Arizona Osteopathic Medical Association
Volume 32, No. 1 Winter 2017
Osteopathic Medicine in the Digital Age
AOMA 95th Annual Convention April 19-23, 2017
95th Annual Convention Technology and Healthcare Member News
As we begin our 41st year of operation, the MICA Board has declared a member dividend â€“ another substantial dividend â€“ of $26 million, representing approximately 26% of an annual premium. Over the last twelve years, as beneficial owners, MICA members will have received, upon their receipt of the most recently declared dividend, their proportionate share of a cumulative $390 million in dividends. Since our founding in 1976, MICA has distributed over half a billion dollars in dividends to our members. To learn more about potential dividends from MICA and how you can become a member, visit our website, www.mica-insurance.com, or contact us at 800.352.0402.
Medical Professional Liability Insurance (602) 956-5276 (800) 352-0402 www.mica-insurance.com AOMA Digest Winter 2017
The dividend declared for the 2016 policy year reflects the Companyâ€™s financial performance. Past performance does not guarantee future dividends. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete detail of coverage, contact your insurance agent or MICA.
Volume 32, No. 1 Winter 2017
2016-2017 Board of Trustees President Shannon Scott, DO, FACOFP President Elect
The Official Publication of the Arizona Osteopathic Medical Association
Laurel Mueller, DO, MBA Immediate Past President Kristin Nelson, DO, FAOCO-HNS Vice President Angela DeRosa, DO, MBA, CPE Secretary/Treasurer Christopher Labban, DO Executive Director/Editor Pete Wertheim Trustees Danielle Barnett-Trapp, DO Elise Barney, DO Craig Cassidy, DO, FACOO Donald Curran, DO Susan Del Sordi-Staats, DO William Devine, DO Datcha Dorvil, DO, MPH David England, MS, DO Michelle Eyler, DO David Leff, DO Kit McCalla, DO, MBA Julie Morrison, DO George Parides, DO, FACOI Wendell Phillips, DO Bunnie Richie, DO, FAAN Resident Trustee Kendra Gray, DO Student Trustees Heidi Kipers, AZCOM, OMS IV Brenda Pecotte de Gonzalez, MPH, MA, SOMA, OMS IV
COLUMNS 2 Presidentâ€™s Message 4 Executive Directorâ€™s Message 8 AOMA in Action
FEATURES 9 Arizona Health-e Connection: 10 Years of Advancing Health Through Information Technology
1 Liability Issues with the Electronic Record 1 14 Transitioning to MACRA and the QPP 16 Recruiting Physicians in the Digital Age 19 Time Sweet Time 20 Cybersecurity in a Socially-Hackable World AOMA NEWS 22 Welcome New AOMA Members 23 Doctors That DO Delivers in Arizona 24 Arizona Emerging Osteopathic Leaders Grants 25 AOMA 36th Annual Fall Seminar 28 DOCME.org - Your Premier Source for Online CME 29 AOMA Business Partners OSTEOPATHIC COMMUNITY NEWS 30 Midwestern University Arizona College of Osteopathic Medicine 33 A. T. Still University School of Osteopathic Medicine in Arizona 35 DOs in the News 36 Advertisers Index 36 Calendar of Events
Speaker of the House of Delegates Jeffrey Morgan, DO, MA, CS, FACOI Vice Speaker of the House Charles Finch, DO, FACOEP
AOMA Staff Director of Education & Managing Editor Janet Weigel
Membership Development Manager
Opinions expressed in the AOMA Digest are those of the 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.
Operations Manager Teresa Roland
AOMA Digest Winter 2017
Awakening Force Judge me by my size, do you? And well you should not. For my ally is the Force, and a powerful ally it is. - Yoda One cannot underestimate the driving force of the Arizona Osteopathic Medical Association (AOMA). This is reflected in our membership, volunteer Shannon Scott, DO leaders, and staff. 2016 – 2017 AOMA President Membership is currently at more than 900 members, comprised of residents, new physicians in practice, academic, retired, self-employed, and employed physicians. In addition, more than 600 osteopathic medical students are members of the Association. The Board of Trustees is diverse in age, experience, and specialty. Currently, it includes 24 members in specialties of anesthesiology, surgery, obstetrics and gynecology, nephrology, neurology, gastroenterology, otolaryngology, pulmonary disease, internal medicine, and family medicine. We have voting board member positions for two students, one resident, and one new physician in practice. Also, within our “Member-at-Large” positions five of these physicians are in their first 10 years of practice. The AOMA House of Delegates is comprised of 82 delegates and alternate delegates representing the seven district societies in Arizona. AOMA has more than 10 committees comprised of dozens of dedicated volunteers. Our staff includes four outstanding people that tirelessly work behind the scenes to support the osteopathic community.
AOMA Digest Winter 2017
Both the momentum and collective work of these groups over the past several months has achieved successful and innovative educational seminars, networking events for students, strengthening of healthcare partnerships, and influencing of key legislative issues in the state. The vast levels of dedication and commitment these groups show towards collective projects are as amazing as they are inspiring – please check out our website at www.az-osteo.org to join the action. The Force is strong with this one. - Darth Vader
Meeting with key partners in Arizona to strengthen relationships and discuss collaborative works is one of the most valuable activities we can engage in as an organization. Most recently we have partnered with the Arizona Medical Association (ArMA) in development of an End of Life Issues Task Force. In addition, our executive committee held a joint meeting with ArMA to discuss critical legislative issues. It is our plan to continue this important work in the future. AOMA has received feedback from both national and local organizations that we model a healthy organization reflective in our membership growth, continuing education, student engagement, finance management, and policy development.
Difficult to see. Always in motion is the future. - Yoda
As a profession in transition with single accreditation post-graduate training and continuous board certification, the AOMA has set the bar high for the next step of member engagement and benefits. We are continually finding and creating new opportunities for further growth and attracting new members. Member needs are changing not only with respect to continuing education, but also in the areas of business of medicine resources and networking events; we are committed to meeting these needs with top notch offerings. Always pass on what you have learned. - Yoda Decades of wisdom form the foundation of the Osteopathic profession with priorities of inclusion, diversity, and education. It is a philosophy in treating the knowledge much like one would the patient: as a “whole”. AOMA members share much of their knowledge and time with communities, patients, colleagues, friends, and families. Our strength is tied to this leadership, volunteerism, and strong community partnerships. Our force also embraces the changing future and recognizes opportunities for growth. We need your help - join our force, give us feedback and direction that will unite our efforts into meaningful outcomes for all. It has been my pleasure to serve as your 2016-2017 AOMA President.
AOMA Digest Winter 2017
Executive Director’s Message
Technology and Public Policy Changes to Curb the Opioid Epidemic Numerous technological advances and public policy changes have been adopted in Arizona and other states to address the opioid epidemic. Many of these are still in their infancy and there are challenges to overcome for them to be fully optimized and effective. Advances in technology have been Pete Wertheim hurried, so prescription AOMA Executive Director drug monitoring programs (PDMPs) are lacking bi-directional and integration capability, and supply and demand has not yet produced the ideal prescription drug monitoring program. Numerous states, including Arizona, have checked most or all of the public policy boxes, e.g. mandated registration and use of PDMP, Good Samaritan law, expanded access to Naloxone, mandated continuing medical education for prescribers, etc. All of these public policy initiatives are well intended, but how they are implemented, how changes are accepted, and how they are enforced are major determinants in their success. AOMA has been at the forefront with these issues as a stakeholder and advocate for effective technological advances and good public policy. From the time this article is finished to its publication, some of the information may already be outdated so we will share what we know today and provide updates. Technological Advances In the past few years, the Arizona Board of Pharmacy (Board) has made numerous changes and upgrades to the PDMP. They have recently transitioned to a new operating system AWARxE, developed by Appriss. AWARxE is considered AOMA Digest Winter 2017
one the leading PDMP platforms and claims to have the fastest response times, best patientlinking algorithms, user-friendly administration, and adaptability to computers, tablets, and smartphones. Effective clinical use of the PDMP system as a stand-alone system is important, but we also need bi-directional integration of the PDMP data into electronic health records. To this end, last year we insisted that legislation to mandate checking the PDMP by prescribers include provisions to incentivize integration and publicize progress updates. First, the mandate for prescribers to check the PDMP cannot go into effect until the system is integrated with Arizona Health-e Connection’s statewide health information exchange. We felt it was only fair that the integration effort be completed before a mandate to check the PDMP goes into effect. The target date for integration and effective date of the mandate is October 1, 2017 and we expect the deadline will be met. Second, we included a requirement that the Board must report quarterly on the number of electronic health records (EHR) companies and number of prescribers who have integrated the PDMP data. Knowing how many companies and prescribers have integrated the data enables us to measure the progress toward the goal of full integration of the PDMP with EHRs. It was troubling to learn from physicians about the enormous expense and lack of affordable options to integrate PDMP data into their EHRs. We have a supply and demand problem in the marketplace, and once the mandate to check the PDMP goes into effect we will have an overabundance of demand. Eventually as supply and demand increases creating a competitive marketplace, there will be more affordable options and perhaps integrating PDMP information with EHRs will no longer be an “add-on” but a core component. You can help us accelerate progress in this area by contacting
Executive Director’s Message
your EHR vendors and asking them about their timeline and plans to integrate the data. Many of these efforts will proceed more smoothly now since we just learned the Board is receiving critical funding to help accelerate the transition of the PDMP to integrate with systems, facilities, and providers at no charge to them. In addition, the current practice of manually inputting provider PDMP registrations will be automated using license applications and renewal dates saving time, resources, and improving accuracy. It is too soon to report on the impact of all of these efforts, but the Board is making the right moves now to get us where we hope to be. It is also important that we hear from you and your ideas for making this a better system for you. Public Policy Changes There are three major public policy changes underway. AOMA is working with Governor Ducey’s administration and policy makers to protect physician and patient interests. In October 2016, Governor Ducey issued Executive Order 2016-06 Prescription Opioid; Initial Fill Limitation. This executive order directed the Arizona Health Care Cost Containment System (AHCCCS) and Department of Administration (DOA) directors to adopt “any necessary policies and rules” to limit initial fills of prescription opioids for adults and children to no more than seven days, and refills for children to no more than seven days. In the case of children, the order allowed exceptions for cancer, other chronic disease, or traumatic injury. This order will impact more than 1.9 million adults and children on Medicaid and the state employee health insurance program. AOMA’s email and phones lit up with physicians responding to this executive order. While most physicians understood the premise, a majority of the concerns surrounded implementation, specifically the lack of exceptions for adults. Once AHCCCS issued the draft policy, AOMA responded with official comments. We followed this up bringing together a team of physician leaders from the AOMA along with the Arizona Medical Association to meet with the AHCCCS medical
director Sara Salek, MD, AHCCCS staff, and representatives from DOA to discuss our concerns. This meeting was extremely helpful and AHCCCS responded to our concerns by adding the exclusions we requested for adults receiving care for cancer, hospice, end-of-life care, palliative care, skilled nursing facility care, and traumatic injury. The limit on post-surgical procedures was also increased from 7 to 14 days. This new policy will go into effect April 17, 2017. AOMA will distribute the final policy, FAQs, and other information as they are finalized later this month. In addition, during his 2017 State-of-the-State address, Governor Ducey directed the Arizona Board of Osteopathic Medical Examiners and the Arizona Medical Board to require that one hour of the 40 biennial continuing medical education hours required for license renewal be in the area of addiction or Substance Abuse and Mental Health Services Administration-supported opioid prescribing training. In his remarks, the Governor cited the need for physicians to have more training and expertise to identify and treat addiction. AOMA has provided and will continue to provide opioid training at our Annual Convention and Fall Seminar CME events. In 2015-2016, AOMA sponsored eight statewide free opioid CME training events with the Arizona Board of Osteopathic Medical Examiners through a grant they received. We are looking to again offer these workshops to help physicians comply with this new mandate. We have requested that the licensing boards allow exceptions to the CME requirement for physicians who do not prescribe opioids and this recommendation is still under consideration. Finally, Senate Bill SB 1283, passed by the Legislature and signed into law in 2016, will go into effect later this year requiring all prescribers to check the PDMP before prescribing opioids with exceptions. Arizona will soon be among a majority of states that have similar requirements. AOMA will be working with the Board and other stakeholders to get information disseminated to physicians to help them prepare for the impending mandate. PDMP continued on page 6
AOMA Digest Winter 2017
Executive Directorâ€™s Message PDMP continued from page 5
If you are unfamiliar with the components of this impending mandate, we have included a checklist with suggestions for compliance. These are the essential elements of SB 1283. Because the mandate is being applied bluntly, there are a large number of exceptions carved out to try to minimize non-clinical use of the PDMP. However, we expect additional exceptions may be necessary and later we may discover that some of these exceptions may not be necessary. Moving Forward The primary reason the law to mandate checking the PDMP passed was largely due to the poor registration and utilization rate of the PDMP by prescribers. Physicians are understandably frustrated with the opioid crisis and feeling singled out by a growing number of unfunded mandates. However, until there is substantial progress to reduce opioid misuse, policymakers will continue to throw everything
they can at this problem until it is effectively mitigated. Unfunded mandates will cease when physicians are compliant with the current ones. Many physicians have neglected to use the PDMP; some due to ambivalence and others due to poor functionality and usability for clinical use. We are holding the Board accountable and meeting with them frequently to ensure that you have the best tools to work with. Once we are successful removing some the barriers to an effective system, it is up to everyone to comply with the law and use the system as it is intended. AOMA is committed to being the chief advocate for osteopathic physicians in Arizona. The Association relies on your continued support through membership, contributions to the AOMA Political Action Committee, participation on the Legislative Affairs Committee, and response to AOMA legislative action alerts to protect and promote the osteopathic medical profession for our patients, now and for the future.
Suggestions for Compliance with the PDMP Mandates for Prescribers 1. Make sure you are registered with the PDMP, visit www.pharmacypmp.az.gov 2. Determine the optimal way to use the PDMP program in your practice, there are essentially three options: a. Use the PDMP independently b. Use the PDMP with program enhancement, e.g. SAS, Past Rx c. If available, use the PDMP with your EHR. 3. Remember that you can authorize delegates to check the PDMP on your behalf; however, they must use a separate log in 4. The mandate will not go into effect until October 1, 2017, or when the PDMP is integrated into the statewide health information exchange, but it is advisable to begin incorporating into your practice voluntarily now to minimize disruption once it becomes mandatory 5. Read the law and make sure you understand it; visit the AOMA website, click Opioid Law under Resources to obtain a copy 6. Understand the requirements for checking the PDMP: a. New patient treatment and continuing quarterly treatment using opioid analgesic or benzodiazepine b. PDMP must be checked for Schedule II, III or IV medications for the preceding twelve months 7. Understand the exceptions to the requirements: a. The PDMP does not need to be checked if the patient is:
AOMA Digest Winter 2017
i. Receiving hospice or palliative care for a serious or chronic illness ii. Receiving care for cancer, cancer-related illness or condition or dialysis treatment iii. Being administered the controlled substance iv. Receiving the controlled substance during the course of inpatient or residential treatment in a hospital, nursing care facility, assisted living facility, correctional facility or mental health facility v. Being prescribed the controlled substance for no more than a ten-day period for an invasive medical or dental procedure that results in acute pain vi. Being prescribed the controlled substance for no more than a ten-day period for an acute injury or a medical or dental disease process diagnosed in an emergency setting that results in acute pain to the patient (does not include back pain) vii. Being prescribed the controlled substance for no more than a five-day period when the prescriber has already reviewed the PDMP within the last thirty days and the patient had not been prescribed a controlled substance previously by another prescriber b. Practitioners may receive a one-year waiver due to technological limitations c. Practitioners are not responsible for checking the PDMP if they are unable to request or receive data due to system failure
Arizona Osteopathic Medical Association 95th Annual Convention April 19 to 23, 2017 Hilton Scottsdale Resort & Villas Scottsdale, Arizona Arizona's largest annual osteopathic medical meeting! Register by March 19, 2017 and save $100! Full five-day and three-day weekend registrations available* Register online at www.az-osteo.org/2017Conv or call the AOMA office at 602-266-6699. CONVENTION CME SCHEDULE Full agenda available at www.az-osteo.org/2017Conv. All topics, speakers, and times are subject to change. WEDNESDAY, APRIL 19, 2017
SATURDAY, APRIL 22, 2017
7:00 am to 5:00 pm
6:00 am to 7:00 am
7:30 am to 8:55 am
Opening General Session
7:00 am to 5:00 pm
9:10 am to 12:05 pm
Concurrent CME Sessions
7:30 am to 11:35 am
Concurrent CME Sessions
12:15 pm to 1:40 pm
7:30 am to 11:35 am
Concurrent OMM CME Sessions
Concurrent CME Sessions
11:45 am to 1:15 pm
Clinical Case Competition Luncheon
1:20 pm to 4:55 pm
Concurrent CME Sessions
1:20 pm to 4:55 pm
Concurrent OMM CME Sessions
1:55 pm to 4:50 pm
THURSDAY, APRIL 20, 2017 7:00 am to 5:00 pm
7:30 am to 11:50 am
SUNDAY, APRIL 23, 2017
11:50 am to 1:00 pm
Lunch in the Exhibit Hall – No CME
7:00 am to 1:00 pm
8:00 am to 12:05 pm
12:30 pm to 2:00 pm
AOMA Awards Luncheon - No CME
1:00 pm to 4:50 pm FRIDAY, APRIL 21, 2017 7:00 am to 5:00 pm
7:30 am to 11:55 am
12:00 pm to 1:25 pm
1:30 pm to 3:55 pm
Registration includes access to all CME sessions, meal functions, and exhibit hall. Exhibitor dates are Thursday, April 20, 2017 7:00 am to 5:00 pm and Friday, April 21, 2017 7:00 am to 12:00 pm. Make the most of your convention experience! Stay with us at the Hilton Scottsdale Resort & Villas. Call 480948-5500 for reservations and ask for the AOMA room rate of $195 per night.
The Arizona Osteopathic Medical Association strives to provide continuing medical education programs to fulfill the needs of the attendees and to meet the AOA Uniform Guidelines and AOA Accreditation Requirements. Comments, questions, or complaints should be submitted in writing to Janet Weigel, Director of Education by mail to AOMA, 5150 N. 16th Street, Suite A-122, Phoenix, AZ 85016, or by email firstname.lastname@example.org.
*The Arizona Osteopathic Medical Association (AOMA) is accredited by the American Osteopathic Association (AOA) to provide osteopathic continuing medical education for physicians. The AOMA designates this program for a maximum of 36.0 hours of AOA Category 1-A CME credits and will report CME credits commensurate with the extent of the physician’s participation in this activity. A maximum of 20 AOA Category 1-A CME credits may be earned for the three-day weekend option. Application will also be filed for AAFP Category 1 prescribed credits. In order to receive CME credits for the AOMA 95th Annual Convention, you must sign in at registration, receive your packet, and submit the online CME attestation form to AOMA by the May 23, 2017 deadline.
MEDICAL SPECIALTY LECTURES SCHEDULED (subject to change)
»» Family Medicine »» Internal Medicine »» Cardiology »» Dermatology »» Gastroenterology »» Hospice & Palliative »» Nephrology »» Neurology
»» Obstetrics & Gynecology »» OMM and OMM/NMM »» Oncology »» Pain Medicine »» Pediatrics »» Psychiatry »» Rheumatology and more!
AOMA in Action
AOMA in Action
AOMA is the voice of osteopathic medicine in Arizona, representing the profession as a healthcare stakeholder and community partner. This activity update covers the five month period from October 1, 2016 to January 31, 2017.
Advocacy/Legislative Affairs • Represented AOMA physicians at more than 15 stakeholder meetings to develop “surprise billing” reform legislation • Successfully opposed efforts by the Arizona Naturopathic Medical Association to expand scope of practice to write childhood immunization medical exemptions • Recorded advocacy training webinars/podcasts for Advocacy Resource Center • Supported legislation for medical preceptor tax credits • Signed on to coalition to raise smoking age to 21 American Osteopathic Association (AOA) • Attended the Strategic Affiliate Alignment Retreat and AOA Advocacy for Healthy Partnerships meeting in Tampa, Florida Continuing Medical Education • Sponsored 13.0 hours of AOA Category 1-A CME credit for the AOMA 36th Annual Fall Seminar in November 2016 • Created and posted seven new online on demand CME offerings on InReachCE.com
Public Health • Represented AOMA on the Arizona Health-e Connection Board meeting • Represented AOMA at The Arizona Partnership for Immunization (TAPI) Steering Committee Students & Residents – The Future of the Osteopathic Profession • Provided new student orientation at SOMA, and advocacy training at AZCOM and SOMA • Student doctors served as moderators at the AOMA 36th Annual Fall Seminar • Attended Rotation and Residency Opportunity Day at Midwestern University • Launched the Arizona Emerging Osteopathic Leaders Grants program for residents For more information about any of these updates, call 602-266-6699 or email email@example.com
MAKE A DIFFERENCE FOR OSTEOPATHIC MEDICINE. Contribute to the AOMA Political Action Committee!
Member Services • Hired new Membership Development Manager Colleen Zubrycki • Added new Business Partner eVisit, telehealth software company Political Action Committee • Raised $5,600 in PAC contributions • Distributed $5,300 to 16 candidates Osteopathic Charities • Raised $2,500 in the 2017 Birdies for Charity campaign • Announced Annual Scholarship Essay Contest to AZCOM and SOMA students Public Relations • Provided advocacy training and support for the American College of Physicians – AZ Chapter’s Day at the Legislature • In conjunction with the AOA, presented the Doctors That DO brand awareness campaign in Arizona resulting in over 28 million impressions during October and November 2016 AOMA Digest Winter 2017
PURPOSE AOMA Political Action Committee (PAC) is an essential vehicle for preserving and fostering the osteopathic medical profession in Arizona. The PAC allows us to endorse and support those candidates for state public office who share our concern about the future of healthcare and improved access to quality care in Arizona. CONTRIBUTE ONLINE! It’s easier than ever to contribute to the AOMA PAC and make a difference. Go to www.az-osteo.org/PAC or scan the code.
Arizona Health-e Connection: 10 Years of Advancing Health Through Information Technology By Melissa Kotrys, MPH, CEO Arizona Health-e Connection
What began in a small office with the Arizona Medical Association is today a statewide resource that is improving healthcare across the state. Arizona Health-e Connection (AzHeC), Arizona’s statewide health information exchange (HIE), has become an increasingly valuable resource for providers as the market shifts to value-based payment requiring more complete patient information and better care coordination. Here are a few recent milestones for AzHeC: • In 2016, participation in the statewide HIE grew from 77 to 250 participants – an increase of 225 percent. A key factor driving this growth was the elimination of participation fees for community providers in October 2015, as well as the integration of physical and behavioral health information in the HIE. • AzHeC is currently receiving ADTs (admissions, discharges & transfers) from Arizona hospitals representing approximately 90% of all statewide discharges. Community providers can “subscribe” to real-time alerts of these ADTs to improve the care coordination for their patients. • The statewide HIE saw a significant increase in data received from participants, increasing from 6.4 million transactions monthly in December 2015 to 10.1 million transactions monthly in December 2016. The HIE now contains clinical information on more than 7 million patients.
It has been quite a journey for AzHeC and the journey began with a roadmap. In 2005, through an executive order of Governor Janet Napolitano, a broad community coalition came together to create a roadmap to guide the coordination and development of health information technology (HIT) and health information exchange (HIE) in Arizona. The result was the initial strategic plan for HIE/HIT in Arizona entitled the Arizona Health-e Connection Roadmap that, among other plans and initiatives, called for the creation of a non-profit, public-private organization to coordinate health information technology development in Arizona. The new non-profit was incorporated in January 2007 and took on the name of the statewide roadmap. AzHeC: 10 Years continued on page 10
AOMA Digest Winter 2017
Features AzHeC: 10 Years continued from page 9
Here are some of the key HIT/HIE developments in AzHeC’s first 10 years: The advancement of electronic health records (EHRs) Through an $11.9 million grant, AzHeC operated the Arizona Regional Extension Center and assisted more than 3,200 providers with the adoption and meaningful use of EHRs. Today EHR adoption is well above 85% statewide, and through the EHR Incentive Program of the Centers for Medicare and Medicaid Services (CMS), more than $650 million has been brought into the state for participating hospitals and providers. E-prescribing and the e-prescribing of controlled substances (EPCS) Through grant-funded programs, AzHeC has advanced the use of e-prescribing by Arizona physicians and pharmacies, with the statewide e-prescribing rate rising from below 10 percent in 2007 to more than 60 percent today. In addition, AzHeC was a part of the collaborative community effort to support legislation that in 2012 made the e-prescribing of controlled substances (EPCS) legal in the state. The rate of EPCS adoption has steadily increased since. The advancement of HIE and patient rights In 2011, AzHeC helped lead a collaborative community effort to support successful legislation that removed barriers to HIE and created regulations to afford and give notice to patients of their rights regarding the sharing of their health information through a health information organization (HIO). The result is a “patient rights process” developed and implemented by AzHeC that provides patients across the state a notice (like a HIPAA notice) when their providers begin to participate in the statewide HIE.
AOMA Digest Winter 2017
Upgrade of HIE technology and new HIE services In 2014 AzHeC formally affiliated with Health Information Network of Arizona (HINAz) and recognized that the statewide HIE required an upgrade to its technology platform. In less than a year, AzHeC went through a selection process and migrated to a new technology platform that went live in April 2015. The technology upgrade provided new services such as alerts and notifications that could provide immediate benefits to users. The result of the upgrade has been a rapid growth in participation and use of the statewide HIE. Integration of physical and behavioral health information In February 2016, the AzHeC Board approved a strategy of integrating physical and behavioral health information in the statewide HIE. Later in 2016, AzHeC began to work with Arizona’s three regional behavioral health authorities (RHBAs) to integrate and connect their behavioral health providers to the statewide HIE. Today there are more than 80 behavioral health provider organizations participating in the statewide HIE, allowing the secure sharing of more complete information on patients. As AzHeC’s second employee, I know how the way we began has played such a key role in our ability to succeed in our first 10 years. Those early years and the original statewide collaborative effort were very important. Through our Board structure and our outreach activities, we have always maintained broad community representation and support, and that support has helped lead us through some difficult challenges and will sustain us in our next 10 years.
Liability Issues with the Electronic Record By Julie Ritzman, MBA, Vice President Risk Management Services Mutual Insurance Company of Arizona
The electronic medical record was initially thought to be the advanced technology that would cure the errors caused by issues humans had been unable to overcome. While the electronic record has improved the speed at which a healthcare practitioner is able to obtain information from a variety of sources within a health system or multiple health systems, it has also been met with serious unintended consequences. We are just now beginning to see the impact of those consequences. However, much more research will need to be performed to fully measure the implications to healthcare quality, patient safety as well as malpractice litigation. Literature Michael Victoroff, MD, a liability expert and critic of the federal program encouraging physicians and other healthcare practitioners to adopt EHR’s told Politico Magazine, “This is kind of like the car industry in Detroit in 1965. We’re making gigantic, horrendous, unsafe machines with no seat belts, and they are selling like hot cakes. But there’s no Ralph Nader saying, ‘Really?’”1
It has been suggested that the introduction of the electronic record has increased the scope and complexity of tasks that clinicians can perform, but by doing so in conjunction with the speed of implementation, the increase in the clinicians’ patient load, as well as the decreasing number of support staff, the electronic record has created the perfect storm. Perspectives in Health Information Management in their Fall 2013 issue stated, “rather than leading to improvements in the quality of data being recorded, (the electronic record) has led to the recording of a greater quantity of bad data.” EHR system vendors often add functionalities to assist with documentation, such as copy and paste, templates, use of standard phrases and paragraphs, and automatic object insertion for a variety of benefits. However, when used inappropriately, these can lead to inaccurate documentation and potentially result in medical errors or allegations of fraud.2 A study published in 2013 in Critical Care Medicine found that 82 percent of residents’ progress notes and 74 percent of attending physicians’ EHR notes in the intensive care unit contained 20 percent or more copied text.3 In a 2008 survey of physicians at two affiliated academic medical centers, 90 percent of physicians used the copy/paste functionality in daily electronic progress notes, while 71 percent acknowledged inconsistencies and outdated information were more common in copied and pasted notes.4 Templates can be a useful tool to assure that physicians do not ignore essential elements of the physical exam. However, templates often automatically populate data elements Electronic Record continued on page 12
AOMA Digest Winter 2017
Features Electronic Record continued from page 11
before they even occur. For example, if a clinician checks “normal” for the GI system, the EMR system may automatically fill in other descriptors such as “abdomen soft” and “normal bowel sounds”, etc. If the clinician did not listen to the patient’s bowels with a stethoscope, this potentially puts the office at risk for quality of care issues, malpractice, falsification of records, etc.5 Just as physicians and other healthcare practitioners can easily determine when copy/paste and template functions were utilized, a plaintiff attorney is also able to recognize this during the discovery phase of a malpractice claim and use it as a demonstration to the judge and jury. Healthcare IT News in April 2015 listed the following as some of the focus of courtroom conversations between judges and attorneys in recent malpractice suits:6 • “Someone had to order (a lab) and the EMR doesn’t seem to track this well,” said the judge in one case where the plaintiff was awarded nearly $2 million after charging that his physician missed an abnormal urinalysis – leading, years later, to advanced kidney damage. • “You have a problem here, it appears neither you, nor your doctor can make sense of this EMR,” said another judge, chiding an attorney for being unable to discern from the record whether one physician or another was responsible for a particular intervention. • One exchange elicited murmurs of disbelief from session attendees, as a witness explained, “Your honor, the EMR allows us to massage the data to filter out items so we can create flow charts and graphs.” “A medical record is a medical record,” the judge replied, incredulously. “You mean to tell me you alter it as you see fit?” • Another judge dismissed the EMR as exculpatory evidence, noting that, “The AOMA Digest Winter 2017
record is not to be believed: There is plagiarism, which you euphemistically categorized as ‘cut-and-paste’.” Other PIAA Companies According to a study by The Doctors Company of EMR-related closed claims from 2007-2013, incorrect information is the most common user-related contributing factor in malpractice cases involving EMRs. In the study, 15 percent of cases involved prepopulating/copy and paste as a contributing factor. In one case, the judge commented about copy-and-paste issues: “I cannot trust any of the physician notes in which this occurred and the only conclusion I can reach is that there was no examination of the patient…it means to me that no true thought was given to the content that was going into ‘the note’.” In about 200 EHR-related legal cases that the CRICO insurance program analyzed, the glitches rarely led directly to patient harm, said Dana Siegal, the company’s director of patient safety services. But she added, “We’re seeing failures to communicate or providers acting on inaccurate information that was driven in part by an EHR issue.” Take the case of an elderly Illinois woman who stabbed herself with a garden fork. An emergency room nurse clicked the “unknown/last five years” tab for the woman’s tetanus immunization status, and a physician interpreted this to mean she did not need to be vaccinated, when in fact, she had never been immunized. The woman later died of tetanus, said Chicago plaintiff’s attorney Kenneth Lumb, who handled the case. MICA Defense Panel Attorney Kathleen Rogers recently reported a case stating, “The state of information in the EMR is not static. Entries, views, and system fields are continuously being updated, meaning one cannot retrospectively
retrieve what was seen at a specific time. This particular EHR will continue to update the patient’s age if accessed later, even if the patient is deceased.” Ms. Rogers went on to provide a case summary involving an emergency physician. The patient had presented to the hospital with a complaint of chest pain but failed to report a prior history of aneurysm. The patient was discharged with the diagnosis of abdominal pain. The patient returned to the hospital, this time reporting the aneurysm which was then entered into the EMR. The EMR then updated the patient’s past medical history system-wide giving the appearance that the information was available at the time of the preceding visit. It appeared as though the aneurysm had been reported and ignored at the time of the first visit. Fortunately, the issue was discovered and resolved during the course of litigation. Other cases have brought to light that dealing with the electronic medical record has brought a new creature, some may refer to as a beast, into the defense of medical malpractice allegations. Many attorneys have reported that when physicians and other healthcare practitioners are preparing for depositions and are shown the printed version of the medical record, it is virtually unrecognizable. The printed version of their documentation looks nothing like the screens they used to create the medical record. In addition, there has been at least one instance in which the electronic record demonstrated that an initial report along with the addendum were both dictated and transcribed at the same moment in time making it appear as though the physician knew details about the patient’s condition and did nothing with the information. Finally, there have also been reports that the listings within the drop down fields are not adequate or do not conform with the physician’s instructions and, at least on
one occasion, caused a physician to order a medication with an inappropriate frequency of administration. The physician then verbally informed the patient of the correct frequency. Once home, the patient followed the instructions on the medication label, not recalling the verbal instructions, and suffered an adverse effect. It is undeniable that the electronic health record is transforming healthcare in ways good and bad. The practice of medicine has always been complex and at this stage the EHR is adding another layer of complexity instead of reducing it. If used inappropriately, which is easy to do, it may lead to adverse unintended consequences for the patients we serve. The paper medical record was helpful to a physician’s malpractice defense because it was created at the time of the encounter, told the patient’s medical story, the physician’s assessment and medical decision-making in a narrative document that was easy to understand and explain. Today, the best protection is to know and understand the electronic system you utilize, to make sure the patient’s condition and your medical decision-making is accurate and readily apparent, and investigate any adverse events involving this technology to ensure the causal factors, human or technological, do not repeat themselves with every patient encounter. References 1. Arthur Allen, Electronic Record Errors growing Issue in Lawsuits, Politico, May 2015 http://www.politico.com/story/2015/05/electronicrecord-errors-growing-issue-in-lawsuits-117591. 2. Sue Bowman, Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications, Perspectives in Health Information Management, Fall 2013, page 4. 3. Daryl J. Thornton, Prevalence of Copied Information by Attendings and Residents in Critical Care Progress Notes, Critical Care Medicine, 41 Issue, 2013, page 4. 4. Heather C. O’Donnell, Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing, Journal of General Internal Medicine, 24 Issue, 2008, page 66. 5. Use of Cloning in Electronic Records, Priority Health, accessed November 2015 https://www.priorityhealth.com/provider/manual/ office-mgmt/records/documentation-cloning. 6. Mike Miliard, EMRs Can be Costly in Malpractice Suits, Healthcare IT News, April 13, 2015 http://www.healthcareitnews.com/print/91616.
AOMA Digest Winter 2017
Transitioning to MACRA and the QPP By Dawn Williams Health Services Advisory Group
The Patient Protection and Affordable Care Act (ACA) of 2010 was landmark legislation that created the National Quality Strategy (NQS) and which included the redesign of Medicare’s fee-for-service (FFS) payment structure. Medicare adapted the NQS with the express purpose of becoming an active purchaser of quality healthcare instead of a passive payer for medical services. As the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, Health Services Advisory Group (HSAG) provides technical assistance to healthcare providers to help in making this transition to payment for quality clear and seamless. HSAG’s current work supports physician incentive programs including the Physician Quality Reporting System (PQRS) and Meaningful Use (MU). PQRS serves as the foundation for assessing the quality of care individual or group practices provide through electronic health record (EHR) submission of evidence-based quality measures. However, 2016 is the last year that quality measures and EHR MU attestation are required for providers who bill Medicare FFS.
New Way Old Way AOMA Digest Winter 2017
As set out in the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation signed into law in April 2015, providers will now submit quality measures through the Merit-based Incentive Program System (MIPS). MACRA replaces the Medicare Sustainable Growth Rate (SGR) and puts into place two types of quality payment programs: Alternative Payment Models (APMs) and MIPS. MACRA streamlines PQRS, MU, and the Value-Based Modifier into one quality program, MIPS. Its requirements mirror the PQRS quality measures and MU requirements (with only six instead of nine quality measures reported), with additional requisites for health information exchange, patient care coordination, and interoperability. Data submission methods remain the same: EHR, qualified registry, web interface, clinical data registry, and claims. CMS also has provided for greater flexibility in implementing MACRA, with all its provisions now collectively referred to as the Quality Payment Program (QPP). Providers may now pick their pace of participation for the first performance period that starts on January 1, 2017, from any of the following choices:i • Test the QPP—As long as a provider submits some (any) data to the QPP, including data from after January 1, 2017, that provider will avoid a negative payment adjustment. This option is designed to allow providers to test their systems and prepare for greater participation in 2018 and 2019. • Participate for part of the year—Providers may opt to submit QPP data for a reduced number of days and still qualify for a small positive payment adjustment. The Centers for Medicare & Medicaid
Services (CMS) allows providers to select from the list of quality measures and improvement activities available under the QPP. • Participate for the full year—Providers may choose to submit QPP information for a full year, which includes submitting data starting on January 1, 2017. Submission for a full year may entitle providers to a positive payment adjustment. • Participate in an Advanced APM— Providers may participate in the QPP by joining an Advanced APM, such as Medicare Shared Savings Track 2 or 3 in 2017. If providers see a minimum threshold of Medicare patients through the Advanced APM in 2017, they would qualify for a 5 percent incentive payment in 2019. Regardless of which data submission method the provider chooses or which QPP option they select, HSAG is here to provide technical assistance to make the transition to the QPP logical and efficient. For more information, contact Howard Pitluk, MD, MPH, FACS, HSAG, Vice President for Medical Affairs & Chief Medical Officer, at hpitluk@ hsag.com References i. The Centers for Medicare & Medicaid Services Blog. Andy Slavitt, CMS Acting Administrator. Available at: https://blog.cms. gov/?s=pick+your+pace. Accessed on January 4, 2017.
This material was created by Health Services Advisory Group the Quality Improvement Organization for Arizona, California, Ohio, Florida, and the U.S. Virgin Islands, 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. QN11SOW-D.1-01042017-01
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AOMA Digest Winter 2017
Recruiting Physicians in the Digital Age By Joan Pearson Catalina Medical Recruiters, Inc.
Your waiting room is full; your patients are double-booked and new patients wait three to six weeks for their initial appointment. In order to continue to provide the level of care your patients have come to expect, do you need to add to your medical staff? It may be time to consider bringing on another physician or advanced level practitioner. We all know there is a severe shortage of physicians and those in the job market have many options to consider. As you consider hiring a new physician, being competitive in the marketplace is critical. With the technology of the internet and a few clicks on their computer, tablet, and phone, physicians can explore new opportunities across the nation. Within minutes they can review the type and size of practice, skill and procedure requirements, call schedule, and compensation package. Don’t forget you have access to this information, too! Online job postings can give you an opportunity to see what the competition is offering with regard to sign-on bonus, salary, relocation expense, CME, and vacation, etc. Physician demand is higher than ever. You will not hire your ideal candidate if you are not competitive. The internet can be helpful in many ways. Conduct a Google search on the candidate and you can read reviews on physician rating sites such as Vitals, RateMDs, and HealthGrades. Many sites often include patient reviews. You can read what new and established patients say about the physician and the organization where they practice. Don’t forget to conduct the same Google search on yourself and your practice. Remember, if you are reading it on the internet, you can be sure candidates and patients are reading it, too. Competition is fierce and it is critical once a Curriculum Vitae (CV) comes across your AOMA Digest Winter 2017
desk that you review it as soon as possible. Reviewing the Curriculum Vitae is your first opportunity to determine if the candidate has the education, training and experience that might be an asset to the practice. Below are tips to assist you in effectively evaluating CVs. • Is the CV written in a professional manner with easy to find contact information, clearly defined sections, easy to read alignment, correct spelling, and word usage? If not, this may be a sign of disorganization, lack of attention to detail, poor communication skills, or discrepancies in education and work history. • Review education/training to assess the quality of educational programs, number of years to complete training, and possible splits in medical training. Breaks in training may indicate the candidate had difficulty matching with a residency/ fellowship or poor performance issues. It could be due to health issues or family matters out of the candidate’s control. Be sure to ask about this during the initial phone interview. • CVs should have work history written in reverse chronological order with months and years so it can easily be screened for gaps. Gaps may be a sign of academic, clinical, or personal issues that reflect on the candidate's qualifications.
• How many jobs has this candidate had and over what time span? Frequent moves and/or short tenure with any organization may indicate an inability to get along with colleagues or administration, poor clinical skills, or other concerns. • Review the CV for board certification status in the primary specialty; is certification current; is the candidate certified in subspecialty areas pertinent to your position; does the candidate have added qualifications in key clinical skills? • Does the candidate have specific achievements such as medical honor societies, chief residency status, citations, and awards? Such accomplishments may provide valuable insight regarding the candidate's academic accomplishments and desire to achieve/excel in his/her career. • Depending on specific job requirements for your position, check for publications, presentations, research grants/interests. • Does the CV indicate committee work or leadership titles? Active involvement in committees or chairman/directorship titles may indicate a candidate with potential to be a physician leader in your organization. • Evaluate volunteer work and personal interests to determine how well the candidate will fit into your practice and community. The availability of this information on a CV will provide you with valuable insight; however don't be alarmed if the information is not included on the CV. You will learn more about the candidate during a telephone interview. Prior to scheduling an initial telephone interview, it is wise to check the status of the physician’s state medical license. Information on Arizona licensed physicians can be obtained online from the Arizona Osteopathic
Medical Board at www.azdo.gov. Simply click on Doctor Search and type in the physician’s name. Information relating to the physician’s license will show any board actions including reprimand, censure, restriction, probation, etc. If the physician is licensed in another state, the information can be obtained online at the Federation of State Medical Boards at www.fsmb.org. This information is useful in determining if you wish to proceed to the next step. Again, prior to the initial phone interview, don’t forget to check the internet. Technology offers an abundance of information that was not available in years past. Conduct a Google search of the physician’s name and you may find important information. LinkedIn is a professional site that can offer valuable insight regarding the candidate’s professional life and interests. Additional information may also be available on Facebook, Twitter, Instagram, and YouTube. However, be cautious! We know not everything we read on the internet is true. Telephone Questions for Candidates The goal of the telephone interview is to help both parties decide if an on-site interview should be forthcoming. This is your opportunity to learn more about the candidate and to share specifics about the opportunity and community. TIP: Preschedule the telephone interview for 30-60 minutes to ensure you and the candidate can discuss the opportunity without interruption. After introductions, provide a 2-3 minute summary (keep it short) of why you are recruiting another provider to join your practice/group. The candidate should have an opportunity to ask you specific questions later in the telephone interview.
Recruiting continued on page 19
AOMA Digest Winter 2017
Features Recruiting continued from page 17
We recommend you add these questions to those you ordinarily ask during a telephone interview: 1. I understand you have an interest in my/ our practice opportunity. Why are you interested in this area? 2. If the candidate is a Resident or Fellow: a. What criteria are you using to compare practice opportunities? b. Tell me about the strengths of your training program. c. Do you plan to focus on a subspecialty area? 3. If the candidate is a Practicing Physician: a. Why are you considering making a change at this time? b. What types of cases/procedures are you doing? c. How many patients do you see each day? How many procedures or surgical cases per week? 4. What is the most important thing you are seeking in a new practice?
AOMA Digest Winter 2017
Just as you have questions for the candidate, be prepared for questions the candidate will have for you. They may ask: • What is the practice philosophy regarding treatment protocols and patient care plans? • What are the long term goals of the practice with regard to growth and number of physicians? • What is level of training and expertise of the practicing physicians? • Does the practice have advanced level practitioners? • What is the patient population and payer mix? There are many steps in the recruitment process. In addition to determining the actual need for a new physician, do you have adequate space? Do you have appropriate staff? Is there support of all the current physicians? Are the financial and contractual matters in place? Looking to the future and being prepared can make for a smooth transition when bringing a new physician onboard. To receive a complete copy of Telephone Questions for Provider Candidates, Tips for Successful Site Visits or Ready to Recruit Checklist, email firstname.lastname@example.org.
Time Sweet Time By Steve Nash, Executive Director Tucson Osteopathic Medical Foundation
According to a 54-page May 2015 Microsoft study, our collective attention span is now eight seconds. That’s a 25% reduction in human attention since 2000. Do I know that for certain? Nope. Can I find the Microsoft study to confirm good research? No. Google supplies hundreds of one page summaries – replete with embedded cat-onRoomba videos. All seem to suggest Microsoft believes we are adapting, somehow focusing sharper not longer. Study or not, we know technology is changing us. Think how hard it is to wait in line, how much farther the commute seems. Do you reach for your phone in those moments? Most do. Or some sort of device when faced with downtime. At work you are bombarded daily with information. Emails, patient portals, EMR warnings, faxed prescriptions, and digital records all compete with texts, phone calls, and quick checks of favorite medical websites, Facebook, and Instagram posts. Is there anywhere tech can actually help in medicine? Tucson Osteopathic Medical Foundation is doing its part. Talks on medical informatics, inter-physician communication barriers before, during and after hospitalization, and use of medical apps in primary care will be subjects at our next conference. Yet, I feel we may be missing something. Last spring I read God’s Hotel by Victoria Sweet, MD. Ostensibly it is a memoir of working at San Francisco’s Laguna Honda Hospital, reputedly the last almshouse in the country. More deeply, however, it is an argument for slow medicine.
Akin to the slow food movement, Dr. Sweet argues against high tech, top of license, constant input medicine as it’s practiced today. She feels we have lost something, and not just patient trust, in the move to scientific medicine. She is no Luddite. Sweet loves the science of medicine and the arsenal of tools. She does her own lab analysis and x-rays. Yet, because of the sleepy environment, old-fashioned facility and dumping ground reality, she observes the miracle of healing over months. She keeps her eyes open, and salutes the out-of-date wards, each with a head nurse, and revels in the time she has just to think and worry about patients. She laments the loss of old medical understanding, summed up by words like anima and spiritus. Time and time again, Sweet faces the results of misdiagnosis in patients sent to her hospital to die. She doesn’t blame her highly trained colleagues working at warp speed to find the logical differential. Instead, she marvels that her abundance of time allows her to examine, to probe and to ask questions of patients – and listen and question back…and wonder. Sweet also earned a PhD in medical history while working at Laguna Honda. In one chapter she sums up her medical observations and academic learning by synthesizing Hippocrates. “The physician is the person who studies physis, the individual nature of his patient, who understands it and follows its lead.” Dr. Sweet will speak in Tucson on Wednesday, March 29, 2017 at 7:00 pm, at the Marriott University. She was invited by the Cindy Wool Memorial Seminar on Humanism in Medicine, a steering committee on which I serve. Every year it stages an event as a gift for the medical community. The social aspect is fine, but the lectures give healers something to chew on and perhaps use. We can’t give them more time, just time wellused. And isn’t that the promise of technology? 19
AOMA Digest Winter 2017
Cybersecurity in a Socially-Hackable World By Jeremy M. Hodder DHSc, MSc, Pg Dip Law, BScN (Hons), RN MICA Supervisor Risk Management Services
How many social media friends do you have? How many of your social media friends do you actually know? How many friend requests have you received (and accepted) where you have no idea who they are or why they are trying to befriend you? They may be an elementary school friend, a friend of the family, or a friend of a friend. Or possibly a cybercriminal. What are cybercriminals after and why? Cybercriminals are out to get any personal data they can find as it leads to financial gain for them through selling in global underground cyber markets, and can lead to personal, financial and emotional loss for you. Credit card details sell for between $5 and $30 in the US; a hacked email account with potential links to retail (Amazon, iTunes, Netflix), finance (bank accounts, credit cards), cloud drives (Dropbox, Google Drive, Microsoft OneDrive), and employment details (work or business data) can be hacked for $129 and further criminal financial gains could be released through accessing each of the aforementioned links. Social media accounts can also command a similar fee (SecureWorks, 2016). Personal health information can command a much higher fee than credit cards due to the broad nature of its content – billing details that include social security and debit or credit card details. How do they do it? We all have a mobile device that hosts applications covering social media, banking, and business. Many of these apps are linked to our debit or credit cards. As in many cases, hacking takes place as the device user is careless (loss of device, no use of password, password sharing, downloading malicious files or apps) or the device is unencrypted leaving the device and its data in a vulnerable state. Cybercriminals can hack into computers AOMA Digest Winter 2017
and networks in many ways and by social engineering (psychological manipulation) they get you to believe that by doing as they ask it will be in your best interest. They use influence tactics to attack the vulnerable individual as you are far easier to hack than major banks or companies. The criminals get you to trust and like them. Phishing is designed to extract user information, passwords, credit card numbers or other sensitive information from apparently trustworthy electronic communications (most commonly, emails with or without attachments). The cybercriminal simply lures you (the fish) with the bait such as the billions of dollars offered by some deposed African prince that we all receive on a regular basis – just send your bank and your passport details and wait for the money to be deposited in your account. A derivative of phishing is the watering hole attack in which the cybercriminal profiles groups of users (companies, organizations) and the most frequent trusted websites they visit. The criminal introduces malicious code to the trusted website (often as a ‘pop up’ or links) and on accessing the link, the users are redirected to another site containing the malware or get infected immediately. Spear phishing is a more deliberate or targeted and personalized form of phishing. The cybercriminals send fake emails from people or businesses that the victim is familiar with and trusts (such as a bank or credit card company). Smishing is the use of SMS text (text message) sent as bait to entice users to enter a website that contains malware. An example of this was when Walmart appeared to send texts to thousands of customers with a free offer of $1,000 if they accessed a link. But in reality, clicking on the link led to malware. Malware. Cybercriminals thrive on introducing malware to any computer via the
computer’s user. This usually takes place in the form of a link or an attachment sent through email. The user clicks on the link or opens the attachment and the malware is introduced instantly. Malware can also be downloaded by clicking on an icon present in an infected web page. Criminals also thrive on lost or stolen electronic devices that contain sensitive data; this is especially more valuable to criminals
in the current world of BYOD (Bring Your Own Device) where healthcare staff are using their own mobile devices to store and transfer PHI. Resources Kaczmarczyk, J.M., Chuang, A., Dugoff, L., Abbott, J.F., Cullimore, A.J., Dalrymple, J.,… Casey, P.M. (2013). E-professionalism: A new frontier in medical education. Teaching and Learning in Medicine, 25(2). http://dx.doi.org/10.1080/10401334.2013.770741 SecureWorks (2016). Underground hackers markets. Annual report – April 2016. Retrieved from https:// www.secureworks.com/~/media/Files/US/Reports/ SecureWorksSECO2123NUndergroundHackerMarketplace.ashx
Tips to Reduce the Likelihood of Hacking on Mobile Devices • Password authentication. Configure your mobile device to require passwords, personal identification numbers (PINs), or passcodes to gain access to it. Choose user names and passwords that have a combination of lower and upper case letters, symbols, and numbers. Longer and not obvious (pet name, your name) passwords are more difficult to hack into – eight characters should be the minimum length. Change passwords frequently. Use different passwords for different devices. The password, PIN, or passcode field can be masked to prevent people from seeing it. Use a screen lock to disable your device after a certain period of inactivity. • Encryption protects information stored on and sent by mobile devices. Mobile devices can have built-in encryption capabilities, or you can buy and install an encryption tool on your device. This is essential when transmitting electronic Personal Health Information (ePHI). • Remote wiping enables you to erase data on a mobile device remotely. If you enable the remote wipe feature, you can permanently delete data stored on a lost or stolen mobile device. Remote disabling enables you to lock or completely erase data stored on a mobile device if it is lost or stolen. If the mobile device is recovered, you can unlock it. • File sharing is software or a system that allows Internet users to connect to each other and trade data and files. Beware! It can also enable unauthorized users to access your mobile device without your knowledge. By disabling or not using file sharing applications, you reduce a known risk to data on your mobile device.
• A personal firewall on a mobile device can protect against unauthorized connections. Firewalls intercept incoming and outgoing connection attempts and block or permit them based on a set of rules. • Security software can be installed to protect against malicious applications, viruses, spyware, and malware-based attacks. • Research apps before downloading. Many apps are safe (from Apple or Google) but mobile malware is on the rise – 16 million mobile devices were hit with malware in 2014. • Maintain physical control. Look after your device – don’t leave it lying around. • Public Wi-Fi networks. Watch out – they aren’t secure. • Minimize your visible personal information on social media. • Resist posting personal information – date of birth, address, email address - and avoid location/geotagging. Never give out your social security number or driver’s license numbers. Use privacy settings. Kaczmarczyk et al, (2013) suggest that 62% of medical students and nearly 68% of residents on Facebook do not use privacy settings. • Monitor your social media invitations. Don’t invite unknown friends or strangers. • Never open a link whose origin is questionable. If it’s suspicious – ignore it. • Use a free credit monitoring service to monitor for suspicious activity. • Remember that your profile and your posts are visible, mostly permanent, and may come back to haunt you! Google your own name and check out your online profile for anything that may harm your personal or professional reputation. 21
AOMA Digest Winter 2017
Welcome New AOMA Members 1st Year in Practice
Atoosa Hosseini, DO Family Medicine - Board Certified Phoenix, Arizona 602-406-8083
Lisa O. Ballehr, DO Radiology - Board Certified Mesa, Arizona 480-396-1142
Shariq Iqbal Chudhri, DO Internal Medicine - Board Certified Tucson, Arizona 520-694-8888
Jason D. Johnson, DO Plastic and Reconstructive Surgery - Board Certified Phoenix, Arizona 602-439-1111
Petran J. Beard, DO Family Medicine Tucson, Arizona
Emily R. Lieder, DO Family Medicine - Board Certified Flagstaff, Arizona 928-213-6100
Dean A. Berman, DO Emergency Medicine - Board Certified Bryan T. McConnell, DO Michael Lacaze, DO Glendale, Arizona Family Practice/OMT Family Medicine - Board Certified 602-406-0100 Board Certified Prescott, Arizona Phoenix, Arizona 928-442-8710 Benjamin T. Clark, DO Family Medicine - Board Certified Thomas Roben, DO Gilbert, Arizona Internal Medicine - Board Certified Out of State 480-728-4100 Phoenix, Arizona Foster Renwick, DO 602-760-1752 Psychiatry -Board Certified Nikunj Doshi, DO Minneapolis, Minnesota Internal Medicine - Board Certified Semone B. Rochlin, DO 612-873-7442 Gilbert, Arizona General Surgery - Board Certified 480-543-2868 Scottsdale, Arizona Laurie Woll, DO 602-653-0540 Dermatology - Board Certified Jean Earl, DO Montclair, California Family Medicine - Board Certified Michella J. Switzer, DO 909-621-5005 Chino Valley, Arizona Obstetrics & Gynecology 928-636-4355 Board Certified Phoenix, Arizona Daniel P. Gay, DO 480-785-2100 AOMA gratefully General Surgery - Board Certified acknowledges all its Bullhead City, Arizona Aaron T. Thornburg, DO members for your 928-704-7163 Pulmonary Disease/Critical Care support of the osteopathic Medicine - Board Certified Christina Goldstein-Charbonneau, DO Phoenix, Arizona profession and your Integrative Medicine, Obstetrics 602-274-7195 association. and Gynecology Bullhead City, Arizona Your membership ensures 928-704-4499
that AOMA is looking out for you and enables us to accomplish great things on your behalf.
James Wesley Hollcroft, DO Family Medicine Glendale, Arizona 602-272-3224
Thank you! AOMA Digest Winter 2017
Doctors That DO Delivers in Arizona For eight weeks during October and November 2016, the Phoenix metropolitan area was flooded with billboards promoting osteopathic medicine. The Arizona Osteopathic Medical Association (AOMA) partnered with the American Osteopathic Association (AOA) to bring the Doctors That DO national brand awareness campaign to Arizona. Poster and digital signs were spotted along Interstate 10 as far south as Ahwatukee and on Interstate 17 as far north as Anthem. On streets From Mesa to Glendale, Tempe to Deer Valley, and all around Phoenix, billboards celebrated the DO difference with a variety of physician photos and messages.
The performance of the campaign exceeded expectations. More than 28 million impressions were delivered during the eightweek period. The “Find Your DO” search feature on the AOA website saw an increase of 26% for osteopathic physicians in Phoenix. In addition to the out of home campaign, a special edition of the AOMA Digest on the Doctors That DO campaign was mailed to all DOs in the state of Arizona, increasing awareness of the Association. AOMA also embarked on a targeted social media campaign on Facebook and Twitter. The visibility of both these platforms increased significantly, reaching across the United States. A very special message was received from Ian Still, a relative of the founder of osteopathy: “To the Arizona Osteopathic Medical Association, I wanted to write to say thank you, thank you for the posts about the new Doctors That DO Campaign, and all the posts regarding the growing awareness of Osteopathy. My family are relatives of the late Dr. A. T. Still and I wrote a letter to the AOA a few years back that had a small role in pushing for a major public awareness campaign. Many of my close friends and brother live in Arizona and I'm glad to see such promotion there. I live in Kansas City, Missouri and I only wish we had the billboards, or even a group that promoted the Profession so strongly. I also wish more people talked/ knew about how Dr. Still fought for equal rights during the time of our country’s Civil War, especially today when ‘racial tensions’ are elevated for various reasons. Again, thank you for all that you DO. I look forward to following and reading more of the Association's postings.” The billboards may be gone from Arizona, but the impact of the Doctors That DO brand awareness campaign still resonates. Learn more at www.doctorsthatdo.org. 23
AOMA Digest Winter 2017
Arizona Emerging Osteopathic Leaders Grants The Arizona Osteopathic Charities announces the Arizona Emerging Osteopathic Leaders Grants program. Created to honor Amanda Weaver, DHL, MBA, long-time Executive Director of the Arizona Osteopathic Medical Association, in recognition of her enduring accomplishments to support residents intending to practice medicine in Arizona, the Arizona Emerging Osteopathic Leaders Grants provide financial support to osteopathic medical residents. Grants are available to assist residents who need financial assistance in order to take advantage of leadership and professional development opportunities. The application process is simple and straightforward. Residents must obtain endorsement from their residency program director and provide attestation of their future plans to practice in Arizona. Applications are reviewed for approval by the AOMA New Physicians in Practice Committee. Grants are subject to the availability of funds. Funding is available for residents intending to practice in Arizona to attend conferences, obtain certifications, and/or receive funding assistance to advance leadership skills and professional development. These special funding grants may be provided to pay for some or all expenses to help residents fulfill an unmet or desired need in addition to their residency program. Programs and projects considered may AOMA Digest Winter 2017
include educating decision makers and/or the public on healthcare; improving access to quality, cost efficient healthcare; developing and influencing healthcare policy. Funding may also be available for residents intending to practice in Arizona to apply for the American Osteopathic Associationâ€™s Training in Policy Studies (TIPS) program. This course allows DO residents to spend a year developing and polishing their advocacy skills and helps residents prepare for leadership roles by becoming an expert on health policy issues. For information on TIPS, visit http://www.nyit.edu/medicine/ training_in_policy_studies. Funding amounts vary from $300 up to $5,000 depending on the need and availability of funds Applicants must be active members of AOMA in good standing, have completed at least one year of graduate medical education, and have approval and recommendation from their residency program director. The grant application is available online www.az-osteo.org/ GrantApp. There are no specific deadlines for application. Applications may take up to 45 days for review and approval or decline. Please direct your questions to email@example.com.
AOMA 36th Annual Fall Seminar
Get Connected The AOMA 36th Annual Fall Seminar was a tremendous success with more than 220 osteopathic physicians, students, and other practitioners gathering in Tucson in November. The two-day event at the Hilton El Conquistador Resort offered 13.0 hours of AOA Category 1-A CME credits including specialty credits in Family Medicine/OMT, Infectious Disease, Internal Medicine, Neurology, Neuromusculoskeletal Medicine, Obstetrics & Gynecology, Pediatrics, Physical Medicine & Rehabilitation, Preventive Medicine-Public Health, and Psychiatry. The AOMA Professional Education Committee, chaired by Lori Kemper, DO, FACOFP, recognizes all the speakers who contributed to the success and prestige of the Seminar with their expertise and experience in the lectures. Thank you to Denise Atwood, RN; David Bryman, DO; William Devine, DO; Francisco Garcia, MD; Kendra Gray, DO; Mary Catherine Harrel, MD; Michael Hogue, PharmD; Sristi Nath, DO; Sean Reeder, DO; Tony Rodgers, MSPH; Anthony Will, DO; Joe Zachariah, DO; and John Zaharapoulos, DO.
Thank you to the osteopathic medical students who moderated the lectures: Leah Goedecke, OMS I, AZCOM; Starr Matsushita, OMS III, SOMA; Chelsea Nagayama, OMS I, SOMA; Sowmya Padakanti, OMS III, SOMA; Jamie Shawver, OMS II, AZCOM; and Mandy Shelley, OMS I, AZCOM. AOMAâ€™s commitment to osteopathic physicians is to provide high-quality CME programs, schedule board certified physician presenters, and offer content for specialty certification. Mark your calendars for November 11 & 12, 2017 for the AOMA 37th Annual Fall Seminar in Tucson.
1. Jeffrey Morgan, DO, AOMA Speaker of the House of Delegates, calls the HOD meeting to order. 2. Caleb Scheckel, DO, Resident Delegate, addresses the House of Delegates. 3. OMM for Primary Care was presented by Anthony Will, DO. 4. Kendra Gray, DO, lectured on the topic of breastfeeding and lactation. Her son Roman and daughter Lydia (with her friend Roxie) shared the spotlight.
AOMA Digest Winter 2017
Get Connected 1
AOMA Digest Winter 2017
Thank you to the following organizations for supporting the AOMA 36th Annual Fall Seminar SPONSOR Blue Cross Blue Shield of Arizona
1. Lori Kemper, DO, and Ryan Dyches, OMS II, get connected at the Fall Seminar. 2. Susan Del Sordi Staats, DO; Kristin Nelson, DO; and Shannon Scott, DO, reconnect. 3. Brad Croft, DO; Kathleen Croft, Chip Finch, DO; and Christine Morgan, EdD, love the Tucson venue. 4. Good friends F. Timm McCarty, DO; Dorcas Brysacz, and Stanley Brysacz, DO, are regulars at the Fall Seminar. 5. Shannon Scott, DO, and Sarah Colwell, DO, share a smile for the camera. 6. AZCOM and SOMA were well represented by osteopathic medical students: Back row, l to r: Sowmya Padakanti, OMS III; Andrew Rork, OMS III; Dennis Datuin, OMS II; Kathryn McClain, OMS III; and Starr Matushita, OMS III. Front row, l to r: Andrew Bitney, OMS II; Samantha Easterly, OMS II; and Jenni Adams, OMS III. 7. Marty Finch and Kelli Ward, DO, catch up while Mike Ward, DO looks on. 8. The Fall Seminar is an opportunity to meet up with colleagues like Gregory Hollick, DO; William Devine, DO; Anthony Pozun, DO; and Anthony Will, DO. 9. Jamie Shawver, OMS II; Ryan Dyches, OMS II; and Michelle Mifflin, DO, enjoyed the evening reception.
EXHIBITORS 3WON, LLC Arizona Osteopathic Charities Banner Health BioTek Labs, LLC Carondelet Medical Group Correct Scoliosis Designs for Health Iasis Healthcare Insight Imaging Ironwood Pharmaceuticals, Inc. John Driscoll & Company Meadows Behavioral Healthcare MGY - CAPACIDAD Midwestern University - AZCOM Mutual Insurance Company of Arizona - MICA Prescription Advisory Systems & Technology Radiology Ltd. Save the Cord Foundation/AZ Public Cord Blood Program SOL Recovery Center The Arizona Partnership for Immunization (TAPI) US Navy Weight Loss Institute of Arizona Womenâ€™s International Pharmacy
AOMA Digest Winter 2017
DOCME.org is your premier source for high quality, pertinent online CME for ostepathic physicians AOMA is excited to offer OnDemand continuing medical education lectures through the DOCME.org online platform. More than 60 different programs are available on a wide variety of topics. AOA Category 1-B credit may be earned for each course. Current offerings recorded at AOMA CME events during 2016 include: Rethinking IBS - David Leff, DO Breast Cancer Risk Assessment - Mary Cianfrocca, DO Aortic Valve Implantation - Alphonse Ambrosia, DO End of Life Care for Native American People - Bridget Stiegler, DO Eustachian Tube Dysfunction - Bryan Friedman, DO Headache Medicine for the Non-Neurologist - Justin DeLange, DO GI at FMC: What We See & What We Do - Gary Cornette, DO Science of Migraines - Eric Eross, DO Treatment of Multiple Rib Fractures - Brian Coates, DO Valley Fever - Craig Rundbaken, DO
AOMA members receive a $10 discount on all AOMA-created CME programs. Enter promo code AOMA2017.
More topics are coming in 2017! Visit the AOMA website under the Education tab.
Keeping the game fair...
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...so you’re not fair game. AOMA Digest Winter 2017
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AOMAâ€™s Business Partners Program provides immediate access to national and local high-quality services and providers. These businesses offer special rates and discounts to Association members. For complete details on services, products, and discounts, visit the AOMA website at www.az-osteo.org/BusinessPartners Interested in becoming an AOMA Business Partner? Contact Colleen Zubrycki, Membership Development Manager, at firstname.lastname@example.org or 602-266-6699. ACCOUNTING Karpinski, Berry, Adler & Company, PLLC Jason Bernstein, CPA 5110 N. 40th St., Ste. 201 Phoenix, AZ 85018 602-244-8411 Ext. 2 email@example.com www.phxcpa.net
BANKING & FINANCE
Delivery Financial Services, LLC Jodi Sugaski, Sales Manager 602-490-3956 firstname.lastname@example.org www.deliveryfinancial.com XOLMed Revenue Cycle Management Corp. J. Patrick Laux 602-396-5900 Ext. 101 email@example.com
Bankers Trust Steve Krenzel, Vice President 2525 E. Camelback Rd., Ste. 100 Phoenix, AZ 85016 602-224-2028 firstname.lastname@example.org www.bankerstrust.com
AFLAC Karen Jones, Independent Agent 16211 N Scottsdale Rd., A6A 614 Scottsdale, AZ 85254 602-229-1970 Ext. 213
Heritage Capital Group, LLC Kathryn A. Marchwick, CFP 623-583-6840 email@example.com www.heritagecapitalaz.com
Mutual Insurance Company of Arizona (MICA) 602-956-5276 800-352-0402 www.mica-insurance.com
Mosaic Financial Associates Anthony C. Williams, President 4650 E. Cotton Center Blvd., #130 Phoenix, AZ 85040 480-776-5920 firstname.lastname@example.org www.mosaicfa.com SoFi Michael Phillips & Team 855-456-7634 email@example.com www.sofi.com
BANK CARD PROCESSING Affinipay Visit the Business Partner the page of AOMA website or call 800-644-9060 Ext. 6974
BILLING & COLLECTIONS
LEGAL Services Comitz | Beethe Edward O. Comitz, Esq. 6720 N. Scottsdale Rd., Ste. 150 Scottsdale, AZ 85253 480-998-7800 firstname.lastname@example.org www.disabilitycounsel.net
PAYROLL PROCESSING Payroll Strategies Group Nick Mawrenko 480-577-2552 email@example.com
SyberSafe Nancy Johnson, Managing Director Toll Free: 877-274-5552 Direct: 480-779-1933 firstname.lastname@example.org www.sybersafe.com Wolfe Consulting Group Craig Heiser, Vice President 602-324-0405 email@example.com www.wolfeconsultinggroup.com
REAL ESTATE RE/MAX Excalibur Kevin Weil, Realtor 602-793-7492 firstname.lastname@example.org www.kevinweil.com
RECORD MANAGEMENT ASDD Document Destruction Ryan Shinn 480-730-4233 email@example.com www.assuredsecurityaz.com
TECHNOLOGY eVisit Gary Gower, Senior Manager 602-892-4381 firstname.lastname@example.org www.evisit.com Information Strategy Design (ISD) Michele Liebau 480-970-2255 Ext. 107 email@example.com www.isdesign.com
AOMA Digest Winter 2017
Osteopathic Community News
First-Year AZCOM Students Practice Patient Analysis at Art Museum
To develop a foundation for the basic observation skills needed to become good physicians, 250 AZCOM students attended a “Learning to Observe” orientation event at the end of July at the Phoenix Art Museum. Lori Kemper, DO, Dean of AZCOM, joined students as they toured through many of the museum’s galleries, from Modern to Asian, European, and Western. Students traveled in small groups to the museum for the afternoon, where they received thought-provoking instruction on how to observe, analyze, and interpret different artworks, including details such as emotion, color, and setting. After practicing the new skills in the galleries, the students came together again to discuss ways to apply their new observation skills to patient interactions.
Dean Lori Kemper, DO (right) instructs first-year AZCOM students on observational techniques at the Phoenix Art Museum.
Incoming DO Students Receive Stethoscopes
Members of the Class of 2020 received brand-new stethoscopes with the words “Excel in Leaving a Mark” engraved in the metal from the Jason Madachy Foundation, named for a medical student at Marshall University’s Joan C. Edwards School of Medicine who passed away unexpectedly in 2007.
AOMA Digest Winter 2017
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Osteopathic Community News
AZCOM Supports National Mental Health Awareness Initiative The Arizona College of Osteopathic Medicine has taken steps to support a national initiative to understand the mental challenges of osteopathic medical education and improve the health of DO students. The Council of Osteopathic Student Government Presidents (COSGP) created the Mental Health Awareness Task Force (MHATF), a first-of-its-kind survey focusing specifically on the mental wellness of osteopathic medical students. The survey results, which included more than 10,000 responses from DO students around the nation, were presented at AACOM’s 2016 Annual Conference, where osteopathic medical education leaders came together to discuss topics, including mental health among medical students. Third-year AZCOM student Caleb Hentges serves as the national MHATF Coordinator. AZCOM’s Student Government Association (SGA) recently distributed mental health awareness cards to all students. The SGA also circulated suicide prevention cards provided by the Advocates for the American Osteopathic Association (AAOA) in conjunction with the Yellow Ribbon Suicide Prevention Program.
AZCOM Sports Medicine Club Conduct Physicals at Grand Canyon University
Top l to r: Chris Tomby, OMS IV; Jonathan Del Mundo, OMS II; Sasha Hallett, OMS III; Carol Chang, OMS II; Joel Sellers, DO, FAOASM, GCU Team Physician. Bottom l to r: Michael Johnson, OMS II; Andrea Mathiason, FNP-C, Nurse Practitioner, Sonoran Medical Center; Shamii Goh, OMS II; Nina Kokayeff, OMS II at GCU.
Bright Lights, Shining Stars Gala Honors Community Leaders
SPEECH-LANGUAGE INSTITUTE OPENS AT MULTISPECIALTY CLINIC The Midwestern University Multispecialty Clinic in Glendale is now home to the new Speech-Language Institute, offering dedicated speech, language, and communication services for children and adults. Faculty work collaboratively with patients and families to help them live up to their full communicative potential. The Institute evaluates and treats a wide range of speech, language, and swallowing disorders. Practitioners serve individuals with developmental delay, cognitive impairment, aphasia, traumatic brain injury, autism, learning disabilities, hearing loss, social communication disorders, voice disorders, and stuttering, as well as assess and remediate feeding and swallowing difficulties encountered by children and adults.
From left to right: Arthur G. Dobbelaere, PhD, Midwestern University Executive Vice President and Chief Operating Officer; COMET Award winner William D. Andrews, MBA, Chair of the Midwestern University Board of Trustees; Shooting Star Award winner Gerald L. Wissink, FACHE, Chief Executive Officer of BHHS Legacy Foundation; and Kathleen H. Goeppinger, PhD, Midwestern University President and Chief Executive Officer at the 2016 Gala. The blacktie-optional event raises over $100,000 annually in scholarship funds for students in all of Midwestern University’s colleges on the Glendale Campus. 31
AOMA Digest Winter 2017
Osteopathic Community News
MWU Names Newest Members of Littlejohn Society Recipients of Midwestern University’s Littlejohn Awards were recognized by Midwestern University President and Chief Executive Officer Kathleen H. Goeppinger, PhD. This year’s honorees are Midwestern University alumnus Virginia Boomershine, PharmD, Senior Manager at Banner Health in the Ambulatory Clinical Pharmacy System and Adjunct Professor, Pharmacy Practice at the College of Pharmacy-Glendale; faculty member Vladimir Yevseyenkov, OD, PhD, Clinical Care Coordinator, Arizona College of Optometry; and staff member Emily Gibson, Library Supervisor, Glendale Campus. Dr. Boomershine is a 2008 graduate from the College of PharmacyGlendale. Dr. Yevseyenkov came to Midwestern University in 2010 and was promoted to Associate Professor in 2015. He specializes in advanced ocular disease and low vision at the Midwestern University Eye Institute. Ms. Gibson was one of the first staff members to be hired on the Glendale Campus and helped set up the Midwestern University Library. She was promoted to Library Supervisor in 2011. The Littlejohn Awards take their name from the Littlejohn brothers, physicians who in 1900 founded the American College of Osteopathic Medicine and Surgery, the precursor to the Chicago College of Osteopathic Medicine which formed Midwestern University’s foundation.
Appointments, Awards, and Grants
Tracy Middleton, DO, FACOFP, Chair, Clinical Education, received fellowship in the American College of Osteopathic Family Physicians (ACOFP) and was awarded Fellows Most Outstanding Scientific Paper (2016) by ACOFP. Kate Mitzel, DO, FACEP, Clinical Assistant Professor, received fellowship in the American College of Emergency Physicians (ACEP). Thomas O’Hare, DO, FACOEP, Professor, Clinical Education, was honored as the 2014 Case Author of the Year by the National Board of Osteopathic Medical Examiners (NBOME) for his work in case writing for the COMLEX Level 2 PE. Evelyn Schwalenberg, DO, MS, FACP, FACOI, FNAOME, Associate Dean, Clinical Education, became a Fellow of the National Association for Osteopathic Medical Education (NAOME). Dr. Schwalenberg also became a member of the Council on Osteopathic College Accreditation (COCA). Lawrence Sands, DO, MPH, Clinical Assistant Professor, was appointed to the National Board of Osteopathic Examiners (NBOME) National Faculty in the Preventive Medicine and Health PromotionDivision of Public Health and Preventative Medicine. Shannon Scott, DO, FACOFP, received the Faculty Advisor of the Year Award from the Student American College of Osteopathic Family Physicians (SACOFP). Mark Speicher, PhD, MHA, FNAOME, Associate Dean, received fellowship in the National Association for Osteopathic Medical Education (NAOME) and was named a 2016-2021 NAOME Fellow in Education Research. AOMA Digest Winter 2017
Gregory Caldwell, OMS III, was selected as the winner of the A. Hollis Wolf Case Presentation Competition by the American Academy of Osteopathy (AAO). Sasha Hallett, OMS III, was elected as the Western Regional Representative of the American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) Medical Student Council. Caleb Hentges, OMS III, was elected as the National Second Vice Chair on the Executive Board of the American Association of Colleges of Osteopathic Medicine (AACOM) Council of Osteopathic Student Government Presidents (COSGP). Mr. Hentges was also named AZCOM Student DO of the Year. The following AZCOM students were selected as OMM Scholars for the 2016-2017 academic year: Senior Scholars: Paavan Patel, OMS IV; Puja Patel, OMS IV; Catherine Vanier, OMS IV Junior Scholars: Gregory Caldwell, OMS III; Trevin Cardon, OMS III; Vanessa Leonhard, OMS III Freshman Scholars: Samantha Easterly, OMS II; Heather Johnston, OMS II; Luisa Quintero Roman, OMS II The following AZCOM students were selected to participate in the GE-National Medical Fellowship Primary Care Leadership Program (PCLP) for the summer of 2016: Jasmine Beebe, OMS II Donia Hussain, OMS II Bradley Brown, OMS II Christine Joseph, OMS II Jeneeca Bruce, OMS II Charles Jun, OMS II Morolake Ugheghe, OMS II The purpose of the program is to provide medical, nursing, and physician assistant students the opportunity to examine primary care firsthand in medically underserved communities across the country.
Osteopathic Community News
ATSU-SOMA Student Changes Wyoming’s Eating Standard Jesse Miller, OMS IV, came to A. T. Still University (ATSU) on a Western Interstate Commission for Higher Education Professional Student Exchange Program scholarship. In 2015, while Miller was in his third year at ATSU’s School of Osteopathic Medicine in Arizona (ATSU-SOMA), he began working on a project to encourage healthy eating by providing locally grown food to residents of his native state, Wyoming. “In order to create healthier environments and improve access to healthier foods, there is a need to acquire thorough market information about local food supply and demand, local trends, and barriers to expanding the local food system,” said Miller. “My hypothesis was that increasing fruit and vegetable consumption would improve longterm health outcomes in Wyoming.” His plans included an e-commerce farmers’ market and a Community Supported Agriculture (CSA) program. CSA emphasizes the health and economic benefits of local food and products. Through the program, local community centers and workplaces received 15 pounds of fresh, local vegetables each week throughout the summer, extending the availability of local produce by four weeks and 45 percent. To finance his ideas, Miller received two $25,000 grants through the U.S. Department of Agriculture Local Food Promotion Program. The funding allowed Miller to explore innovative models to develop community health and local food systems statewide. As a result of Miller’s efforts, the Wyoming Farm-to-Plate Task Force was formed to develop a robust local food system throughout the state. As chair of the task force, Miller organizes and moderates statewide meetings to bring
stakeholders together in conversation. Miller has also organized health fairs for lowincome schools and raised more than $240,000 to develop school and community garden programs. Now in his fourth year at ATSU-SOMA, Miller is outlining the project in a paper titled “Healthy Eating Through Local Food.” The paper will highlight synergies between community health and economic development and the potential to promote healthy eating. After graduation, Miller plans to fulfill the requirements of his scholarship by practicing in Wyoming for three years, continuing to serve the underserved in his home state.
ATSU Finalizes Purchase of Three Buildings on Arizona Campus ATSU has finalized the purchase of three buildings on its Arizona campus at 5835, 5845, and 5855 E. Still Circle. The buildings are home to Arizona School of Dentistry & Oral Health, Still Research Institute, Orthopedic Clinic of Arizona, Arrowhead Health Centers, Ahwatukee Dental Laboratory and Sun Dance Dental Laboratory. The purchase will increase ATSU’s assets and reduce overhead costs, while providing additional space and greater control of the campus environment.
AOMA Digest Winter 2017
Osteopathic Community News
Overcoming the Fear of Falling In April 2013, 76-year-old Elizabeth Welsh was on her way to the local bookstore when she fell. Although she was able to get up, first responders insisted that she go to the hospital. There, Welsh discovered that what she thought was a minor injury was actually very serious. After several surgeries, Welsh was afraid to leave her house. Her daughter learned of ATSU’s Still Standing Fall Prevention Outreach and enrolled her mother in the eight-week program. “When my daughter signed me up for the program, I thought ‘What do I need that for? I’m not going anywhere,’” said Welsh. “Once I got into it, the students were wonderful. I got my confidence back.” Participants like Welsh can expect to graduate with a better understanding of how to prevent falls and manage the fear of falling. Since it began in 2008, more than 2,500 participants have completed the program.
ATSU’s Kim Perry, DDS, MSCS, Named President of National Dental Association Kim Butler Perry, DDS, MSCS, ATSU Associate Vice President of Strategic Partnerships, was recently installed as the 93rd president of the National Dental Association (NDA). Dr. Perry was the associate dean of clinical operations for ATSU’s Missouri School of Dentistry & Oral Health before moving to the Arizona campus in 2016. “A. T. Still University of Health Sciences congratulates Dr. Perry on this important and deserving achievement,” said ATSU President Craig Phelps, DO, ’84, FAOASM.
AOMA Digest Winter 2017
“My most memorable moment was the smile and pride on Elizabeth’s face when she shared how much confidence she gained,” said student coach Nia Jarrett, PA, ’17. “The cognitive restructuring of the program showed results quickly, and as she shared her experience, the seeds of confidence grew in the other participants.” According to Elton Bordenave, MEd, CHC, director of ATSU’s Aging Studies Project, falls are the leading cause of fatal and non-fatal injuries for older Americans. “This fact is what prompted us to spearhead a dynamic program focused at curbing falls among older adults in Arizona,” said Bordenave. Student coaches from physical therapy, occupational therapy, audiology, athletic training, osteopathic medicine, and dental medicine are trained to deliver the curriculum and assigned to a teaching site. They work with peers from different disciplines, creating dynamic groups and a unique opportunity to learn about the importance of collaboration. Working with different healthcare disciplines opens up a discussion about how participants do not need to be limited as their lives change. “Patients need strategies and a plan for how to navigate their lives, and if there are some limitations, communication and planning by multiple healthcare professionals can renew their quality of life,” said Jarrett.
ATSU Dean Named One of 32 Most Influential People in Dentistry
Jack Dillenberg, DDS, MPH, Dean of ATSU’s Arizona School of Dentistry & Oral Health, has been named one of the 32 most influential people in dentistry by Incisal Edge dental lifestyle magazine. Key metrics included company size, budget, the organization’s influence, and the individual’s speaking, writing, or research activities. This list is the first of its kind for dentistry. 32 dentists were ranked – one for every tooth!
Osteopathic Community News
Lawrence Sands, DO Receives Honor
Saretskys on Family Feud Normally, a feuding family is not a good thing, but for Robert Saretsky, DO, his wife Marilyn, daughter Erika, daughter Randi Pierce, and sonin-law Vade Pierce, it meant a chance to appear as contestants on the game show Family Feud. The Saretsky family members are avid fans of game shows and Marilyn previously appeared on two other programs, so when there was a call for auditions in Phoenix, they were all in. After a series of auditions, the family was flown to Atlanta, Georgia, to play the game and tape the show. The taping occurred in May 2016, but the Saretskys’ episode didn’t air until October 12, 2016. In the meantime, they weren’t allowed to reveal the outcome of their game until after the show aired. They didn’t win, but they all agree it was a fun family experience.
From left: Dr. Robert Saretsky, Marilyn Saretsky, Erika Saretsky, Randi Pierce, and Vade Pierce on Family Feud.
Got a DOs in the News item? Send it to firstname.lastname@example.org and we will share it in the Digest.
AOMA Member and Past President Lawrence Sands, DO, MPH was recently recognized by the Midwestern University Chicago College of Osteopathic Medicine (CCOM) Alumni Association with the Outstanding Achievement Award. This award is granted annually by the CCOM Alumni Board of Governors to alumni and other deserving individuals “in recognition of distinguished and devoted service to the osteopathic profession and having brought credit to CCOM.” Dr. Sands, CCOM ‘81, is Clinical Associate Professor, Preventive Medicine and Public Health, at Midwestern University Arizona College of Osteopathic Medicine. He also serves as Board Chair of Adelante Healthcare in Phoenix.
Jeffrey Morgan, DO Dancing with the Stars Arizona Jeffrey Morgan, DO, MA, CS, FACOI and AOMA Speaker of the House of Delegates, recently competed in the National Kidney Foundation Arizona’s 11th Annual Dancing with the Stars competition. The annual fundraising gala partners community superstars with professional dance instructors for exciting performances. The ATSU-SOMA dean and his partner finished in second place and surpassed their pledge goal of $12,500, raising more than $13,000. 35
AOMA Digest Winter 2017
Osteopathic Community News
2017 Calendar of Events April 19-23, 2017 AOMA 95th Annual Convention Hilton Scottsdale Resort & Villas 6333 N. Scottsdale Road Scottsdale, AZ 85250
August 21, 2017 3rd Annual Flagstaff Osteopathic Medical Conference Flagstaff Medical Center Flagstaff, Arizona
April 19, 2017 AOMA Board of Trustees Meeting 7:00 pm Hilton Scottsdale Resort & Villas
November 10, 2017 AOMA Board of Trustees Meeting 6:30 pm Hilton Tucson El Conquistador Resort
April 21, 2017 AOMA House of Delegates 4:00 pm Hilton Scottsdale Resort & Villas June 24, 2017 AOMA Board of Trustees Meeting A. T. Still University Mesa, Arizona
November 11, 2017 AOMA House of Delegates 3:00 pm Hilton Tucson El Conquistador Resort
Advertisersâ€™ Index MICA...................................Inside Front Cover Catalina Medical Recruiters...............Page 15 ProAssurance.......................................Page 28 AOMA Career Center.......Inside Back Cover Arizona Osteopathic Osteopathic Community News Charities .......................Outside Back Cover
November 11 & 12, 2017 AOMA 37th Annual Fall Seminar Hilton Tucson El Conquistador Resort 10000 N. Oracle Road Tucson, AZ 85704
Show support for your state association! AOMA polo shirts now available in the AOMA store.
Shop with a Purpose. Support Arizona Osteopathic Charities! Each time you make a purchase on amazon.com a portion of your purchase will be donated to Arizona Ostepathic Charities. Go to www.az-osteo.org/amazon
Available in a variety of colors. Just $40. Visit www.az-osteo.org to order. AOMA Digest Winter 2017
Do you know someone who isn’t a member of the Arizona Osteopathic Medical Association. . . and should be? Recruit a new member and you’ll both receive a $100 credit toward membership dues or continuing medical education fees! Recruiting new members is simple: 3 Review your network of colleagues. You may be surprised who is not a member. 3 Check their membership status using the online member directory or by calling the AOMA office at 602-266-6699. 3 Ask them to join! Express how membership has benefited you. For all the details on how to recruit a new member* and receive your credit, visit the AOMA website at www.az-osteo.org under the Members tab or contact Colleen Zubrycki, Membership Development Manager, at email@example.com. *New member must be an active, dues paying member. Does not apply to recruitment of “out-of-state” or “retired” members.
Searching for a job? Looking to fill a position? Expanding your practice? AOMA Career Center Visit www.az-osteo.org/Jobs
Update Your Member Profile and WIN! You could win a $100 VISA gift card. Please take the time to visit the AOMA website and login to update your professional profile information for the online AOMA Directory. Deadline to be entered into the gift card drawing is May 31, 2017. See what’s new on the AOMA website. Register for the 95th Annual Convention; nominate a colleague for an AOMA Award; or take an online CME course. Visit often for future enhancements and features!
5150 N. 16th Street, Suite A-122 Phoenix, AZ 85016
Keep it Local. Save Time. Save Money. AOMA 95th Annual Convention April 19-23, 2017 A ARIZONA RIZONA www.az-osteo.org/2017Conv
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