staff and patients. The medical director SHOULD NOT be an active participant in the activities of the dispensary or cavalier in making appropriate recommendations concerning medical needs of the qualified patients with special attention to substance abuse or the danger of masking of an underlying medical condition. How do you avoid substance abuse in these patients? It has been demonstrated in other states that many chronic marijuana users are also poly substance users and adding marijuana to chronic use of opiates could expose them to medication interactions and more significant and potentially dangerous side effects than the marijuana itself. Here are a few suggestions to reduce the risks: • Consider providing periodic drug testing for medical marijuana users and exclude from certification patients who are found to be using illicit drugs. • For those on prescription opioids, your documentation should demonstrate whether the patient is getting any benefits from the marijuana use, is experiencing any side effects, or is having other co-morbid problems associated with the chronic pain (e.g., depression, anxiety disorder, sleep, cognitive disturbance, memory problems, or other behavioral issues such as isolation and withdrawal). • If the chronic marijuana use is worsening or interfering with the management of the underlying condition, then the risk/ benefit profile for ongoing marijuana use would suggest that the treating physician should recommend that the marijuana use be stopped. • If the patient resists your recommendations and refuses to adapt their marijuana usage despite well-documented negative consequences of the marijuana use, then documentation in the medical record will assist in any medical legal challenges. • Consider discharging from care or transferring to an addiction specialist those patients whose marijuana use suggests abuse and dependence. As you can see, like any other expanded area of practice, the decision to enter into the process of certifying a patient for the medical use of marijuana should not be taken lightly. Careful deliberation of risks and benefits should be undertaken as you educate yourself about your responsibilities under the law. Detailed information can be found at http://www.azdhs.gov/

For more Risk Management recommendations, insureds may call the RM “Hotline” at 602-808-2137or 800-352-0402 and ask for the RM Hotline.

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AOMA Digest Summer 2011


Business Partner Listings

AOMA Business Partners

Provide Services for a Health Practice and your Finance USE YOUR MEMBER DISCOUNT

Answering Service

A Professional Image Answering Service

Lori Horton, General Manager 1140 S. San Jose Dr., Ste.1 Mesa, AZ 85202 (480) 921-1300 www.aprofessionalimage.com A Professional Image (API) sets the pace of excellence in providing nationwide TELEPHONE ANSWERING SERVICE to the medical industry. API offers many new features such as customized accounts, 2-way text messaging (SMS), and wrap-up announcements. They are a friendly, professional service that offers many benefits as well as HIPAA compliant.

Appointment Reminders

Notifymd (formerly Medvoice)

• connecting patients and physicians one call at a time. • A provider of patient communication services – live and automated. Jodi Selko (480) 481-9292 877-553-5377 Direct jselko@notifymd.com http://www.notifymd.com • Appointment Reminders • Answering Services • Confidential Messaging • Patient Outreach Calls • Daytime Call Management

Jean Ann Morris 100 W. Washington, 4th Floor Phoenix, AZ 85003 (602) 528-3036 Jean.Ann.Morris@wellsfargo.com www.wellsfargo.com Wells Fargo provides many products and services tailored to meet the needs of any medical practice including all forms of comprehensive Professional and Personal Insurance, Financial Planning, Practice Credit Lines, SBA and Conventional Financing for real estate or equipment, and discounted Merchant Card and Banking Services exclusive to AOMA Members.

Billing & Collections

ABC Medical Billing Consultants

Elizabeth Peralta 4441 E. McDowell Rd. Phoenix, AZ 85008 ElizabethP@ABCMedical.net www.ABCMedical.net ABC Medical Billing Consultants is a professional practice management firm partnering in all types of medical specialties nationwide since 1992. We do Billing, Certified Coding, Practice Management, Credentialing, Contract Negotiations, HIPPA Compliancy, IT Management and InOffice Medication Dispensing Program. When you hire ABC Medical you are partnering with profitability and the knowledge that your practice is reaching its maximum potential. ABC Medical is bonded, insured and licensed by the Arizona Department of Financial Institutions.

J.R. Brothers Financial, Inc.

Bank Card Processing

Affinipay

Visit the AOMA website, Member Services Business Partner Listings or call (800) 644-9060 Ext. 6974 AOMA members are entitled to a very special processing package from Affinipay. Their on-line reporting lets you quickly see your deposit and payment information.

Banking Services

U.S. Bank

David Baxter Home Mortgage/Equity Loans 17851 N. 85th St., Ste. 205 Scottsdale, AZ 85255 (480) 221-0819 david.baxter@usbank.com Contact David Baxter, AOMA’s representative for all banking services. He will direct you to additional representatives with access to customized Investment Management, Personal Trust, Private Banking, Insurance and Financial and Estate Planning Services to clients who want an integrated, personalized approach to achieving their unique financial goals.

AOMA Digest Summer 2011

Wells Fargo

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Robert Antenucci – President (602) 371-1001 www.jrbfinancial.com jeff@jrbfinancial.com J.R. Brothers Financial, Inc. (JRB) is a medical collection agency since 1986. AOMA members are offered a lower collection fee with exceptional service and recovery. Clients can access the status of their accounts online through the JRB Client View Program.

Car Rental

Avis & Hertz

Discount coupons available through the AOMA Office, call (602) 266-6699 or our toll free number (888) 266-6699. You may also request coupons by emailing sharon@az-osteo.org, or go to the AOMA website www.az-osteo.org and under Member Services, select Business Partner Services.

Financial Planning

Mosaic Financial Associates Anthony C. Williams, President 4650 E. Cotton Center Blvd. #130 Phoenix, AZ 85040 480-776-5920 Fax: 480-776-5925 anthony@mosaicfa.com


Business Partner Listings Mosaic Financial Associates provides a holistic approach to wealth management. They believe your financial advisor should provide a pathway to the financial goals you dream of and work hard to achieve, while taking into account all aspects of your life and building a long-term relationship based on trust and top-notch service.

Strategic Wealth Solutions An Office of MetLife

480-638-2211 Fax (480) 638-2200 Kathryn A. Marchwick, CFP® Financial Services Representative Jonathon Staats, Financial Services Representative 60 E. Rio Salado Pkwy., Suite 610 Tempe, AZ 85281 Their purpose is to enrich the financial aspects of the doctor’s practice and personal lives through knowledge, integrity and personal service beyond expectations. They will work with you and your tax and legal advisers to help you select the most appropriate product solution to suit your specific needs and circumstances. Metropolitan Life Insurance Company (MLIC), 1095 Avenue of the Americas, NY, NY 10036. Securities offered by MetLife Securities, Inc. (MSI) (Member FINRA/SIPC). MLIC and MSI are MetLife, Inc. companies.

Health Information Technology

Information Strategy Design (ISD)

Michele Liebau (480) 970-2255 x107 michele@isdesign.com Information Strategy Design (ISD) is a leading healthcare technology solutions provider with its central office in Mesa. ISD has been providing network design and implementation to Heathcare Practices in the South West since 1996. ISD’s focus is on medical practices to allow them to provide cost-effective computer networking, telephony, off-site backup and remote monitoring. ISD’s value offering to AOMA members allows for one time and ongoing discounts based on using two or more ISD services.

InVision Technology Solutions

Sandra Juarez 4745 N. 7th Street, Ste. 215 Phoenix, AZ 85014 sandra.juarez@invisionaz.com http://www.InVisionaz.com InVision Technology Solutions is a complete IT solutions provider for the medical industry including; network design, server configuration and installation, EMR/PM implementation, phone system solutions and all your on-going computer support. For a complimentary consultation, please contact Sandra Juarez.

MD Tech Pro

IT & EMR Solutions for Medical Practices Libby Murphy (480) 463-4638 | (888) 638-3242 libby.murphy@mdtechpro.com http://www.mdtechpro.com Based in Phoenix AZ, MD Tech Pro is the national leader in IT and EHR solutions for medical practices and your strategic partner for all healthcare technology needs. They have been providing pro-active, top-flight technical services in the medical community since 1997 and focus exclusively on working with healthcare clients. You get enterprise-level IT support with comprehensive expertise to tackle any challenge, without the overhead. We are pleased to extend the following special pricing for valued AOMA members: 10% off all support agreements and free IT or EMR evaluation consultation.

Noteworthy Medical Systems

Woody Howard (602) 277-6277 x5515 whoward@noteworthymedical.com Noteworthy Medical Systems is a leading provider of software and solutions to ambulatory healthcare specialties. Their web-based PM, EHR and ePrescribing applications surpass typical functionality by enabling individual providers, hospitals, health systems and other data providers (labs, radiology, pharmacies, etc.) to securely exchange crucial healthcare data for improved care and communication. Noteworthy is offering AOMA members a 10% discount on these products. Insurance

AFLAC

Karen Jones, Independent Agent 16211 N Scottsdale Rd., Ste. A6A 614 Scottsdale, AZ 85254 (602) 229-1970 x213 No Deductible, No Copay, No Preauthorization. AFLAC supplemental insurance policies are available at special Association Rates for AOMA members and their families.

Ian B. Ackerman, Ltd.

4747 N. 7th Street, Ste. 426 Phoenix, AZ 85014 (602) 265-8093 Offers discounted premiums on disability insurance. They can review your current insurance programs to determine if your discounts offset your dues.

Mutual Insurance Company of Arizona

(602) 956-5276 (800) 352-0402 www.mica-insurance.com Each medical practice is unique with individual risk management needs based on specialty and practice characteristics. Their experienced Risk Management Consultants can assist you in assessing and providing service designed to reduce your risk of a malpractice claim or suit. MICA is owned by all of the physicians it covers and provides educational grants to AOMA.

Legal – Disability Insurance Claims and Healthcare Litigation

Comitz Beethe

Edward O. Comitz, Esq. Scottsdale Spectrum 6720 N. Scottsdale Rd., Ste. 150 Scottsdale, AZ 85253 (480) 998-7800 Fax (480) 219-5599 ecomitz@cobelaw.com www.disabilitycounsel.net Mr. Comitz has extensive experience in disability insurance and healthcare litigation, representing physicians in reversing the denial or termination of their disability insurance benefits. Mr. Comitz has earned a national reputation for prosecuting claims based on fraud and unfair practices in the insurance industry. A free consultation is provided to AOMA members.

Medical Record Scanning & Management

Access Information Management

Woody Colebank (623) 478-9393 Fax (623) 478-0777 wcolebank@accesscorp.com Access Information Management of Phoenix is a national Information Security and Records Management company with services including records storage and management on both a box level and chart/file level, certified document destruction, scanning (for both independent files or to electronic

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AOMA Digest Summer 2011


Business Partner Listings record management systems), and data/media storage and rotation services. Call for a no-obligation cost analysis to see what ways they can help you efficiently and securely manage your records today. Access Information Management offers a 10% discount for AOMA members.

Payroll Processing

Automatic Data Processing (ADP)

Alisa Jones, Regional Account Specialist (602) 677-0333 alisa_jones@adp.com ADP is able to provide AOMA members with a user friendly way to streamline the payroll process, improve productivity, and simplify administration on a year-round basis. In addition ADP’s tax services ensure your company’s compliance with local, state, and Federal regulations as well as automatically calculating, filing, depositing, and reconciling your payroll taxes. They offer all new clients a 20% discount on ADP services. Other Available Services: Retirement Plans, Background Checks, Time & Attendance Systems, Human Resource Assistance, Workers compensation, etc.

Human Capital Strategies

Nick.Mawrenko (480)577-2552 nick.mawrenko@hcscando.com www.hcscando.com Human Capital Strategies is a national provider of Professional Employer Organizations (PEO) Services, Administrative Services, Organizations (ASO) Services, and Payroll Services. Managing every aspect of payroll, human resources, taxes, employee benefits, 401(k) plans and workers’ compensation management is what makes Human Capital Strategies “the next best thing to no employees!” Human Capital Strategies offers a 10% discount and $0 setup fees for AOMA Members.

Practice Management

Sunbelt International Consulting, LLC Family Medicine Center 2000 W. Bethany Home Rd. Phoenix, AZ 85015 (602) 380-6012 info@sunbeltinternationalconsulting.com www.sunbeltinternationalconsulting.com

Sunbelt is owned and operated by a practicing physician who not only consults on practice management, but also actually runs a medical practice on a day-to-day basis. They provide comprehensive and practical business management solutions to solo and group practices.

Wolfe Consulting Group

Patrick Hayden, Consultant (602) 324-0416 patrick.hayden@wolfecon.com AOMA members will receive a free initial problem definition meeting and also receive a discount on a wide array of business consulting services. Services, from Improving Income to Practice Sale for Retirement, will serve as the basis for the free initial consultation. A listing of these services can be reviewed at www.wolfeconsultinggroup.com. Real Estate services from Office Leasing to Building Purchase are also available through a wholly owned subsidiary of Wolfe Consulting Group, Ltd., Healthcare Realty Advisors, Inc., at no direct cost to AOMA’s members.

Real Estate

Medical Office Brokers

Aaron Kuhl, Designated Broker (480) 947-5845 aaron@arizonamob.com www.arizonamob.com Medical Office Brokers (“M.O.B.”) is focused exclusively on representing medical tenants and buyers in their commercial real estate transactions and does not represent owners.

Williams Real Estate – Sunbelt Realty

Kevin Weil, Realtor (602) 793-7492 kevin@kevinweil.com Kevin Weil of the Williams Real Estate Group is one of the top realtors in the valley and specializes in serving the needs of physicians. AOMA members are entitled to video previewing of homes of interest and other services uniquely designed to save the time of, and maximize the interests of AOMA members. Kevin and Williams Real Estate have selected Arizona Osteopathic Charities as the charity to receive a donation based upon member participation.

Staffing

Jobing.com

Robin Shulman Industry Specialist (602) 200-6800 robin.shulman@jobing.com Jobing.com provides AOMA members with a discounted online local employment advertisement source. Robin Shulman, Healthcare Industry Specialist, is available to help our members with writing ads, posting positions online and answering any questions that come up.

AOMA Digest Summer 2011

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Features

Arizona Regional Extension Center Update

REC to Provide Free Membership and Services until End of 2012 or Goal Met. Approximately 700 free memberships still available to eligible providers.

T

he Arizona Regional Extension Center (REC), officially endorsed by AOMA, has federal funding to offer 1,958 primary health care providers “hands-on” technical assistance to become Meaningful Users of electronic health records (EHRs) and receive federal incentives, if eligible. Originally, the REC planned to have a fee structure associated with REC membership and services to help support a 10 percent match the program must meet. However, due to the positive response to REC membership and services among Arizona health care providers, the REC will continue to offer free membership and services until the end of 2012 or until the program reaches its 1,958 recruitment goal. This means that approximately 700 more Arizona primary care providers can join the REC to receive services (estimated at $25,000) at no cost.

To date, nearly 1,300 Arizona health care providers have joined the REC and are leading the way to recognizing the benefits of EHRs and health IT for their practice and patients. Dr. Bradford Croft, an AOMA Board member and family physician in Flagstaff, is an early EHR adopter. He joined the REC to demonstrate support for the program and serve in an advisory capacity, offering his knowledge and lessons learned to other physicians who are making the transition to EHRs and Meaningful Use. Dr. Croft recently shared his views with the REC about EHRs in an interview that can be viewed at http://www. youtube.com/user/AZHealtheConnection. Hear Dr. Bradford Croft’s views on electronic health records at http://www.youtube.com/user/AZHealtheConnection.

Learn More!

If you are interested in learning to see if you qualify for free REC membership and services, please contact the REC at her@azhec.org or by phone at (602) 688-7200.

Hear Dr. Bradford Croft’s views on electronic health records at http://www.youtube.com/user/AZHealtheConnection.

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AOMA Digest Summer 2011


Just D.O. It

Just D.O. It Kellen Hansen, OMS III

Editor’s note: “Just D.O. It” is a continuing series in the AOMA Digest. Each column highlights an AOMA member and his or her community involvement. We hope the column provides recognition to some of our hard-working D.O.s and at the same time, provides readers with inspiration to get involved in community service.

E

ver since serving a two year mission for his church in Guatemala, third year medical student Kellen Hansen has been captivated by the nation and its people. There he was inspired to pursue a medical degree so that he could continue to give back to communities and nations where resources and care are not easily accessible. He jumped at the opportunity to return to Guatemala in 2011 on a DOCARE trip with Midwestern University. DOCARE International, NFP provides medical outreach to indigent and isolated people in remote areas in the world. DOCARE was founded in 1961 by an osteopathic physician and uses volunteer services of physicians, medical students, various other medical professionals, and lay people. In Guatemala, it is often difficult to access health care services, especially primary care. Those in need of hospital care may have to travel upwards of half of a day to reach the nearest facility. The beauty of the DOCARE program is that prior to the trip the planning teams determine the areas most in need of medical outreach. From there, they determine what supplies they need to collect for the trip. Kellen was responsible

for the acquisition and transport of over 70 different medications, which he was able to procure with the assistance of his community health center in Washington, Healthpoint. Once on site, the volunteers provided eight days of clinics in four locations. They saw patients from 8:30am – 4:00pm each day, averaging 350 visits per day. Throughout the eight days, Kellen reported that they saw a total of over 2,800 medical patients, 1,000 vision patients, and 300 dental patients. Inspired by this and his other trips, Kellen along with the SOMA DOCARE club already have plans to return to Guatemala in April 2012. They hope to recruit 50 – 60 volunteers for the trip including roughly 30 physicians and medical students. In addition to the traditional mission activities, the SOMA group plans to interact with local physicians and health workers to gain a greater understanding of the local healthcare system and hopes to engage local people and health workers with skills and knowledge to

create a lasting effect from their trip. If you are interested in joining or supporting the 2012 SOMA trip, you may contact Kellen at kellenh@gmail.com.

Kellen Hansen is a third year medical student at A.T. Still University’s School of Osteopathic Medicine in Arizona (SOMA). He is currently studying at SOMA’s Washington State community campus. Kellen was the first recipient of the new DOCARE Travel Scholarship from the Arizona Osteopathic Charities, which was established to encourage osteopathic medical students to participate in DOCARE missions by offsetting some of their costs.

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AOMA Digest Summer 2011


D. O. Day

2011 D.O. Day at the Legislature

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1. Amanda Weaver, MBA leads the D.O. Day Orientation. 2. School of Osteopathic Medicine in Arizona (SOMA) student Melissa Blessing, Patrick Hogan, D.O., and Jeffrey Morgan, D.O., MA attend D.O. Day Orientation and learn health-related bills. 3. Senator Nancy Barto spoke with the D.O. Attendees about the work she does as the Chair of Senate Health Committee. 4. Michael Ward, D.O. poses with his legislator, Senator Ron Gould. 5. A.T. Still University School of Osteopathic Medicine in Arizona (SOMA) students in front of the Arizona Capitol Building.

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Thank You for Providing our Strength in Numbers at the

2011 D.O. Day at the Legislature

Claudia Alvarez Abigail Alviar Chad Andicochea Leo Bay Ryan Bleck Melissa Blessing Maxwell Braverman Stephanie Butler, AZCEP David Capaccio, D.O. Alice Chen Sharon Chi Jin Choi Randal Cieslak James Dearing, D.O. Estelle Farrell-Nierenberg, D.O. Charles Finch, D.O. AOMA Digest Summer 2011

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Stuart Friedman, D.O. Lindsey Frischmann Samuel Galima Brian Goodman Leah Hess Patrick Hogan,D.O. Kim Joon Mitchell Kasovac, D.O. Lori Kemper, D.O., M.S. Jonathon Kirsch,D.O. Stephen Kwak Elizabeth Langmore-Avila Lorrance Majewski Robert Marotz, D.O. Kit McCalla, D.O. Thomas McWilliams, D.O.

Joshua Menefee Jeffrey Morgan, D.O., MA Adam Nally, D.O. Craig Phelps, D.O. Howard Shulman, D.O. Moina Snyder Leonard Staff, D.O. Isaac Theerman Bret Uhler Gillian Wackowski Kelli Ward, D.O., M.P.H. Michael Ward, D.O. H.C. Watters, D.O., M.P.H. Sutira Wendt Heather Westemeyer Holly Yuan


Eighty-ninth Annual Convention

2011 AOMA Convention Exhibitors A.T. Still University Allscripts American Osteopathic Association Ameritox Arizona Air National Guard Arizona Health-e Connection Arizona Heart Institute Arizona Osteopathic Charities Arizona Society of ACOFP Asterino & Associates, Inc. Astra Zeneca Pharmaceuticals Auxilium Pharmaceuticals, Inc. AZ State Assoc of Physician Assistants BlueCross BlueShield of Arizona Boehringer Ingelheim Pharmaceuticals Calloway Labs Cancer Treatment Centers of America Comitz Beethe Cryopen Inc. CryoProbe Dr. Fuji Cyber-Relax e-MDs General Southwest Risk Management

Genzyme Biosurgery Grace Hospice Greenway Medical Technologies Health Outreach through Medical Education (H.O.M.E.) Hospice Family Care Hospice Inspiris Hospice of the Valley Humana Information Strategy Design (ISD) InVision Technology Solutions itSynergy/gloEMR Kowa Pharmaceuticals Lifeprint LipoScience Lippincott Williams & Wilkins MD Tech Pro Medical Billing Group West, LLC Medvoice International, LLC Merck Midwestern University. Mutual Insurance Company of Arizona (MICA)

NMT Centers Novasom, Inc. Phoenix Children’s Hospital Provident Medical Telemessaging Reckitt Benckiser Rosewood Centers for Eating Disorders Sage Software Healthcare, LLC Scoliosis Rehab Inc. SGA Medical Solutions SimonMed Imaging Sojourner Center Sonora Quest St. Joseph’s Hospital Takeda Pharmaceuticals Tucson Osteopathic Medical Foundation U.S. Army Medical Recruiting Valley Pain Consultants Williams Real Estate - Sunbelt Realty Wolfe Consulting Group LTD Women’s International Pharmacy Xlear, Inc.

Platinum Mutual Insurance Company of Arizona SILVER BlueCross BlueShield Tucson Osteopathic Medical Foundation

“Thank You” to our 89th Annual AOMA Convention Sponsors

Platinum Sonora Quest

“Thank You” to these organizations and individuals for their support as part of this year’s 89th Annual AOMA Convention Arizona Society of the American College of Osteopathic Family Physicians (AzACOFP) Gilead Sciences, Inc. LipoScience Novartis Vaccines and Diagnostics, Inc. The France Foundation

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AOMA Digest Summer 2011


Osteopathic Community News

Arizona Osteopathic Medical Association hosts 89th Annual Convention

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3 1. Incoming President Jan D. Zieren, D.O., MPH presents outgoing President Kelli M. Ward, D.O. with a thank you gift. 2. Kelli M. Ward, D.O., MPH presents Fred Schwartz, D.O. with the “Excellence in Osteopathic Medical Education Award.” 3. David Parrack, D.O. receives the “Outstanding Mentor Award” from Kelli M. Ward, D.O., MPH. 4. Charles A. Finch, FACOEP is presented with the “Physician of the Year Award.”

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Osteopathic Community News

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6 5. Bradley Downing, D.O. accepts the “Humanitarian of the Year Award” from Kelli M. Ward, D.O., MPH. 6. Kelli M. Ward, D.O., MPH presents MICA CEO James Carland, M.D. with the “Distinguished Service Award.” 7. Craig Hoffbauer, D.O. accepts the “President’s Award” from Kelli M. Ward, D.O., MPH

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AOMA Digest Summer 2011


Eighty-ninth Annual Convention

AOMA PHYSICIAN OF THE YEAR AWARD The Arizona Osteopathic Medical Association Physician of the Year Award is the highest honor for a member who: Provides his/her community with compassionate, comprehensive and caring medical services on a continuing basis; Is directly and effectively involved in community affairs; and supports his/her community, state, professional associations and humanitarian program. Those who have gone to an emergency room in the Scottsdale Health Care System may have been lucky if they were treated by Charles Finch, D.O., an E.R. physician, who really cares about the patients and will advocate for them. Dr. Finch was AOMA’s President for two terms and has served on almost every committee. He is an educator at AZCOM. He was appointed by Governor Napolitano to a Task force to develop recommendations to address the Emergency Department crisis in Arizona he was the only ER physician on the task force of 25 people. Dr. Finch founded Camp Paz which is a grief camp for children who lost a close family member. Under his leadership, it now is one of many programs in Stepping Stones of Hope, a charitable non-profit. He recently received the coveted Hon Kachina Award for his leadership with Stepping Stones of Hope. He also is involved in Camp-nota-Wheeze.

AOMA H. TED PODLESKI DISTINGUISHED SERVICE AWARD The H. Ted Podleski Distinguished Service Award honors a physician or non-physician who has significantly contributed to improving the community and promoting osteopathic medicine. This year, AOMA honored Dr. James Carland, CEO of Mutual Insurance Company of Arizona or better known as MICA. He has been a leader in medical liability insurance reform and physician workforce issues. He is a good friend of the osteopathic medical family in Arizona.

AOMA PRESIDENT’S AWARD The AOMA President’s Award honors an AOMA member who has contributed significantly to the AOMA via the Board of Trustees, House of Delegates and/or Committees. This year’s award winner was Craig Hoffbauer, D.O. who has served as Chair of the Public Awareness Committee for 14 years. He will be passing the torch to Jonathon Kirsch for this committee. Dr. Hoffbauer is Past President of the Association.

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AOMA EXCELLENCE IN OSTEOPATHIC MEDICAL EDUCATION AWARD The Excellence in Osteopathic Medical Education Award honors a physician or non-physician who has contributed significantly to the advancement of osteopathic medicine in Arizona. Fred Schwartz, D.O. is an outstanding educator having national impact with extensive experience in grant writing. Dr. Schwartz has had considerable impact on both of Arizona’s osteopathic schools.

AOMA HUMANITARIAN AWARD This award honors a socially responsible AOMA member who has donated his/her time and/or efforts to improve mankind. Bradley C. Downing, D.O. has been involved for years with Sunshine Acres, a faith based organization for children in the East Valley which is run solely by private contributions. Dr. Downing is Immediate Past President of the Arizona Society of the American College of Osteopathic Family Physicians.

AOMA OUTSTANDING MENTOR AWARD The AOMA Outstanding Mentor Award honors a physician who has volunteered his time to students or physicians as a mentor and is known as “one who makes a difference” in that person’s life. David Parrack, D.O. has mentored students in developing surgical skills needed to survive in a surgical residency. He also routinely spends hours supporting student clubs and individuals who want to be surgeons in the future.

AOMA VOLUNTEER OF THE YEAR AWARD This award honors those who have volunteered their time and provided significant contributions and services to the community and/or the association. James Cole, D.O. has continued with AOMA activities although he works part time. He is Vice Speaker of the House and an active member of the Legislative Affairs Committee. His passion is the DOCARE International Program.


Eighty-ninth Annual Convention

Aoma Student Distinguished Service Awards This award honors a student currently enrolled in an osteopathic medical school that has provided significant contributions and service to the school, community and/or the Association.

Arizona College of Osteopathic Medicine (AZCOM) Awardee – Maxwell Braverman

Kirksville College of Osteopathic Medicine School of Osteopathic Medicine in Arizona (KCOM) Awardee – (SOMA) Awardee – Joshua Behlmann Brandon Abbott, MPH

Previous Recipients of AOMA Special Recognition Awards Physician of the Year Award 1995 Karen J. Nichols, D.O. 1996 Stanley Brysacz, Jr., D.O. 1997 F. Timm McCarty, III, D.O. 1998 William Inboden, D.O. 1999 Joseph J. Lovett, D.O. 2000 Nicholas Pazzi, D.O. 2001 John F. Manfredonia, D.O. 2002 David Bryman, D.O.

2003 Steven Pitt, D.O. 2004 Paul M. Steingard, D.O. 2005 Craig E. Hoffbauer, D.O. 2006 Lori A. Kemper, D.O. 2007 Kelli M. Ward, D.O., M.P.H. 2008 Carrol E. Wheat, D.O. 2009 James Dearing, D.O. 2010 Jan D. Zieren, D.O., M.P.H.

H. Ted Podleski Distinguished Service Award 1995 Jerry Colangelo 1996 Ted Podleski 1997 Mutual Insurance Company of Arizona 1998 Robert Bohm 1999 Paul M. Steingard, D.O. 2000 U.S. Senator Jon Kyl 2001 State Senator Susan Gerard 2002 Karen J. Nichols, D.O.

2003 Shirley Carpenter 2004 Marge Croushore 2005 Ross Kosinski, Ph.D. 2006 Senator Robert Cannell, M.D. 2007 Lew Riggs, Ed.D. 2008 Bradford Croft, D.O., M.B.A. 2009 Arizona Medical Association 2010 Senator Carolyn S. Allen

President’s Award 1996 John F. Manfredonia, D.O. 1997 Harmon L. Myers, D.O. 1998 Leonard Staff, Jr., D.O. 1999 Craig E. Hoffbauer, D.O. 2000 Lori A. Kemper, D.O. 2001 Karen J. Nichols, D.O. 2002 Lawrence K. Sands, D.O. 2003 Nicholas C. Pazzi, D.O.

2004 Deborah M. Heath, D.O. 2005 Jeffrey W. Morgan, D.O. 2006 Jan Zieren, D.O., M.P.H. 2007 Bradford Croft, D.O., M.B.A. 2008 Sanford Moretsky, D.O., FACOO 2009 Thomas McWilliams, D.O. 2010 Michael Altamura Jr., D.O.

Humanitarian Award 1999 Kenneth E. Root, D.O. 2000 Lawrence R. LeBeau, D.O 2002 Thomas W. Eyler, D.O. and Charles (Chip) Finch, D.O. 2003 Thomas B. Bennett, D.O. 2004 James W. Cole, D.O.

Excellence in Osteopathic Medical Education 1996 Jack Kinsinger, Ph.D. 1997 Mitchell Kasovac, D.O. 1998 John F. Manfredonia, D.O. 1999 Craig M. Phelps, D.O. 2000 Wilbur V. Cole, III, D.O. 2001 Richard Dobrusin, D.O. 2002 Dean James Cole, D.O. 2003 Kathleen Goeppinger, Ph.D.

2004 Thomas McWilliams, D.O. 2005 William H. Devine, D.O. 2006 Susan Gerard, M.B. A. 2007 Ross Kosinski, Ph.D. 2008 Dana Sue Devine, D.O. 2009 Harmon Myers, D.O. 2010 Lori A. Kemper, D.O., M.S.

Student Distinguished Service Award 1999 Suzanne Frasca, AZCOM 2000 Helene Labonte-Carroll, AZCOM 2001 Christine Estrada, AZCOM 2002 Melody Rodarte, AZCOM 2003 Jessica Jewart, AZCOM 2004 Kara Beasley, AZCOM 2005 Anne Yost, AZCOM 2006 Rebeccah Rodriguez, KCOM & B. J. Ho, AZCOM

2007 Amy Adams, AZCOM 2008 Tomas Chavez, SOMA; Ben Wilde AZCOM; Stacie Gooch, KCOM 2009 Brian Liem, AZCOM; Eugene Bukham, KCOM; Danielle Barnett, SOMA 2010 Melissa Blessing, SOMA; Cory Maughan, AZCOM; Michael Paddock, KCOM

Outstanding Mentor Award 2004 Ben Field, D.O. 2005 Scott Steingard, D.O. 2006 Karen J. Nichols, D.O. 2007 Jordan Ross, D.O.

2008 Tracy O. Middleton, D.O. 2009 Mitchell Kasovac, D.O. 2010 Thomas E. McWilliams, D.O.

Volunteer of the Year 2006 Betty Toothman 2007 Leonard Staff, Jr., D.O. 2008 Deborah Hudak, D.O.

2005 L. Markham McHenry, D.O. 2006 Robert Tognacci, D.O. 2007 Michael Ward, D.O. 2008 Kevin M. McCabe, D.O. 2009 Richard Reilly, D.O. 2010 Alan Schalscha, D.O.

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2009 Rev. Dick Stafford with Team of Physicians for Students (TOPS) 2010 William J. Rappoport, M.D.

AOMA Digest Summer 2011


Osteopathic Community News

The Arizona Osteopathic Medical Association Hosts Annual Awards Presentation at the Eighty-Ninth Annual Convention in Scottsdale

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1. 2011–2012 AOMA President Jan D. Zieren, D.O., MPH, FACOFP, dist. with her husband Jeff Mews. 2. AOA Trustee Norm Vinn, D.O. and James Cole, D.O. catch up at the Gala. 3. Julie Sabeeh, Kristin Will, and Bunnie Richie, D.O. pose for a photo at the Gala. 4. 2011 – 2012 AOMA Leadership – President Jan D. Zieren, D.O., MPH, FACOFP, dist.; Secretary/Treasurer dam Nally, D.O.; Immediate Past President Kelli M. Ward, D.O., MPH, FACOFP; and President Elect Thomas E. McWilliams, D.O., FACOFP. Vice President Craig M. Phelps, D.O., FAOASM was out of town. 5. Connie Mariano, M.D. gives a keynote lecture on “Caring for the First Patient” at the Wednesday luncheon.

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Osteopathic Community News

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6. The Finalists for the 2011 Student Poster Competition are called to the stage. Jacob Smigel (center) was announced as the winner and received a plaque and monetary award. 7. James W. Cole, D.O., FAODME accepts the Volunteer of the Year Award. 8. The posters from the Student Clinical Poster Competition on display in the Exhibit Hall. 9. The 2011 – 2012 AOMA Leadership is sworn in at the House of Delegates Meeting. From left to right: Secretary / Treasurer Adam Nally, D.O.; Immediate Past President Kelli M. Ward, D.O., MPH, FACOFP; President Jan D. Zieren, D.O., MPH, FACOFP, dist.; President Elect Thomas E. McWilliams, D.O., FACOFP; Speaker of the House John Manfredonia, D.O., FACOFP, FAAHPM; and Vice Speaker of the House James W. Cole, D.O., FAODME; Vice President Craig Phelps, D.O. is not pictured. 10. An Osteopathic Medical Student along with his wife and baby enjoy the Gala. 11. Executive Director Amanda Weaver presents MICA representative Karen Owens with a Kindle during the Exhibitor’s Raffle. 31

AOMA Digest Summer 2011


Osteopathic Community News

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5 1. President Jan D. Zieren, D.O. presents Mikel Skousen, D.O. with his prize from the raffle drawing. 2. Drs. Bunnie and Carlton Richie with Deb Hudak, D.O. enjoy the Silent Auction. 3. Russell Camhi and his wife enjoy the Silent Auction. 4. Shelly Cohen and Dr. Jan Zieren share a laugh. 6

5. AOMA Immediate Past President Kelli M. Ward, D.O. prepares for the evening’s festivities with her iPad. 6. James A. Martin, D.O. meets with a vendor in the AOMA Convention Exhibit Hall.

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Osteopathic Community News

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7. Representative Kimberly Yee meets with AOMA members during the reception for the AOMA Political Action Committee (PAC). 8. Jesse McGuire entertains the Gala attendees with his beautiful music. 9. A Convention Attendee converses with a vendor in the Exhibit Hall. 10. Leonard Staff, D.O. and Craig Hoffbauer, D.O. converse as the Gala begins. 11. The Finalists for the 2011 Student Case Competition are called to the stage. Russell Camhi (left) was announced as the winner and received a plaque and monetary award. 12. Dr. Mariano signs copies of her book, “The White House Doctor” after her lecture. 13

13. Scott Steingard, D.O. and William Devine, D.O. enjoy each other’s company at the Convention.

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AOMA Digest Summer 2011


Features

Arizona Osteopathic Charities Student Scholarship Winners

The Board of the Arizona Osteopathic Charities is honored to present two $1,000 scholarships to osteopathic medical students enrolled at schools in Arizona. One scholarship was awarded to a student from Arizona College of Osteopathic Medicine (AZCOM) and one from the School of Osteopathic Medicine in Arizona (SOMA).The winners of the scholarship are chosen based upon their essay “Why I Became a D.O.”

“Why I Became a D.O.”

Chelsea D. Paskvan Gawryletz, AZCOM OMS IV

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laskan tundra extends wide and vast allowing me to focus my intent towards nature and healing. I reflect upon my childhood growing up in a small unique community south of the Arctic Circle and north of the village North Pole, Alaska. In Fairbanks, my hometown, I emerged with a solid, deep foundation in sciences, music, sports, art, and family. The strength of my family positively impacted my own physical and emotional health providing a structural base to give care to others. Osteopathy encompasses a similar balance among self, profession, and community. Osteopathy encourages the innate ability of Chelsea D. Paskvan the body to heal itself, a vital cornerstone of achieving true health. Osteopathy enables the Gawryletz, physician to participate in healing others with AZCOM OMS IV our hands, our hearts, and our minds. With these tenants in mind, I chose to become an osteopathic physician. Throughout my journey, in obstetrics and gynecology my eager hands assisted a mother in the delivery of her child. In oncology, my seeking hands palpated a solid mass in the upper outer quadrant of

the right breast of a young woman. In pediatrics, my fostering hands felt the warmth of a 1-year-old child’s feverish forehead in the midst of roseola infantum. My dexterous hands sutured the deep forehead laceration on a dog-sled musher after a chain-saw accident in rural Alaska. In surgery, my deft hands removed a necrotic gallbladder during an open cholecystectomy from a patient previously suffering from intense pain in the upper right quadrant of his abdomen radiating to his right shoulder. My compassionate hands and my aching heart gently touched a young 24-year-old woman at 20 weeks gestation to inform her that she is HIV positive and her unborn child is at risk. My stalwart hands and resilient heart reached out to a psychiatric patient suffering from severe depression with suicidal ideation. My open ears and active auscultation heard the audible rales and crackles deep within the lungs of a 92-year-old male whom died later that evening of pulmonary edema in congestive heart failure. My heart, hands and mind appreciate the opportunity and gift to participate in the management of care for others. As an osteopathic student doctor, I will continue to warmly embrace the patients within the populations I serve. I will actively seek health disparities among underserved populations home and abroad. Guided by osteopathic principles I forge ahead, with an intrepid spirit, into my future practice of medicine.

“Why I Became a D.O.”

es in pizza delivery, while most of my peers in the neuroscience program at the University of Rochester completed their first year at allKyle Spagnolo, SOMA OMS II opathic institutions. That summer I slept in a tent to make my life as chose to become an osteopathic physician for a number of reaa CNA at Vail Valley Medical Center possible. It was a difficult path sons, but most importantly because I believed that the osteopath- to take but I discovered humility to be synergistic with compassion, ic philosophy would best lend itself to practicing medicine with making the patient care experience something it otherwise never a patient-centered approach. The discovery of osteopathic medcine would have been. emblazoned my passion to become a physician, The reward I experienced due to this discovery was embodied in as it was through the patient care experience a brief moment in my career as a CNA. While transporting a 59 yearthat I found medicine to be my calling. old cancer patient off the medical unit to the OR, I put my hand upLike most of my peers at the University of on the patient’s shoulder and wished him good luck. Up until the Rochester, when I graduated in 2006 I had moment my hand touched that man’s shoulder, he was devoid of exnever even heard of osteopathy. Though I depression, with eyes shut above a foggy non-rebreather mask. But sired to become a physician, I knew something when my hand touched his shoulder, he looked at me with intention was missing from the traditional allopathic pro- and spoke the two most valuable words ever to have fallen upon my grams. At a time when I felt I needed to see ears. And he spoke in complete lucidity – “Thank you.” Kyle Spagnolo, patients and understand the world from their The focus of my career thenceforth was the patient and not the SOMA OMS II perspective, allopathic programs had not emdisease. After three tumultuous years in the “real world,” spent hovphasized a patient-centered approach as crucial to their mission. It ering in and out of poverty in search of a purpose beyond monetary would take me three years of exploring medicine on my own to dis- reward, I knew that osteopathic medicine was my calling. The allocover osteopathic programs like ATSU-SOMA that emphasized a pathic route was the precedent set by my peers at the University of patient-centered approach through early clinical encounters. Rochester. But my nonconvention gifted me with humility, allowing But it was not merely medicine I explored in the years since my returns of infinite value within the patient care relationship. I chose graduation in 2006. I got to see the world as most patients see it, osteopathic medicine not for what I wanted to learn, or even for outside of academia. In 2007 I garnered the lowest possible wagwho I wanted to become, but for who I already was.

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AOMA Digest Summer 2011


Practice Management

The Three Greatest Risks to your Wealth Anthony Williams, ChFC, RFC, CLU

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ome ten plus years ago, we were asked to define our practice in one sentence. What is it we do? We help doctors and their families grow their net wealth in a tax-efficient manner while minimizing exposure to litigation. Plainly stated, the goal is to help clients grow and protect wealth while eschewing the risks doctors face. Let’s discuss the three greatest of these risks in more detail.

Risk #1: Taxation Many clients focus first and foremost on the question of how to lower their tax liability now. While this question is important, one should also ask: “How do I lower tax liability as I grow my wealth?” and, “How do I lower my tax liability when distributing my wealth in the future?” We’ve witnessed a majority of people focus primarily on saving taxes today with little regard for the impact of taxation during the accumulation phase, and virtually no thought as to how taxes will impact their net wealth in the future.  Today. Taking advantage of your pre-tax savings plans such as a 401k, 403b, SEP IRA, or Profit Sharing Plan will lower your tax liability in the year in which you contribute. For example, if you earn an annual income of $350,000 and contribute $49,000 of that to your employer-sponsored 401k or Profit Sharing Plan you would lower your tax liability by approximately $18,000 for that year.1 Notice we didn’t say “save” money in taxes, but strategically used the word “lower” to describe the affect. In our opinion, this is more than a simple matter of semantics because it is important to remember that at some point you will pay taxes on these monies. Where do you think federal tax brackets will be when you access this bucket of wealth? Based on demographics alone (the number of baby boomers in this country will double in the next twenty years2), the likelihood of federal tax brackets increasing is high due to the incredible strain placed on Social Security, Medicare, and Medicaid. Couple this demographic shift with the heavy spending in the previous and current administrations and one conclusion comes to bear: Your retirement allocation must be balanced accordingly between taxable and tax free sources of income.  During your career. Here are some important considerations while you are earning income and building your wealth: 3 Are your assets growing tax-efficiently?

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3 Are you maximizing your growth using the impact of compound interest? 3 Are your investment vehicles adding to your tax liability? 3 Further, what is the lost opportunity cost associated with these taxable investments? To illustrate these questions, consider this example. Imagine Anthony Williams, ChFC, RFC, CLU that your investments for the year generated a $10,000 tax bill due to capital gains tax, etc. The lost opportunity cost represents how much that $10,000 may have grown over 30 years if your assets had been structured in a tax-efficient way that allowed you to avoid the tax and keep the $10,000 invested. A simple tip to help you determine how much your money will grow is The Rule of 72,3 whereby you take your expected rate of return and divide that number into 72. The resulting number reflects how many years it will take for your investment to double. Therefore, using our example above, and estimating an 8% rate of return, the $10,000 would double every nine years. That would result in $40,000 in 18 years, and $80,000 in 27 years. We often say to clients to express the true impact of paying this tax: “It’s about much more than the $10,000 in extra tax you are paying today; it’s also about losing out on the $40,000, $80,000, or more that you sacrifice by not investing tax-efficiently.”  Retirement and Beyond. As you begin to withdraw money for living expenses from your various retirement accounts, the drains on your wealth include: the rising cost of living, medical care, and taxes. Many have been led to believe they will be in a lower tax bracket in retirement than they were pre-retirement. Are you one of them? For most investors, this notion is misguided for several reasons:  You will no longer have retirement contributions lowering your tax liability.  You likely will not have the interest deduction on your home.


Practice Management  You likely do not wish to lower your standard of living? Or perhaps you will. Here’s the deal. If you are a diligent and disciplined saver, you should expect to have a fairly significant net wealth at age 60. This said, even if you only peel off enough income to keep you in a lower tax bracket in retirement, you likely are taking less than the interest will be earning. The result is that your wealth continues to grow. Think of a snowball going down a hill: it grows largest at the bottom! If you only peel off a small amount relative to the entire balance you are setting yourself up for a vital challenge. The IRS Age 70½ Required Minimum Distribution rule carries a heavy burden whereby the IRS becomes your business partner and dictates all the terms. Effectively, you must begin mandatory withdrawals from your tax-deferred qualified retirement accounts (401k, SEP, 403b, profit sharing plans, etc.) at a pace quickly enough to liquidate those accounts by your estimated mortality (if you don’t elect this distribution, in addition to taxes you are hit with a 50% penalty). For example, assume you have $4 Million in your taxable accounts at age 70½ (remember, these monies are taxed at distribution) and you are earning 4%.4 Let’s also assume an age 85 mortality rate. In this illustration, the RMD would require you to withdraw 1/15 of your principle balance annually–roughly $267,000 in addition to the interest of $160k. The IRS will now have more control over your tax bracket than you do.

Risk #2: Litigation What doctor isn’t concerned with the affect of being sued? Who isn’t afraid of having some type of lawsuit take your accumulated wealth? Asset Protection is a key planning concept which is often overlooked. There are certain investment vehicles which provide automatic protection against creditors and litigation. Additionally, in some states, insurance company assets are also protected from these risks. A qualified financial planner can help identify these basic asset protection vehicles. Beyond these however, we believe that it is critical to identify a professional whose sole purpose is to protect your assets. One Asset Protection Attorney, whom we consider a trusted colleague, has a simple yet powerful maxim, “Own nothing. Control everything.” Through a variety of simple to complex legal structures and strategies, this attorney works with his clients to provide assurance that their net wealth is protected. It just makes sense to dedicate some of your time and resources in addressing this serious issue.

Risk #3: Income Loss Your journey to financial freedom will stall if you have no means to regularly gas up your vehicle. The issue of income loss is one which will prevent you from accumulating wealth. Multiply your income by 2.5 years, which is the average length of disability for adults5. How long would it take you to accumulate that amount of money? How long could you go without your income? Are you prepared to cover your expenses for any period of time? What about your ability to continue saving? This tragic detour can be avoided. Our suggestion when evaluating disability insurance is to acquire True Own Occupation coverage. The definition of disability for doctors’ insurance should read: “The inability to perform the material and substantial duties of your own occupation (recognized specialty).” This means that if you are unable to perform the functions required to earn your income in your chosen occupation, you are considered disabled, even if you are able to earn income in some other fashion. Many people we’ve met through the years have disability insurance contracts in place which include the definition above with an add-on stating, ‘so long as you are NOT working in any other capacity.’ The difference is considerable. Are you covered properly? Relative to the amount of money you risk losing should you become disabled, the amount of premium you will pay to insure this loss with disability insurance is reasonable if not insignificant. We hope you NEVER collect on your disability insurance. As a doctor, you know all too well that people don’t plan to become ill, have an accident, or receive a critical diagnosis. What would you pay for the peace of mind that comes with knowing that your lifestyle and retirement savings will continue on even in the event you can no longer earn?

Securities and investment advisory services offered through NEXT Financial Group, Inc. Member FINRA and SIPC. Mosaic Financial Associates is not an affiliate of NEXT Financial Group, Inc. This article intends to offer general information on the subjects discussed and should not be regarded as a complete analysis of these subjects. Any tax or legal information in this piece is merely a summary of our understanding and interpretation of current laws and regulations and is not exhaustive. Neither NEXT Financial Group, Inc. nor its representatives are qualified to give tax or legal advice. Please consult your tax or legal professional regarding your particular situation.

This illustration uses current tax rates. U.S. Census Bureau statistics; www.census.gov The Rule of 72 is a mathematical concept and does not guarantee investment results or function as a predictor of how your investment will perform. It is simply an approximation of the impact a targeted rate of return would have. Investments are subject to fluctuating returns and there can never be a guarantee that any investment will double in value. 4. For this example, we assume a lower rate of return, due to expected conservative, lower risk investment strategy in retirement. 5. From “Disability Statistics” published by the Council for Disability Awareness. Additional information is available at the council’s website, www.disabilitycanhappen.org, which compiles data from the US Census and Social Security Administration. 1. 2. 3.

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AOMA Digest Summer 2011


Osteopathic Community News

Arizona Society Foundation for Osteopathic Medical Education (ASFOME) The Foundation hosted its third annual golf tournament May 21st and raised $5000 for Osteopathic Family Medicine scholarships. Thanks go out to David Berge with Total Pain Solutions, Mike Basten with Foothills Sports Medicine Physical Therapy and Mantej Sra, MD with Sun Radiology for their sponsorship over the last three years, each has contributed to the success of our tournament in so many ways and have committed to joining us again next year. We are very fortunate to have their support.

16222 N. 59th Avenue, Ste. 122 Glendale, AZ 85306 www.totalpainsolutions.com

15410 S. Mountain Parkway, Ste. 112 Phoenix, AZ 85044 www.foothillsrehab.com

13090 N. 94th Drive, Ste. 103 Peoria, AZ 85381 www.sunradiology.com

A special Thank You to Robert Luberto, DO our Golf Committee Chairman and Hole sponsor. Dr. Luberto will be stepping down as Committee Chairman, however promises to stay involved with the Arizona Society Foundation golf tournament.

Thank You to our Hole, Prize and Raffle sponsors: Arizona Osteopathic Medical Association, Amanda Weaver, MBA Bohm & Jones, Robert BohmCool Clubs, Kyle Monfort Milissa Cooper, DO, Steingard Medical Group A great day Bradley C. Downing, DO for golf! David Green, Preferred Pain Center Dr. Luberto (L) Humble Pie, Scottsdale Dr. Sra (R) F. Timm McCarty, DO MICA, Sponsorship for Five Holes Tracy Middleton, DO, Chairman AZCOM Family Medicine Pesto’s Wine Bar Pinnacle Fitness, Luke Sullivan Harry Watters, DO, Women’s Health Jan Zieren, DO, MPH, FACOFP dist., AzACOFP President

Thank You to those who provided Student Player Sponsorships to compete in the Bed Pan Tourney ATSU AZCOM Stacia Kagie, DO Lori A. Kemper, DO FACOFP, Dean AZCOM Lawrence LeBeau, DO

AZCOM Wins 2011 Bedpan Tourney!

Howard M. Shulman, DO Mitchell Kasovac, DO Mark R. Speicher, DO William F. Morris, DO David M. Steinway, DO

THANKS and congratulations go out to the Sponsors who supported the AZCOM Golf Team. Lori Kemper, DO, FACOFP, Dean of AZCOM; Howard Schulman, DO; David Steinway, DO; Mark R. Speicher, DO. THANKS to the AZCOM Family Medicine Department for sponsoring a hole, supporting their team on the course: Tracy Middleton, DO; Alan Schalscha, DO; Anette Gawelko, DO; Shannon Scott, DO; David Hume, DO; and Christine Estrada, DO.

Congratulations to: Jarvis Walters, Brady Bulian, John Deegan, and Matt Rachwalski!

AOMA Digest Summer 2011

38

AZCOM will keep the Traveling Bedpan Trophy through 2011 and in 2012 the Arizona Society Foundation for Osteopathic Medical Education will host the next Bedpan Tourney….


Osteopathic Community News

AzACOFP Presidential Perspective Jan D. Zieren, D.O., MPH, FACOFP, dist. Arizona Society of ACOFP President

C

DOc TALK

patient/diagnoses code generated letters

urrent medical care is like “grocery shopping” –

to remind the primary

although the patient may choose the “store” and push

physician of follow up

the “cart”, the physician or health care worker at the

concerns. Pharmacies

“store” fills the cart and then at check out – the patient gets

can provide computer

to pay (hopefully with some “coupons” or insurance to help

generated drug lists and

with the bill.) A savvy patient or a discriminating consumer

potential interaction

will probably interject some comments, refuse on occasion,

messages. Yet more

nod in agreement at times or even delay a “purchase” for

efforts are crucial to

another time. Perhaps the best medical care is a “team

improve the safety for

approach” with explanations, evidence based treatment

patients. Many patients

suggestions, informed consent and mutual decision making between the physician and an empowered patient. But what

Jan D. Zieren, D.O., MPH, FACOFP, dist. President 2010-2012

about the patients who can’t? In 2008 over 51% of emergency room visits for adverse

fail to mention another physician’s prescriptions thinking only to list

current meds from the physician being seen at that visit.

medication reactions were adults over the age of 50. How

(Glaucoma meds go unlisted – Pain medications from the

many times is a list of medicines reported by the patient in

urgent care center are in the purse but not on the list – The

one’s office as complete as it should be? As a patient’s age

antibiotic from the dentist was forgotten because the tooth

and the complexity of medical conditions goes up, the risk of

pain is gone). Perhaps the best medical care is when health

drug/drug or drug/disease interactions and contraindications

care providers and patients collaborate to eliminate patient

rises as well. The savvy patient or discriminating consumer

safety concerns. But what about the patients who can’t?

will bring a complete list of medications or recite the litany

One is the loneliest number that you’ll ever do. – Two can

of drugs well. Perhaps the best medical care is a “team

be as bad as one…It’s the loneliest number since the number

approach” in which patient and physician interaction is

one. (apologies to Three Dog Night) For many seniors, the

strongest with good communication. But what about the

opportunity to live alone is freedom. But for a significant

patients who can’t?

number, there are no other options and the safety and health

Medical errors are a leading cause of US hospital deaths.

dangers are insurmountable. These lonely souls may not

Actually, these adverse events (hospital acquired infections,

be eating well or enough; they may have a tendency to fall;

surgical errors, and medication errors) can occur not only in

possibly they are pack rats with all related inherent dangers;

hospitals, but in doctors’ offices, nursing homes or even just

some rack up credit card bills and mounds of purchased

as a result of drug interactions. Systems are in place to help

items by shopping online or through QVC. Their depression,

decrease the number of errors. Hospitals can adopt a Code

financial issues or concerns, lack of cleanliness, loss of safety,

of Conduct (commitment, compliance and professionalism)

need for assistance to medical appointments (if they can’t

to display good judgment and high ethical standards. There

drive or get lost) are only a partial list of problems. Perhaps

are mechanisms to assist in minimizing errors (arm bands

the patients can’t even remember their appointments, or don’t

– bar codes – software checks – warnings to alert). Studies

understand their medications (taking duplicates by using

advise that patients should speak up if there are minor errors

both brand and generic) or haven’t realized how the dosage

to help prevent the major mistakes. One study classified 44%

changed. Many outpatient procedures require someone to

of the problems as preventable. Insurance companies have

Presidential Perspective cont. page 48

39

AOMA Digest Summer 2011


Osteopathic Community News

Midwestern University/Arizona College of Osteopathic Medicine Midwestern University President Recognized as a “Most Admired CEO” by the Phoenix Business Journal

K

Kathleen H. Goeppinger, Ph.D.

athleen H. Goeppinger, Ph.D., President & CEO of Midwestern University, was named as one of Arizona’s Most Admired CEOs by the Phoenix Business Journal. Dr. Goeppinger is one of 25 top-level executives in Arizona to receive the honor and was recognized at a special dinner held at the Westin Kierland Resort in Scottsdale on May 19th, 2011. Dr. Goeppinger was the sole highereducation representative on the list, which included the CEOs of Phoenix Children’s Hospital, the Arizona Department of Health Services, and the Phoenix Suns. During her tenure as President and CEO of Midwestern University, she has been repeatedly recognized for her outreach and leadership and has been responsible for significant growth at the University, including opening the Glendale Campus, supervising the construction of over 25 major buildings including three state-of-the-art medical clinics, and introducing 18 new academic programs.

Midwestern University Hosts National Student Osteopathic Surgical Association Convention

Alicia Stone-Zipse named AZCOM’s Student D.O. of the Year

In March, Midwestern University’s Arizona College of Osteopathic Medicine (AZCOM) hosted over 100 students representing osteopathic medical schools around the nation at the annual National Student Osteopathic Surgical Association (SOSA) Convention. The convention consisted of two days of lectures, discussions, networking, and demonstrations that helped educate aspiring osteopathic surgeons in proper techniques and procedures.

The Arizona College of Osteopathic Medicine (AZCOM) Student Government Association recognized the 2010-2011 Student D.O. of the Year Winner, second-year student Alicia M. Stone-Zipse. Student Doctor Stone-Zipse has been an exemplary asset to the AZCOM community through her teaching, leadership and community service. She has served as the Vice President of the Pediatrics Club and has helped to organize the annual Cuts for Kids fundraising event for the last two years. She Alicia M. Stone-Zipse has also been involved in community outreach through volunteering at the H.O.M.E (Health Outreach through Medical Education) clinics, American Diabetes Association and AIDS Walks, Habitat for Humanity and numerous others. She has served the AZCOM community through her leadership as a Big Sib/Little Sib Program Co-Chair and as a Gross Anatomy Teaching Assistant.

Midwestern University Volunteers Step Up To Provide Free Cuts for Kids On March 14, Cuts for Kids, organized by the Midwestern University Pediatrics Club, offered haircuts from professional stylists to benefit children with special health and social needs in a fun carnival-style atmosphere. Over 130 people donated 10 or more inches of hair to receive their haircuts free of charge, and 158 ponytails totaling over 1,700 inches of hair were collected and donated to Locks of Love to make wigs for kids with long-term hair loss. Proceeds from Cuts for Kids supported the Phoenix Children’s Hospital “Crews ’n Healthmobile,” a 35-foot Mobile Medical Unit (MMU) that brings free, comprehensive medical help directly to at-risk youth who lack health insurance and do not have access to appropriate health care.

AOMA Digest Summer 2011

40

Summer TOPS Student Physicals Program The summer edition of the Team of Physicians for Students (TOPS) program took place at Midwestern University on June 11th, 2011. TOPS offers free sports physicals for high school athletes at schools around Arizona. The spring TOPS event, conducted at Mesquite and Sunnyslope High Schools, screened over 3,100 athletes from 75 schools via ECGs and echocardiograms in search of potential cardiac issues. TOPS relies on clinical volunteers including physicians, physician assistants, nurse practitioners, pharmacists, and physical therapists along with MWU faculty and students.


Osteopathic Community News

AZCOM Commencement 2011

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Commencement for AZCOM took place on June 3 in Midwestern University’s Auditorium. 151 D.O. graduates received their degrees, led by valedictorian Matheau G. Eysser. Congratulations to the Class of 2011!

Dental Institute Welcomes Pediatric Dentistry Specialist

n June, students from the Arizona College of Optometry (AZCOPT) began patient treatments in conjunction with AZCOPT faculty at the Midwestern University Eye Institute. The AZCOPT Doctor of Optometric Medicine (O.D.) degree was established in 2009, and thirdyear students are now trained and ready for rotations at the Institute. They will provide care under the supervision of experienced and licensed AZCOPT faculty. First- and second-year optometry students will continue to observe treatments performed by Eye Institute faculty as well. The student-faculty treatment model is patterned after a similar model in place at the Midwestern University Dental Institute.

The Midwestern University Dental Institute has established new Pediatric Dentistry services with the appointment of Kimberly K. Patterson, D.D.S., M.S., to the Dental Institute faculty. Dr. Patterson comes to Midwestern University after over a decade of practicing Pediatric Dentistry in Texas. She will oversee third- and fourth-year College of Dental Medicine-Arizona (CDMA) students as they provide preventive services (exams, cleanings, fluoride treatments), restorative services (fillings, crowns), and Kimberly K. Patterson, preventive and dietary guidance to children D.D.S., M.S. six years of age and older. Dr. Patterson will also instruct a Special Needs course at CDMA and serve as a guest lecturer for CDMA’s Advanced Clinical Education Series.

Appointments, Awards & Grants Jon Benfield (MS-III) was elected as the American Osteopathic College of Physical Medicine and Rehabilitation (AOCPMR) Immediate Past President. Michelle Bradley (MS-IV) and Gina Hart (MS-IV) took first place in the clinical-case poster competition at the American Academy of Osteopathy (AAO) Convocation in Colorado Springs, CO., in March. Maxwell Braverman (MS-II) was elected as a Council of Osteopathic Student Government Presidents (COSGP) National Parlimentarian. Emily Burk (MS-III) was chosen as the Student Osteopathic Medical Association (SOMA) National Board Clinical Clerkship Coordinator. Troy Bushman (MS-II) was named as a American Osteopathic College of Physical Medicine and Rehabilitation (AOCPMR) Bylaws Committee Representative and Membership Committee Member. Ryan Eubanks (MS-III) was elected as the Student Osteopathic Surgical Association (SOSA) National Executive Board Vice Chair. Charles Finch, D.O. (AZCOM), Chair, Integrated Medicine, was named Physician of the Year by the Arizona Osteopathic Medical Association. 

Optometry Students Begin FacultySupervised Treatments at Midwestern University Eye Institute

Dr. Finch also joined Randall Ricardi, D.O. (AZCOM), Clinical Assistant Professor, Clinical Education, and Carlton Richie, D.O. (AZCOM), Clinical Associate Professor, Osteopathic Manipulative Medicine, in being recognized by Phoenix Magazine in its “Top Docs” special issue. Monsoor Jatoi (MS-III) was elected as a Council of Osteopathic Student Government Presidents (COSGP) AOA Board of Trustees Student Delegate. Adam Lundberg (MS-III) was appointed as a Student Osteopathic Medical Association (SOMA) Foundation Chairperson and Board of Trustees Member. Jasmin Mosley (MS-II) was named the American Osteopathic Academy of Sports Medicine (AOASM) Western Region Representative. Nicole Mullins (MS-III) was elected as the Student American Academy of Osteopathy (SAAO) National Council Chair. David Parrack, D.O., FACOS (AZCOM), Chair, Surgery and Anesthesia, was named Mentor of the Year by the Arizona Osteopathic Medical Association. Chelsea Paskvan Gawryletz, MS-IV (AZCOM), received the Presidential Scholarship on April 8, 2011 at the Arizona Osteopathic Charities’ President’s Gala. Regan Riley (MS-II) was elected as the Student Osteopathic Surgical Association (SOSA) National Executive Board Treasurer. Denton Shanks (MS-II) was named as a Student Academic Member on the American College of Osteopathic Family Physicians (ACOFP) Board of Governors. Anthony Will, D.O. (AZCOM), Chair, Osteopathic Manipulative Medicine, was honored as a Patients’ Choice Physician.

Upcoming MWU Events: Mark Your Calendars Bright Lights, Shining Stars Gala On October 15th, 2011, Midwestern University will hold its annual Bright Lights, Shining Stars gala. The black-tie-optional gala is an opportunity for the University and community leaders to come together to recognize and honor individuals for their commitment to helping others, with proceeds benefiting Midwestern University student scholarships. The event features a silent auction, dinner and dancing under the stars, and the presentation of the prestigious COMET and Shooting Star awards.

41

AOMA Digest Summer 2011


Osteopathic Community News

Medical Trailblazers

ATSU-SOMA graduates first class using unique, forward-thinking curriculum

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inety-two newly minted doctors of osteopathic medicine reserved their place in history June 3 as members of the inaugural graduating class of A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA). “Today is a dream come true – for every one of you and certainly for me,” said Douglas Wood, ATSU’s senior vice president-academic affairs, and SOMA’s founding dean, who met to thank students personally prior to the ceremony. “These are individuals who took a chance on an unproven medical school, and for that I will forever be grateful,” he said. “I cannot tell you how proud I am of these students.” When the inaugural ATSU-SOMA Class of 2011 walked across the stage at the Mesa Arts Center in Mesa, Ariz., to receive their diplomas, they did so not in alphabetical order, but according to the community health center campuses where they lived and studied for the last three years. Graduates will enter residencies across the country in July, with 83

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ATSU-SOMA interim dean recognized for distinguished service

homas McWilliams, D.O., FACOFP, received the Distinguished Service Award from the Arizona Society of the American College of Osteopathic Family Physicians at its annual meeting Friday, April 8. Dr. McWilliams, clinical professor and interim dean of A. T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA), was recognized for his leadership to the society and for exemplifying the role and impact of an osteopathic physician and educator. A third-generation D.O., Dr. McWilliams entered the Indian Health Service as one of the first Public Health

AOMA Digest Summer 2011

42

percent going into National Association of Community Health Center (NACHC) needed specialties, including primary care. Fifteen ATSU-SOMA graduates will remain in Arizona for residency training. A.T. Still University’s School of Osteopathic Medicine in Arizona receives full accreditation status The American Osteopathic Association’s Commission on Osteopathic College Accreditation (COCA) has awarded A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA) located in Mesa, Ariz., its initial full accred­ itation status upon graduation of the first class. ATSU-SOMA received official notification of the status on May 31. What sets ATSU-SOMA apart is its innovative curriculum. The Clinical Presentation Model, developed at the University of Calgary Medical School, is based on three categories in which patients present to physicians: signs, symptoms, and abnormal laboratory findings. The ATSU-SOMA Clinical Presentation Model integrates both clinical and basic sciences into organ-based courses so that students immediately learn how to clinically apply what they learn in their first year of medical school. Clinical activity comprises 10% of the year one curriculum, 20% of year two, and 90% of years three and four.

Service scholarship recipients. He is a diplomate for the American Osteopathic Board of Family Physicians and the American Board of Emergency Medicine and has completed fellowships in rural medicine, national health policy, teaching and learning, and leadership. He has held teaching appointments at the University of Washington Thomas McWilliams, and at ATSU’s Kirksville College of D.O., FACOFP Osteopathic Medicine and is past president of both the Arizona and Missouri Rural Health associations.


Osteopathic Community News

—SOMA Faculty Updates— Robin Pettit, Ph.D., joined the faculty of A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA) as professor in January 2011. After postdoctoral training at the National Animal Disease Center and two early faculty teaching positions, Dr. Pettit joined the Cancer Research Institute at Arizona State University. Dr. Pettit was assistant director and group leader for microbiology. She led a biological research group dedicated to

T

natural products drug discovery. Julie Massoud, D.O., assistant professor of clinical medicine,joined ATSU-SOMA in January 2011. She specializes in emergency medicine. Prior to joining ATSU-SOMA, Dr. Massoud served as an emergency room physician at Chandler Regional Medical Center in Chandler, Ariz., and Mercy Gilbert Medical Center in Gilbert, Ariz. She was also an adjunct faculty member of ATSU-SOMA.

Douglas L. Wood Receives Medal of Public Service

he Walter F. Patenge 2011 Medal of Public Service has been awarded to Douglas Wood, D.O., Ph.D., A.T. Still University (ATSU) senior vice president–academic affairs, and founding dean, ATSU’s School of Osteopathic Medicine in Arizona (ATSU-SOMA). The award was given by the Michigan State University College of Osteopathic Medicine’s (MSUCOM) College Advisory Council at a ceremony held on May 26 in East Lansing, Mich. The Walter F. Patenge Medal of Public Service is the highest honor that MSU-

COM awards annually to individuals for their public policy leadership, their example of quality family medicine practices, and for exemplifying the best tradition of concerned administration and public involvement. Dr. Wood was one of four individuals awarded this year’s medal. Dr. Wood served as the inaugural dean of ATSU-SOMA from 2005 until 2010. Prior to coming to ATSU-SOMA, Dr. Wood served as president of the American Association of Colleges of Osteopathic Medicine (AACOM) from 1995 to 2005.

Carolyn Glaubensklee, Ph.D., is associate professor of physiology, ATSUSOMA, who joined the faculty in January 2011. Prior to joining ATSU-SOMA, Dr. Glaubensklee served at Rocky Vista University College of Osteopathic Medicine (RVUCOM) in the physiology department. She taught both systems courses and integrative medical courses as a founding faculty at RVUCOM.  Joy H. Lewis, D.O., Ph.D., FACP, joined the faculty of ATSU-SOMA as assistant professor, family and community medicine, and director of postgraduate education in January 2011. She is esta­blishing communitybased primary care residency programs for ATSU-SOMA and is also course directing second-year courses in epidemiology, biostatistics and preventive medicine. She directs the ATSU-SOMA Practice Based Research Network (PBRN) and will be conducting community-based applied research in her areas of interest including health literacy, patient safety and preventive medicine.

ATSU announces new dental program to move forward in Missouri

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.T. Still University, Chair of the ATSU Board of Trustees Carl G. Bynum, D.O., M.P.H., and University President Jack Magruder, Ed.D., announced that the proposed dental program in Kirksville will move forward. The Kirksville program will be a branch campus of the innovative and successful model of dental education at ATSU’s Arizona School of Dentistry & Oral Health (ATSU-ASDOH) in Mesa, Ariz. The first group of students will enter the program in fall 2013 and graduate in May 2017. It is anticipated that the size of the first class will be between 40 and 50 students, with the possibility of future expansion. The new dental program will partner with several Community Health Centers (CHCs) around Missouri, including one in Kirksville run by the Northeast Missouri Health Council. These partnerships will ensure that students receive the proper training and be exposed to all levels of patient procedures.

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AOMA Digest Summer 2011


Osteopathic Community News

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School of Osteopathic Medicine in Arizona develops unique OMM curriculum

raining MD’s to supervise D.O. students performing OMM and an innovative program of OMM supervision in the clinical clerkship years. A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSUSOMA) faculty members Deborah M. Heath, D.O., associate professor, Hollis King, D. O., Ph.D., professor, Jonathon Kirsch, D.O., director, osteopathic principles & practice, William Morris, D.O., professor, and Fred Schwartz, D.O., professor and associate dean for community campuses, have been involved in developing a unique program that addresses training M.D.s to supervise students performing osteopathic manipulative medicine (OMM) in their third and fourth years of school. The innovative program was developed in response to concern by both ATSUSOMA faculty and students that although students are trained in their first two years both in advancements in medical knowledge and developing their palpatory skills in diagnosis and treatment, as they integrate into their third- and fourth-year clinical rotations, their application of osteopathic

J

palpatory diagnosis and treatment may be at best, intermittent or sporadic. As part of the strategy for standardization of OMM training at all sites, Dr. Heath developed a “Top Ten” list of basic skills and procedures, which she and her colleagues have implemented in the ATSU-SOMA curriculum. These particular skills and procedures were selected on the basis of their safety, their applicability to

SOMA Students Volunteer in Tornado-ravaged Alabama Town

ennifer Rosemore, OMS III, and Andrew Tonini, OMS III, volunteered on May 7 with the American Red Cross (ARC) in Hackleburg, Ala., a town that sustained major damage recently by tornadoes. Jennifer is currently doing her A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA) clinical rotation in an Alabama Community Health Center, and Andrew is doing a visiting rotation in Alabama. Alabama Medical Education Consortium (AMEC) students, with whom ATSU-SOMA is a partner, also assisted in a relief effort on May

AOMA Digest Summer 2011

44

common clinical problems, and their ability to be taught in a consistent manner. At the completion of their first year, all students reach competency in these ten skills and procedures through extensive practical examination and small group discussion. In year two, remote-site OMM instructors work with students in helping them gain confidence in and mastery of these Top Ten skills and procedures.

13, 2011 for victims of the deadly tornadoes. Dr. and Mrs. Pat Walker of Luverne, Ala., assembled the team of students in response to one local family practice physician, Keith Morrow, D.O., who lost his entire practice clinic in the storms. Assisting Mrs. Walker on the team were John Nguyen, Sunni Beeck, Caleb Whaley, and David McCall, ATSU-SOMA II students based at the AMEC/SOMA Community Campus in Troy, Ala., along with pre-med students, Marc Richburg and Terrissa Stevens.


Osteopathic Community News

A.T. Still University’s School of Osteopathic Medicine in Arizona receives full accreditation status

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he American Osteopathic Association’s Commission on Osteopathic College Accreditation (COCA) has awarded A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA) located in Mesa, Ariz., its initial full accreditation status. ATSU-SOMA received official notification of the status on May 31. “To achieve accreditation status is a tremendous accomplishment for any medical school,” said Thomas McWilliams, interim dean, ATSUSOMA. “It is particularly gratifying to have done this in a program that is as innovative as ATSU-SOMA.” What sets ATSU-SOMA apart is its innovative curriculum. The Clinical Presentation Model, developed at the University of Calgary Medical School, is based on three categories in which patients present to physicians: signs, symptoms, and abnormal laboratory findings. In many traditional medical education curricula, the first two years are spent in a large lecture hall setting learning anatomy, physiology, and microbiology, and each system is learned one at a time, such as cardiac, pulmonary, and gastrointestinal. The ATSU-SOMA Clinical Presentation Model integrates both clinical and basic sciences into organ-based courses so that students immediately learn how to clinically apply what they learn in their first year of medical school. Clinical activity comprises 10% of the year one curriculum, 20% of year two, and 90% of years three and four. Prior to receiving full accreditation, a site visit by the COCA to ATSUSOMA was conducted on January 1921, 2011. COCA determined at their meeting on May 1 that ATSU-SOMA completed the provisional accreditation phase of its recognition process and

advanced to accreditation. “The unique curricular approach that distributes its students to underserved communities throughout their second, third, and fourth years of training was challenging for visiting accreditation team members who were familiar with more traditional models,” said Dr. McWilliams. “On further analysis, they were rapidly able to grasp the importance of our dedication to training healers for needed specialties and communities of need. It was truly heartwarming to hear their comments regarding each of the 11 community campuses that have been developed in close partnership with the

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National Association of Community Health Centers. The opportunity to play a role in this has been the most important activity of my entire professional life. Our faculty, staff, and pioneering students have all done an exemplary job!” Added Douglas Wood, D.O., Ph.D., ATSU senior vice president–academic affairs, and founding dean, ATSUSOMA, “Attaining full accreditation is truly a milestone in the life of the new osteopathic medical school. It is the result of much effort involving faculty, staff, and students who have worked diligently over several years. I thank them for their efforts.”

SOMA ACOFP chapter wins national awards

.T. Still University’s School of Osteopathic Medicine ATSU-SOMA chapter of the Student Association of the American College of Family Physicians (SAACOFP) placed first in two categories, leading chapters in communication and the A.T. Still Award. The A.T. Still award is presented by ACOFP annually to a chapter that best promotes the integration of osteopathic principles and practice of osteopathy’s founder, Dr. Andrew Taylor Still, and their integration into family medicine. The award is based on a chapter’s sponsorship of events, speakers, and/or workshops that address the use of osteopathic manipulative medicine (OMM) as a family physician.

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AOMA Digest Summer 2011


Osteopathic Community News

The Doctor’s Report Card

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atients and patient empowerment is at the center of osteopathic medicine. We are known for being intensely patient oriented and especially regarding the health problems that really threaten a community. The Foundation conducted a survey of 100 primary care physicians in Tucson to find out what the real problems were that they were seeing a lot of. In essence, we wanted to know what those physicians who are on the front line of medical care had to say about what ails Tucson. Responding were 76 MDs and 24 DOs from the primary care fields of family practice, obstetrics and gynecology, general practice and pediatrics. They were asked to rate the severity of each key health issue from a list of 22 prepared by West Group Research who conducted the survey. Then the Foundation asked the doctors to give us a “report card” on what they felt about what they were seeing.

The Top Ten

Based on what physicians were seeing on a daily basis in their offices, top ten issues emerged. 1. Obesity in adults. 81% of the respondents said this was at the top of the list. 2. Diabetes. 63% said this was the next most frequent problem. 3. Obesity in children. A startling 62% of the primary care physicians said this was a major problem they were trying to treat. 4. Hypertension. 52% said this was the fourth largest health problem. 5. Tobacco use. 38% listed this as a serious problem that patients wanted help with. 6. Teen pregnancies. 32% of the physicians said they were seeing far to many of these. 7. Asthma. 30% said this was a frequent issue with patients. 8. Drug use. 30% of the responding physicians said they were still dealing too much with this. 9. Alcohol use. 23% listed this as the tenth most serious problem presented by patients.

The Top Five Having identified the top ten health issues, the primary care physicians polled were then asked to indicate the top five health issues in Tucson that they believe need to have the highest priority within the medical community for education and action. Those were: 1. Obesity in adults. 2. Obesity in children. 3. Diabetes. 4. Tobacco use. 5. Drug use.

AOMA Digest Summer 2011

46

Significantly, obesity in adults, obesity in children, and diabetes all received the highest percentage of “number one” rankings further demonstrating the primary care physician’s opinion that these three issues taken together are not only the most significant health problems they are seeing in their offices, but these are the ones that should receive the Lew Riggs, Ed. D., CAE TOMF Executive Director highest priority in terms of education and action within the Tucson medical community. While obesity is a national issue and one that has received a lot of press, the fact that our doctors are seeing such a striking problem with both adults and children in our own community is alarming. Over the years one of the Foundation’s goals has been to conduct research into key health and community issues to provide unbiased information to both the medical, health and lay communities for significant action. Several programs have since developed to provide increased patient education with the goal of empowering patients to take charge of their own health and to deal more intelligently with the health care system. This year and next, the Foundation will inaugurate a small grants program to further stimulate this initiative.


In The News

In the News…. Dr. Thomas Miller – Recipient of Lifetime Achievement Award

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OMA Honorary Life member Thomas Miller, D.O. was recently honored for his record gold medal performances in World and National Duathlon Championships. Dr. Miller was awarded with the USA Triathlon’s first Lifetime Achievement Award for his participation in many duatalons over the course of two decades. He dominated the World Championship scene in the 1990’s with gold medal wins at Cathedral City, CA (1991), Frankfurt, Germany (1992), Dallas, TX (1993), Tasmania, Australia (1994)Cancun, Mexico (1995) and Guernika, Spain (1997). Miller also earned gold medals at the National Duathlon Championships in Santa Fe, NM (1991), Phoenix, AZ (1992) and Marlboro, MA (1999). More information is available from http://www.usat-southwest.org/news.html.

Arizona Student Selected for Osteopathic Health Policy Intern Program

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.T. Still University’s School of Osteopathic Medicine in Arizona (SOMA) fourth year student Melissa Blessing has been selected to participate in the 2012 Osteopathic Health Policy Intern (OHPI) Program affiliated with the American Association of Colleges of Osteopathic Medicine (AACOM). Her credentials, letters of support and brief health policy paper impressed the reviewers. Ms. Blessing is currently in Flagstaff on rotations. She credits the AOMA with generating her interest in health policy when a presentation was made at the campus to the first year students. Melissa Blessing

Presidential Perspective

Attempts to save money on medications may lead to fake

continued from page 39

meds or inappropriate substitutions. The correct response

drive them to and from the facility with perhaps some need

to any improprieties or suspected wrongs is to report to the

for post procedure in-home care. Trust and integrity are

proper authorities or agencies responsible for monitoring or

at the top of the list for this vulnerable population to have

investigating fraud or abuse activities. But what about the

someone in the home to help or assist in their care. Stealing

patients who can’t?

money, medications or valuables can happen easily when the

Mostly physicians are part of the health care team, not

patient is unaware for whatever reason and taken advantage

part of the problem. Mostly patients are willing to be the

of by the family member or care giver. These social concerns

other part of the health care team, not part of the problem.

have a profound effect on the percentage of the senior

Maintaining a relationship with a primary care physician,

population for whom living alone is a sad state of affairs.

making yearly well visits, keeping healthy habits (eating well

Perhaps the best medical care is provided for patients who are

and exercising without abusing drugs, alcohol or tobacco)

an active participant in the process or as part of the team. But

and utilizing appropriate medications (if needed) all help

what about the patients who can’t?

these patients live a long and good quality life. But what

Fraud and abuse are always a concern with the geriatric

about the patients who can’t? Whether for social, financial

patients. Perhaps a nursing home uses inferior medicine or

or physical/medical reasons – this vulnerable population

medical equipment, yet bills for premium services. Less than

needs a voice to speak for them. Who is there to assist that

adequate care and monitoring can lead to pressure ulcers,

population without taking advantage? Where does patient

sepsis, dehydration or even falls with ultimate fractures.

advocacy begin when there are no family members or

Again, medication errors, food poisoning, emotional or

awesome neighbors to assist an elderly patient? How are the

verbal abuse can occur in long term care facilities, assisted

needy patients found if they can’t make the office visits or

living facilities or nursing homes. Arrangements between

are home alone and have fallen and “can’t get up”? What

nursing homes and hospices are vulnerable to fraud and

can be done for patient advocacy – someone to speak for

abuse because nursing home operators have control over

the patients who can’t? When will an efficient mechanism or

the choice of hospices to provide services. There are scams

an affordable system be in place to advocate for this special

involving fake medical insurances for elderly people unable

group? For now, we just continue to worry about or ignore

to get health insurance due to preexisting conditions.

the “patients who can’t”.

AOMA Digest Summer 2011

48


Meeting Dates & Locations

2011-2012 Meeting Dates and Locations AOA Annual Convention October 24 – November 3, 2011 Orlando, FL

April 17, 2012 AOMA Board of Trustees – 7:00 p.m. April 17 – 21, 2012 AOMA 90th Annual Convention Scottsdale Hilton Resort & Villas 6333 N. Scottsdale Road Scottsdale, AZ

November 11, 2011 AOMA Board of Trustees – 7:00 p.m. November 12, 2011 AOMA House of Delegates – 3:00 p.m.

April 19, 2012 AOMA House of Delegates 3:45 – 6:00 p.m. PAC Reception – 6:00 p.m.

November 12 - 13, 2011 AOMA Fall Seminar – Omni Hotel Golf Resort & Spa 2727 W. Club Drive, Tucson – (520) 297-2271 February 4, 2012 AOMA Winter Board of Trustees – 9 a.m. A.T. Still University

Advertisers’ Index MICA............................................Page 2 Comitz & Beethe..........................Page 5 Catalina Medical Recruiters..........Page 15 notifymd......................................Page 20 Cox.............................................Page 22 Ian Ackerman, Ltd.......................Page 35

Centers for Medicare and Medicaid Services . ..................Page 47 Hospice of the Valley...................Page 49 A Professional Image...................Page 49 Lifeprint......................................Page 51 AOMA Career Center.............Back Cover.

49

AOMA Digest Summer 2011


Mark your calendar! Plan on attending the

31st Annual AOMA Fall Seminar November 12th & 13th, 2011 AOMA Fall Seminar Omni Tucson National Golf Resort & Spa 2727 W. Club Drive., Tucson 520-297-2271

Co-sponsored by the

Mutual Insurance Company of Arizona (MICA) and the Arizona Society of American College of Osteopathic Family Physicians (AzACOFP) The Arizona Osteopathic Medical Association has requested that the AOA Council on Continuing Medical Education approve this program for 12 hours of AOA Category 1-A CME credits. Approval is currently pending. An additional 1 hour of Category 1-A CME may be earned by completing the outcomes assessment after the Seminar. Register before October 12, 2011 to receive a generous discount. Visit www.az-osteo.org for more information or ask us for details. (Be sure to mention that you are with AOMA to receive your group discount)

Arizona Osteopathic Medical Association

Have you registe re d for th e Fall Seminar yet?

AOMA Fall Seminar

OMNI Tucson National Golf Resort & Spa

Call Omni for Room Reservations – (520) 297-2271 & Ask for the AOMA Block November 12 – 13, 2011

Register Today

q Member Registration fee is $250

q Non-member Registration fee is $350

Late Registration (beginning 10-12-11) $325

Late Registration (beginning 10-12-11) $425

q AzACOFP Member Registration fee is $215

Late Registration (beginning 10-12-11) $290

Name: ___________________________________________________________________ AOA #: ______________________________________ Address: _______________________________________________________________________________________________________________ City: _____________________________________________________________________ St: _______ Zip: _____________________________ Phone: ___________________________________________________ Fax: ________________________________________________________ Email: _ _______________________________________________________________________________________________________________ Payment: [ ] Visa [ ] MasterCard [ ] American Express Credit Card Number: __________________________________________________________ CVV Code: ___________ Exp. Date: ________________ Signature: _ _________________________________________________________________________________

Call (602) 266-6699 or Fax to (602) 266-1393 or Register Online at http://www.az-osteo.org AOMA Digest Summer 2011

50


5150 N. 16th Street, Suite A-122 Phoenix, AZ 85016

Presorted Standard U.S. Postage PAID Phoenix, AZ Permit No. 1273

Profile for Teresa

AOMA's 2011 Summer Digest  

Welcome to the 2011 Summer edition of the AOMA Digest.

AOMA's 2011 Summer Digest  

Welcome to the 2011 Summer edition of the AOMA Digest.

Profile for aoma
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