Spring 2013 AOMA Digest

Volume 28, No. 1 The Journal of the Arizona Osteopathic Medical Association Spring 2013

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N Perspectives from AOMA Members and Arizona Academy of Pediatrics N Fall Seminar Highlights N AOMA 91st Convention – April 16 – 20, 2013 N Practice Management Articles

2012-2013 Officers President Thomas E. McWilliams, D.O. President Elect Craig M. Phelps, D.O.

Contents

Volume  No. 

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Immediate Past President Jan Zieren, D.O., M.P.H. Vice President Adam S. Nally, D.O. Secretary/Treasurer Kristin Nelson, D.O. Executive Director Amanda L. Weaver, M.B.A. 2012-2013 Board of Trustees Craig R. Cassidy, D.O. Melissa A. Cooper, D.O. Donald J. Curran, D.O. William H. Devine, D.O. David P. England, D.O. Michelle E. Eyler, D.O. Charles A. Finch, D.O. Patrick Hogan, D.O. Jonathon Kirsch, D.O. Christopher J. Labban, D.O. Julie A. McCartan Marsh, D.O. Jeffrey Morgan, D.O., MA Laurel Mueller, D.O. George Parides, D.O. Wendell B. Phillips, D.O. Shannon Scott, D.O. Resident Trustee Danielle Barnett, D.O. Student Trustees Ezekiel Anderson, KCOM Ryan Meinen, AZCOM Speaker of the House of Delegates

;:6IJG:H Caring for the Underserved Special Feature

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President’s Message From the Desk of the Executive Director What We Have Done For You Lately AHCCCS Expansion and Governor Brewer’s Medicaid Plan Dr. Politics D.O. Day at the Legislature Medical Services Project HOME Arizona Health-e Connection Article AOMA Member Perspectives: Laurel Mueller, D.O./H.O.M.E. Project MICA: Confusing Rx Leads to Drug Overdose AOMA Business Partners Welcome New AOMA Members

6DB6 :K:CIH '' Fall Seminar Highlights (- AOMA’s 91st Annual Convention Information and Registration DHI :DE6I=>8 8DBBJC>IN C:LH '+ AzACOFP President’s Message ', Midwestern University / AZCOM (& A.T. Still University (* Tucson Osteopathic Medical Foundation )' Calendar of Events – Advertisers Index

John F. Manfredonia, D.O. Vice Speaker of the House James W. Cole, D.O.

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

Opinions expressed in the AOMA Digest are those of authors and do not necessarily reflect viewpoints of the editors or official policy of the AOMA, or the institutions with which the authors are affiliated unless explicitly specified. AOMA Digest does not hold itself responsible for statements made by any contributor. We reserve the right to edit articles on the basis of content or length.

Although all advertising is expected to conform to ethical medical standards, acceptance does not imply endorsement by this magazine. The appearance of advertising in the AOMA Digest is not an AOMA guarantee or endorsement of the product, service or claims made for the product or service by the advertiser.

Copyright 2013

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AOMA Digest Spring 2013

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President’s Message he New Year is just starting and I am already reminded that

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osteopathic residencies.

we are a minority profession and that much needs to be done

The three new programs

to increase awareness of the contribution of osteopathic

at Mountain Vista

medicine to our health care workforce and to the wellness of

Hospital as part of

Arizona’s citizens. Actions speak louder than words alone. When

MWU/ AZCOM’s

a former candidate for the state legislature incorrectly observed

OPTI (Family Medicine,

that Arizona’s only contribution to our Graduate Medical

Internal Medicine and

Education (GME) system came from the University of Arizona,

Surgery) and the 60

one of our M.D. faculty members stepped up and provided

new ATSU/Still OPTI

background information regarding the large number of graduates

positions that were

from MWU/AZCOM and ATSU/SOMA (not to mention

recently approved by

ATSU/KCOM and their “Kirksville in Arizona” presence here for

the AOA for Family

over 30 years). She invited him to her local campus to see, first

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hand, the impact that osteopathic medical education was having

2012-2013 AOMA President

Medicine are some of the latest examples. On January 14, 2013 I was

on his local community. Almost every month another radio, TV, or newspaper segment highlights a “new” approach to training

notified that a substantive change adding an additional Family

health professionals that we have been effectively using for years

Medicine residency at Unity Health Care in Washington, D.C.

or even decades. I am asking for all osteopathic physicians to be

was approved. This program will utilize Howard University

proactive and use these situations as opportunities to educate and

Hospital for the needed inpatient clinical experiences to

advocate on behalf of our profession.

complement the ambulatory strengths of the 650,000+ annual

We have, indeed, experienced significant progress, and are

patient visits at the teaching health center. All of these new

now often invited to participate in serious discussions regarding

programs will have residents beginning July, 1, 2013 and the

health policy in Arizona. When the Arizona Chamber of

teaching health center programs that are part of Still-OPTI are

Commerce and Industry put together their excellent analysis

being allowed to sign contracts with the residents immediately,

of Graduate Medical Education http://www.azchamber.com/

although they are also participating in the match process. We

news/view_article.cfm?ID=794, there was broad representation

have a long ways to go in meeting the needs of osteopathic

that included both of our local private, non-profit osteopathic

graduates and the environment is becoming more competitive.

schools. The Chamber is spear-heading an effort to restore

Your advocacy in building new residency programs and active

AHCCCS funding for GME in a fashion that will provide

participation in training medical students and residents is a great

critical support for new programs in addition to the existing

service to Arizona and is highly appreciated.

residencies. This is particularly important because of the 2 to 1

Best wishes to all as we step forward to meet the challenges

federal match that triples the impact of any state contribution.

and opportunities of the New Year. As our elected officials

We are also asking for a restoration of the loans that were

continue to “kick the can down the road” regarding Medicare

previously authorized for new programs but never effectively

reimbursement and other critical budget issues our collective input

funded. This program provided resources for residency expenses

has never been more important.

that bridged the gap between new program initiation and the arrival of funding from CMS. Since these are merely loans, the

In kindness and friendship,

long term impact on the budget is minimal.

Tom

Progress is also being realized in the development of new

AOMA Digest Spring 2013

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Caring for the Underserved

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his issue is focused on the â&#x20AC;&#x153;underservedâ&#x20AC;? which is a broad term because it is inclusive of many diverse populations. The population would include, but not be limited to, economic, linguistic, cultural, geographic and religious barriers. The underserved have roadblocks before them to truly have access to healthcare. I was at a reception where the Dean of the Arizona School of Dentistry and Oral Health gave an update. I learned that the developmentally disabled, autistic and extremely obese population have roadblocks to access for dental and oral health care.

The Washington Post had an excellent article on March 11, 2013 entitled â&#x20AC;&#x153;Osteopathic doctors may help alleviate a shortage of medical care in rural areasâ&#x20AC;? written by Ankita Rau. Did you know that according to a 2011 report from the Department of Health and Human Services that 20% of the U.S. population lives in rural areas and only 9% of physicians practice in these areas,. Ms. Rau also reported that â&#x20AC;?many osteopathic medical schools are springing up in oďŹ&#x20AC;-the-beaten path locations â&#x20AC;&#x201C; usually to recruit applicants from rural areas and then hope those doctors practice where they grew up. Both the Edward Via College of Osteopathic Medicine in the Blue Ridge Mountains in Blacksburg, VA, and the University of Pikeville Kentucky College of Osteopathic Medicine in the Appalachian Mountains come to mind.

There is a national shortage of physicians as well as Arizona, especially primary care physicians. The osteopathic profession is addressing this need with the two colleges of osteopathic medicine in Metropolitan Phoenix â&#x20AC;&#x201C; Arizona College of Osteopathic Medicine (AZCOM) and School of Osteopathic Medicine Arizona. (SOMA). Although there is a lack of adequate residency programs in Arizona. AZCOM and SOMA have had some

success in developing new programs. Additionally, the Arizona Chamber of Commerce is leading a group of healthcare stakeholders and organizations in developing strategies needed to increase the number of funded slots and number of programs.

The Graduate Medical Education (GME) issue has presently 6bVcYV A# LZVkZg! B#7#6# been overshadowed AOMA Executive Director

by Governor Brewerâ&#x20AC;&#x2122;s proposal to expand Medicaid eligibility to 133% of Federal Poverty Level (FPL) as in the AďŹ&#x20AC;ordable Care Act (ACA,) and to restore the Proposition 204 population or coverage for childless adults.

This will increase access to care for up to 400,000 people by 2017.

This is a divisive issue because of concerns of the federal debt and state sovereignty. A letter from AOMA President was sent to the membership as to why there is a consensus to support this proposal.

(See article on page 8) As your Association, we must stay aligned with the mission of the Arizona Osteopathic Medical Association which â&#x20AC;&#x153;is to promote the osteopathic medical profession, serve our members, provide osteopathic continuing medical education, and advocate for access to care.â&#x20AC;?

Other Notable Numbers: AZ Health Rankings 2012 â&#x20AC;&#x201C; paints a picture that Arizona has a long way to go in improving our health care delivery system and public health eďŹ&#x20AC;orts. See statistics below: DkZgVaa GVc`/ '*

t NJMMJPO PCFTF BEVMUT MPX

t NJMMJPO EJBCFUJD BEVMUT

t DIJMESFO JO QPWFSUZ IJHI

t DBSEJPWBTDVMBS EFBUIT MPX

t DBODFS EFBUIT QPQVMBUJPO MPX

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SOURCE: United Health Foundation â&#x20AC;&#x153;Americaâ&#x20AC;&#x2122;s Health Rankingsâ&#x20AC;? 2012 Edition

AOMA Digest Spring 2013

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“What We Have Done For You Lately” This regular feature of the AOMA Digest provides members with a recent update of the Association’s activities. We are representing the profession as a healthcare stakeholder and are a voice and are “at the table.” This covers the nine month period from July 2012 – March 2013.

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t Hosted “House of Medicine” reception for Senator Kelli

t Launched a campaign to increase Pertussis immunization

Ward, D.O. See page 25 for more information. t Participated in healthcare stakeholder meetings at the

legislature on graduate medical education, electronic prior

rates among healthcare offices in partnership with Arizona Partners against Pertussis. t Executive Director serves on the board for Health Services

authorizations, reimbursement on vaccines, expansion of

Advisory Group (HSAG) and is Vice-Chair of Arizona

AHCCCS, and biologic substitutions.

Health-e Connection (AzHEC).

t Testified with the naturopaths opposing the expansion of

scope for chiropractors to administer nutritional remedial

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substances via injections & IVs. They withdrew their

t Hosted “Office Managers Institute” on Meaningful Use –

application at the end of the hearing. t Hosted D.O. Day at the Legislature on March 5.

Stage 2, in January. See page 25 for more information. t The second Office Manager’s Institute was held on March 13

and the topic was on improving collections.

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t Added 11 new members during this period.

t Sent 10 Delegates to the AOA House of Delegates who gave

Arizona’s D.O.s a voice and vote for legislative, education and

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public policy for the national organization.

t Associate Executive Director working with students at

t Executive Director representing the National Assocation of

Midwestern University’s Arizona College of Osteopathic

Executive Directors serves on the Bureau of State Government

Medicine (AZCOM) and A.T. Still University’s School

Affairs and the Medicaid Managed Core Task Force.

of Osteopathic Medicine in Arizona (SOMA) to develop programs and increase participation.

8dbbjc^in HZgk^XZ t Arizona Osteopathic Charities raised funds via the Birdies for

Charity Campaign for the charitable programs to which they donate and student scholarships.

t Provided scholarships for students from AZCOM and

SOMA to attend AOA’s D.O. Day on the Hill. t Awarded a $500 scholarships to one student at AZCOM and

SOMA.

8dci^cj^c\ BZY^XVa :YjXVi^dc 8B: t Provided 12 hours of category 1-A Continuing Medical

Education (CME) at the Fall Seminar

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The Arizona Medical Association, Arizona Osteopathic Medical Association, Maricopa County Medical Society, and Pima County Medical Society are pleased the Governor has included in her goals for 2013 expansion of the AHCCCS program. Availability of high quality health care remains one of our most pressing concerns in Arizona and the AHCCCS program is a key component of providing essential medical services.

We stand ready to support the Governor in this effort and pledge to work with her administration, and the legislature, to secure this result on behalf of physicians and their patients.

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AOMA Digest Spring 2013

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AHCCCS Expansion Letter to Membership Regarding Governor Brewer’s Proposal to Expand Medicaid and Restore Proposition 204 Governor Jan Brewer was opposed to the Accountable Care Act (ACA) and participated in a unsuccessful lawsuit claiming the ACA was unconstitutional. It was clear to her and others that it is the law of the land. She did her research and expanding Medicaid eligibility to 133 %i was shown to make the most business and economic sense. This is a divisive issue and AOMA President Tom McWilliams, D.O. sent a letter to the membership on March 14 as to why there was consensus for AOMA to support her proposal.

“Arizona Osteopathic Medical Association (AOMA) Members, AOMA supports quality, access, affordability and sustainability.

The AOMA joined a coalition of 110 organizations, including all of the associations representing physicians, nurses, non-physician clinicians, hospitals and health plans representatives, in the support of Governor Jan Brewer’s proposal to restore Arizona’s Proposition 204 population (childless adults) and expand Medicaid from 100 – 133% of Federal Poverty Level (FPL). This topic was addressed at several meetings, including the Board of Trustees, Legislative Affairs, Executive Committee, and five district meetings. AHCCCS expansion and Proposition 204 restoration was the focus of D.O. Day at the Legislature on March 5, 2013.

Why did the Arizona Osteopathic Medical Association leadership have consensus on support, especially since the AOMA did not endorse the Affordable Care Act (ACA) and still does not endorse the full ACA? The health policy tenets of access to care, cost and quality served as the guidelines.

We must be aligned with our mission: “The Mission of the Arizona Osteopathic Medical Association is to promote the osteopathic medical profession, serve our members, provide osteopathic continuing medical education, and advocate for access to healthcare.” The restoration of the Prop 204 population will prevent more than 50,000 remaining childless adults losing coverage on January 1, 2014 in the middle of their treatment, and restore coverage to another 240,000 Arizonans.

The AHCCCS expansion of eligibility for adults up to 133% of the FPL from 100% will provide coverage for about 57,000 people. If more people have access to health care on a continuous basis, they will be healthier and their quality of life will improve. Additionally, a safety net will be in place to relieve the uncompensated care financial burden on the hospitals, especially the rural hospitals.

What are the costs for more people to receive coverage without affecting the state’s general fund? We reviewed policy papers from the Arizona Chamber Foundation and the non-partisan Grand Canyon Institute’s (GCI) “Arizona’s Medicaid Options under the Affordable Care Act: Fiscal and Economic Consequences.” The GCI reviewed the economic impact of three different options over the period of FY 2014-2017 and recommended Option 3 which is full compliance with the ACA (133% of FPL); 434,855 additional lives would be covered costing the state $1.5 billion but matched with federal funding of $7.9 billion. In FY 2015, the federal funding would be $1.6 billion with an Arizona general fund cost of $154 million to restore adult

AOMA Digest Spring 2013

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eligibility and expand to 133% of FPL. This cost would be shifted to a hospital bed assessment that replaces the City of Phoenix provider tax.

The state general fund will be freed up for other programs. A circuit breaker is built into the plan that if the federal match falls below 80%, the expansion of coverage for childless adults would be automatically repealed. Because the Affordable Care Act has remained the “law of the land” despite multiple challenges, the consensus has been that Arizona’s citizens would benefit economically if we choose to participate rather than allowing the funds to flow to other states.

Remaining Concerns: 1. Sustainability – the federal government may not have the funds to match and continue with the funding. There could be an enormous negative impact on our children and grandchildren because of the looming federal debt.

2. Hospital assessment – The concern that the hospital bed tax could be passed on to patients or third party payers is no longer a concern because there is language in the draft bill to prevent this.

3. Physician workforce – there may not be enough physicians to provide health care for the additional people with coverage.

According to Marc Leib, M.D., Medical Director of AHCCCCS, the plans have room to expand their panels to add more physicians and there are physicians currently interested in being providers, but the panels are filled.

Next steps: 1. There is an informational hearing on Wednesday, March 20, 2013 AOMA attended, as well as other stakeholder meetings that will be scheduled.

2. When the bill is formally introduced, it will be reviewed by the Legislative Affairs Committee and the Board of Trustees for a position and sent to the House of Delegates for a vote.

We have learned over the years that no bill is perfect and compromise is part of the legislative process. We are committed to advocating for the osteopathic medical profession, aligned with the AOMA mission, and representing the majority of our membership.

Yours in friendship and kindness,

Thomas McWilliams, D.O., FACOFP 2012 – 2013 AOMA President

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AOMA Digest Spring 2013

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Dr. Politics

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hings at the Arizona Legislature are a little different this year – there is a D.O. in the State Senate! I am honored to serve Arizona as the Senator from Legislative District 5 (LD-5).

My district includes most of Mohave County and all of La Paz. I am also the only female D.O. currently serving. It is exciting to be a part of the law-making process. I will be updating our members on news from inside the Legislature regularly.

HZhh^dc 7Z\^ch Ninety members of the Legislature were sworn in on January 14, 2013. We swore our oath to uphold the Constitutions of the United States and of Arizona. After hearing Governor Brewer’s State of the State address, we were off and running. A lot of what I have done so far is meeting with various groups to learn their issues, make connections so that I know the appropriate person to call when an issue comes up, and hitting the ground running on the legislative process.

Hd ;Vg» When someone has an idea for a new law, the idea goes through several phases. First, stakeholders often come together to hone in on what is important to accomplish. Next, legislative counsel is contacted to help draft the appropriate language for the bill and a draft is created. The goal is to have the draft as correct as possible so many amendments and changes are unnecessary as the bill moves along. However, all legislation is amendable if it is the will of the legislators. Once the draft is satisfactory, an introset is ordered. The sponsor of the bill can submit it alone or, more often, seeks out other supportive legislators to sign on to the proposal.

Once the sponsor is happy with his co-sponsors, he “drops it in the hopper.” This is the time when the idea gets assigned a bill number and moves forward into the process. The Senate president and the Speaker of the House determine whether or not a bill will be assigned to a committee. Once assigned to a committee, the committee chairman decides whether or not to hear the bill. If so, it will be placed on the agenda for formal discussion, public testimony, and voting. Bill sponsors often testify before the committee to let the members and the public know what the new law would do and why it was proposed. If the bill passes committee, it is brought before the caucus (the Republicans and the Democrats each meet separately to discuss the new bills). Bills that make it through the entire process are eventually voted upon on the floor and go to the Governor to be signed or vetoed.

BV`^c\ V 9^[ [ZgZcXZ You can make a difference in Arizona. The voice of the constit-

AOMA Digest Spring 2013

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uent is powerful. While lobbyists and special interest groups do have a large presence in Phoenix, hearing from constituents is special. When an individual citizen takes the time to write an email, make a phone call, drop a line in the mail, or visit a legislative office, it has an impact on the legislator. Personally, I believe that keeping the constituent in mind @Zaa^ B# LVgY! 9#D# at all times is extremely State Senator, Legislative District 5 important. I equate it to always putting the patient first. So, get involved – come to D.O. Day at the Legislature to get your feet wet, find an issue you are passionate about, and help shape our state!

L]n BZ4 I decided to run for office for a lot of reasons – I want a great state and country for my kids, I believe we need a reasonable, rationale, experienced voice for healthcare, I hope to see an increase accountability and personal responsibility in our people (that’s a tough one!), and I want to help create a business-friendly environment in our state so we can attract more high paying jobs for the people of Arizona. I think my experience as a family physician has made this transition to legislator even easier. Day-to-day as a family doc, I take complicated issues and put them into terms that are easy to understand, I deal with people who are often ill, in pain, or scared and make connections to help them with their health, and I build relationships with people all the while being bombarded with visits from drug reps. I equate drug reps with the lobbyists I see every day – they have very valuable information for me, but I have to remember to take it with a grain of salt as I know they are selling their product!

I realize the importance of building relationships, gaining trust, telling the truth, coming up with an acceptable plan, and getting buy-in from the people involved. It is difficult to keep a patient healthy or treat an illness if you don’t do these things. It is difficult to have a healthy state or a healthy country without keeping these things in mind as well. I hope that having a “Dr. Politics” in the AZ Legislature will benefit our profession, our state, and the people we serve.

Keep in touch at www.kelliward.net, email me at kward@azleg.gov, or connect on Facebook at www.Facebook.com/KelliWard4Arizona.

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D.O. Day at the Legislature I

here were 59 D.O.s and osteopathic medical students who attended D.O. Day at the Legislature on March 5, 2013 to discuss and learn about Medicaid expansion and Proposition 204 restoration. The participants experienced democracy in action and the politics of health policy. This is a divisive issue and perhaps more now understand the political process of compromise. Some of the participants were not in alignment with the position of support.

Representative Heather Carter, Don Hughes with the Governor’s office, and Senator Kelli Ward, D.O. were well spoken about their support of or opposition to the restoration and expansion of Medicaid. All of them are healthcare leaders and conservative Republicans. When Arizona lost the lawsuit against the Affordable Care Act (ACA) following Mitt Romney ‘s losing the presidential election, it

became clear to Carter, Hughes (and Governor Brewer) that the ACA is the law, more people will have access to care and there are financial incentives for Arizona so they revised and moderated their positions to support what they believed is best for the people and state of Arizona. Senator Ward’s opposition was based on many concerns, including that the Governor’s proposal is primarily based upon the federal match to state funding and this will increase the federal debt. She believes that Arizona will be at economic risk if the federal funding dries up and she too believes her position is best for the people and state of Arizona.

Governor Brewer held a press conference at noon and the AOMA group was joined by M.D.s, nurses, P.A.s and others in their white coats as a show of support for her proposal. Please refer to the article on the Medicaid expansion and restoration as to why the AOMA decided to support he the Governor’s proposal. Pictures speak louder than words so please enjoy these.

1

2

4

3

5

1. AOMA Past President Larry Sands, D.O., MPH was interviewed by the Arizona Chamber of Commerce 2. Governor Brewer’s Health Policy Advisor Don Hughes explained why the Governor changed her position to 6 support of the Medicaid expansion as outlined in the Affordable Care Act (ACA).

3. Senator Kelli Ward, D.O. discussed her position of opposition for the expansion and restoration.

4. AzCOM student Kendra Gray was interviewed for the Arizona Chamber of Commerce.

7 5. Heather Carter, Chair of the House Health Committee, gave insight as to why it is important to Arizonans to have this expansion and said it was important to do the math to access the economic benefits.

6. AOMA Lobbyist Joe Abate discussing the current legislative environment 2. AOMA President Tom McWilliams, D.O. was one of four featured speakers at the Governor’s press conference which was televised by several networks.

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AOMA Digest Spring 2013

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Arizona Chapter of the American Academy of Pediatrics Medical Services Project

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he Medical Services Project is a community services project which helps children ages 3-18 who have limited access to care.

These children are in the notch group of Americans whose

parents make too little to afford private insurance, but too much to afford AHCCCS. They may also be children who do not qualify for AHCCCS because they are recently immigrated or otherwise undocumented. These are children who through no fault of their own are presently not receiving the health care they need.

Children are identified by a school nurse of health aide working in the schools under the supervision of a licensed nurse, who

their ears by participating otolaryngologists, and their lives have

see children for acute or episodic health issues such as impetigo,

been changed forever by improving their hearing, allowing them to

bronchitis, ear aches, etc. Because they do not qualify for other

learn both at school and at home. Parent Surveys which are a part

services, they are referred to the Medical Services Project, where the

of the program, are a testament to just how grateful the parents of

project manager identifies and refers them to the closest Medical

these children are to have been seen by a medical provider when

Services Project provider in the area. The family then pays a $5

their children needed the services. These families again and again

fee to the provider who sees them. Should further evaluation be

tell us how appreciative they are for your donation of time and

needed, MSP has contracted with Radiology Services and Labs to

talent.

see the student free of charge. The Medical Services Project also

We are still in need of more providers, both primary care as

contracts with a pharmacy which provides prescriptions free of

well as specialists. We have limited providers in certain areas in

charge to the patient with an MSP voucher.

the state and are in need of certain specialists, so would very much

There are also numerous pediatric specialists who have agreed

welcome your participation! Please contact our project manager,

to see Medical Services Project patients. It is important, to know

Molly DeLeon (molly@azaap.org) at the Arizona Chapter of the

however, that the patients are screened prior to referral to these

American Academy of Pediatrics if you would like to become a

specialty care doctors to ensure that their problems are acute

Medical Services Project provider or simply for more information

and episodic and not long term or chronic, requiring extensive

on this program.

or lengthy evaluation and follow up. A $10 co-pay is the fee for Elizabeth Homans McKenna, MD, FAAP

specialty care.

From a provider standpoint, it is wonderful to be able to help

Medical Director, Medical Services Project

children that would have no other recourse for their health, other than the ER where they would incur huge expense as well as adding to the burgeoning cost of uncompensated care for hospitals. It is also rewarding when these patients return to your office, when they are in better financial circumstances and your office becomes their medical home. There are countless children who have had their lives markedly improved by their referral to the Medical Services Project. Some children have had tympanostomy tubes placed in

AOMA Digest Spring 2013

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The Medical Services Project is a program of the Arizona Chapter of the American Academy of Pediatrics (AzAAP). AzAAP is committed to improving the health of Arizona children and supporting the pediatric professionals who care for them. Learn more at www.AzAAP.org or email AzAAPLeadership@azaap.org.

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Time and Technical Assistance Required to Improve Quality in Medically Underserved Areas

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rizona Health-e Connection (AzHeC) operates the Arizona Regional Extension Center (REC), one of 62 RECs nationally that were created by a part of the American Recovery and Reinvestment Act of 2009 to advance the use of electronic health records (EHRs) and health IT. The Act established RECs to provide assistance and education to all providers in a region and directed them to prioritize assistance to individual or small group primary care practices, critical access hospitals, federally qualified health centers (FQHCs) and other entities that are located in medically underserved areas1, areas defined as not only having a shortage of health professionals but also as having population issues such as high infant mortality, high poverty and/or a high elderly population.

The REC now assists more than 2,400 providers across Arizona, including community health centers (CHCs), critical access hospitals (CAHs), public hospitals, small primary care practices and health care organizations that provide care to underserved populations. Since opening its doors in October 2010, the REC achieved its grant goal of recruiting 1,958 primary care providers to the program by February 2012. To date, 77% of these members have successfully implemented a certified EHR and 19% have successfully attested to Stage 1 Meaningful Use.2 Like most RECs, we have put a lot of time, effort and resources into assisting and transforming provider practices through the adoption of EHRs. A good and legitimate question, however, is whether RECs can make a real difference in medically underserved areas, that is, whether measurable improvements in health care quality can be achieved through the assistance of an REC. This question was addressed in a recently published study in the January 2013 issue of Health Affairs.3 The study evaluated the early effects on quality of the Primary Care Information Project which provides subsidized EHRs and technical assistance to primary care practices in underserved neighborhoods in New York City, using the REC model. The project started in 2005 and became an REC in 2011. This project is an ideal subject for a study since, with more than 3,300 physicians in more than 300 practices enrolled in the program, it is the largest community-based EHR implementation and extension program in the United States and one of the models used in developing the REC program nationally. The study tested whether physicians in the project improved their outpatient quality measures more than a set of matched comparison physicians in New York who did not participate in the program.

1 HITECH Act, Section 13301, PHSA Section 3012 (c)(4) 2 www.cms.gov/EHRIncentivePrograms 3 Health Affairs 32, No.1 (2013): 53-62

The study looked at improvements in quality measures, including “EHR-sensitive” measures that can be monitored through an EHR such as breast cancer screening for women, urine testing for patients with diabetes, chlamydia screening for woman, and colorectal screening.

The study also looked at any improvements in quality of care at six, twelve, eighteen and twenty-month intervals; and any improvements associated with the number of technical assistance visits received by a practice, from zero to eight or more technical assistance visits.

BZa^hhV 6# GjiVaV! BE= Chief Executive Officer, Arizona Health-e Connection

I]Z gZhjaih d[ i]Z hijYn hjeedgiZY i]gZZ bV^c XdcXajh^dch/ Participation in the project did not show improvement in quality of care across all quality measures, only in “EHR-sensitive” measures; EHR implementation alone was not sufficient to improve quality of care. Only those physicians who received high levels of technical assistance, i.e. eight visits or more, associated with EHR implementation saw improvement. Even physicians exposed to EHRs for up to two years were not associated with quality improvement without high levels of technical assistance; Even with high levels of technical assistance, about a year of exposure to the project was required before the positive effects on quality of care were observed.

While these conclusions are not surprising, they are well worth noting. The REC model works, but it doesn’t work without a considerable investment in time, effort and technical assistance. It can be a valuable tool in assisting with improvements in EHRsensitive quality measures and other measures that help transform a provider practice. That is why the REC recently opened its doors to all Arizona providers, hospitals and clinics, including original REC members who want to continue their practice transformation after they have attested to Meaningful Use Stage 1. To learn more about membership in the new REC, call us at 602-688-7200 or email us at ehr@azhec.org.

AzHeC is also providing education and assistance to providers on health information exchange (HIE) and e-prescribing, two areas that are critical in continuing to meet Meaningful Use in 2013 and beyond. For more information on HIE or e-prescribing, please visit www.azhec.org and click on the Programs tab.

13

AOMA Digest Spring 2013

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

Health Outreach though Medicine and Education (H.O.M.E.) Laurel Mueller, D.O., MBA

>

had finished three years with Indian Health Service’s Hopi Healthcare Center and was looking for what comes next. I moved from the reservation to a new home in Sedona. I knew I wanted a challenge, something that would integrate my business skills (I have an MBA in Finance from The Wharton School) with my medical knowledge. The right opportunity arose when Dr. Lori Kemper, Dean of AZCOM, asked me if I was just going to retire to the golf course in Sedona or would I want to work?

Knowing never to dismiss a new opportunity outright, I asked her, “What do you

have in mind?”

She explained that at Midwestern University’s AZCOM there was an extracurricular club in need of an advisor. This was a AVjgZa BjZaaZg! 9#D#! group of med B76 students who went to homeless shelters in the Phoenix area to provide basic medical care and health education to the homeless. The organization needed some-

Precepting (prē sept ing), primary method of providing supervision and independence in the outpatient or inpatient setting — Society of Teachers of Family Medicine

AOMA Digest Spring 2013

14

one to take it to the next level and make it truly interdisciplinary and cohesive.

Health Outreach through Medicine and Education (H.O.M.E.) was started in 1999 by community-minded medical students.

The group was growing every year, but lacked a faculty presence to guide it. The job would entail precepting the students at the shelters, grant writing for funds, and ad hoc teaching in the clinical education’s family practice department. The thrust of the position is to shape up an organization which could potentially become a community service requirement for all students.

Just my kind of challenge: here’s the haystack; see how many needles you can find! Knowing that there might be twenty, or, potentially, twenty thousand needles, I went to work. After three weeks, I figured out what H.O.M.E. is, who the players are, and how/where to launch a strategic plan.

I put up a whiteboard in in my office and drew a huge organization chart. I started with the twelve DO student leaders, as well as the Physician’ Assistants and Pharmacy student coordinators. I then mapped out connections to Midwestern University’s other programs: Dental, Clinical Psychology, Podiatry, Optometry, and Physical Therapy/Occupational Therapy. I listed the deans of these respective schools and left a space to add a future student coordinator

;ZVijgZh

from each of these.

As with any newly created position, no one on campus knew who I was or what my job was. I called up or e-mailed all the previous preceptors and made an appointment to meet with them face-to-face. I also contacted many of the previous years’ student leaders to ask their thoughts about H.O.M.E.: What was good, what could be improved, what was the biggest challenge they had encountered? One preceptor actually thought that I was coming to meet him to tell him H.O.M.E. was being shut down. He was surprised to learn when I said, “Oh, no, no, no. I am here to thank you for your service! The students love you!

Please continue what you are doing. And here’s my card. Call me with your questions and concerns.”

Eight months into this job, I see the huge strides we have made: up to 20 students participate at every clinic. We are truly interdisciplinary – we have expanded the roles of students from Dental, Podiatry and Pharmacy, and started participation by the Clinical Psychology students. We’re still working on the others.

HOME held its first orientation session on November 28, only to be overwhelmed

by over 400 students attending from every discipline. We saw the need to hold a second orientation class since so many students were turned away from the first session – the auditorium couldn’t seat everybody!

The rate-limiting step in this equation is the lack of PRECEPTORS. We rely on health professionals in the community who volunteer their time and experience to precept at the clinics for three hours on a

weeknight.

As I see it, precepting is a two way street: the students get hands-on experience of patient care with guidance, while I hone my precepting skills. Students remember why they wanted to be a healthcare provider in the first place. They see and treat patients during their academic years. I believe that we can play a role in training the next generation of healthcare providers in this country. Each one of us can remember a professor or preceptor who made a difference in our medical training and education. For some people, precepting is a way to give back. For others it offers the opportunity to continue giving patient care and add some teaching to their experience.

In any case, it’s a win-win situation and something I have grown passionate about.

As we expand into opening more clinics – for homeless youth, the working poor who have no insurance, and victims of domestic violence, the need for more preceptors is crucial. Whether you want to precept once a month or once a quarter, H.O.M.E. is the place for you to volunteer.

You can reach me at lmuell@midwestern.edu or phone number 623-572-3874.

15

AOMA Digest Spring 2013

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Confusing Rx Leads to Drug Overdose

6

complicated by a GI bleed and severe

and one functioning kidney was seen for complaints of a rash.

was performed removing 55 centimeters

The rash started one month previous to the visit and spread over his

of his colon. The patient had a long and

entire body. After a complete dermatologic work-up, which included

difficult recovery which included wound

biopsies, the patient’s diagnosis was Pityriasis Rubra Pilaris (PRP)

dehiscence, MRSA, liver abnormalities,

with exfoliative dermatitis. Acitretin was prescribed.

acute renal failure and septic shock.

60-year-old male with a history of high blood pressure, heart murmur, stomach ulcer, colitis, bleeding problems, arthritis

pancolitis. A colectomy with ileostomy

One week later, the acitretin was discontinued due to the patient’s concern about the risk of kidney impairment. A tapering

The patient and his wife filed a lawsuit

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dose of prednisone was prescribed. The rationale for discontinuing the medication was not documented. The physician sought

naming the physician, the physician’s group and the pharmacy. The lawsuit

against the physician and group settled in the 6-figure range.

authorization for etanercept but it was denied.

The patient’s condition improved, but because of concerns about the side effects of prednisone, a low dose of cyclosporine was

EgdWaZbh l^i] i]^h XVhZ/ 1. The patient’s refusal to continue acitretin was not

prescribed. The patient experienced an exacerbation of his PRP

documented in the medical record requiring the defense

along with abnormal laboratory findings so the cyclosporine was

to rely solely on the physician’s memory to provide an

discontinued and prednisone was restarted. Approximately one

explanation.

week later, the physician directed a medical assistant (MA) to call

2. The medical record was silent with respect to the counselling

the patient and advise him to try a test dose of Methotrexate. The

provided by the physician regarding the risks, benefits

MA explained the importance of drawing labs five days after the

and side effects of the medications, acitretin, prednisone,

test dose and called the prescription into the pharmacy.

cyclosporine and methotrexate.

The pharmacy contacted the physician and said the patient did

3. The patient’s medical record did not reflect any of the

not want to pay two co-pays for the Methotrexate. He wanted one

telephone conversations between the physician, the medical

prescription for the test dose and the continuing medication. The

assistants and the pharmacy.

physician authorized the prescription with no refills. The pharmacy’s records documented two additional phone calls with MAs in the practice. Authorization was received for three refills of Methotrexate.

One week after starting the therapeutic dose of Methotrexate, the patient called the physician to clarify how to take it. The

4. The pharmacy’s documentation of their conversations

regarding the methotrexate refills was not consistent with the physician’s and office staff ’s recollections.

5. The group relied on unlicensed staff to address questions

regarding high-risk medications.

usual adult low dose is 7.5 mg taken one day per week. The patient reported taking 7.5 mg of Methotrexate each day. The physician instructed the patient to stop taking the medication

9^hXjhh^dc/ Since the FDA approved the use of Methotrexate for rheumatoid

and go to an emergency department. The studies completed by

arthritis in 1988, it is increasingly used as an effective treatment

the emergency department were normal. However, the patient

in low weekly or twice weekly doses for immunomodulation in

subsequently developed fever, chills, nausea, vomiting, and sores on

rheumatoid arthritis, asthma, psoriasis, and other conditions. Due to

his chest and in his mouth. He was diagnosed with pancytopenia,

the number of reported fatalities from errors with oral methotrexate,

thrombocytopenia and neutropenia.

the Institute for Safe Medication Practices issued a Medication Safety

The patient’s complex medical problems were further

AOMA Digest Spring 2013

16

Alert in 2003. It warned of serious and sometimes fatal overdoses of

;ZVijgZh Methotrexate occurring when this drug is accidentally taken daily rather than the intended weekly dose.

Errors in prescribing, dispensing and administration of

● Document the refill authorization in the patient’s medical

record. ● When possible, the prescriber should speak directly

Methotrexate are common. Unclear directions or no listed indication

with the pharmacist if there are questions regarding the

for the medication on a prescription interferes with a pharmacist’s

indication or dosage schedule. Physicians who delegate

ability to review the reason Methotrexate is being prescribed and

authorization for refills to unlicensed staff are liable and

to verify proper dosing before dispensing the drug. Inadequate or

place their license and reputation at risk in the event of an

unclear directions have resulted in a daily dose, instead of a weekly

error, claim or lawsuit.

dose, causing serious consequences for patients including death.

The physician involved in the case could have prevented the error by adopting the following risk management strategies: ● Consider Methotrexate a high alert medication prompting

extra care when prescribing. ● Include a specific indication, e.g. rheumatoid arthritis,

psoriasis, etc, when prescribing Methotrexate. ● Implement a system for high alert medication refills to

● Provide written instructions for medications, including

clear directions for use, and verbally review them with the patient. Ask the patient to repeat the instructions in their own words to demonstrate their understanding. ● Document written and verbal instructions given in the

patient’s record. ● Give special attention to informing the patient of

potential complications or side effects with significant

include a double check of the indication and dosing before

consequences. Additionally, instruct the patient regarding

the physician or other clinical practitioner licensed to

what to do should they experience a complication from

prescribe medication authorizes the refill.

the medication.

17

AOMA Digest Spring 2013

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AOMA Digest Spring 2013

18

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19

AOMA Digest Spring 2013

7jh^cZhh EVgicZg A^hi^c\h

AOMA Business Partners

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

ACCOUNTING

F INANCIAL

McGladrey

Mosaic Financial Associates

George M. Cohen, CPA, Senior Director (602)760-2779 george.cohen@mcgladrey.com McGladrey is a leading provider of tax planning and compliance (individual and practice), assurance and consulting services to physicians, physician groups and health care companies. AOMA members will receive a 20% discount off regular fees.

Anthony C. Williams, President 480-776-5920 Fax: 480-776-5925 anthony@mosaicfa.com

BANK CARD PROCESSING

Affinipay Visit the AOMA website, Member Services Business Partner Listings or call (800) 644-9060 Ext. 6974

HEALTH INFORMATION TECHNOLOGY

Information Strategy Design (ISD)

AOMA members are entitled to a very special processing package from Affinipay. Their on-line reporting lets you quickly see your deposit and payment information.

Michele Liebau (480) 970-2255 x107 michele@isdesign.com

BILLING & COLLECTIONS

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

CAR RENTAL

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

AOMA Digest Spring 2013

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

20

Information Strategy Design (ISD), a leading healthcare technology solutions provider with its central office in Mesa. ISD has been providing network design and implementation to Heathcare Practices in the South West since 1996. ISD’s focus is on medical practices to allow them to provide cost-effective computer networking, telephony, off-site backup and remote monitoring.

ISD’s value offering to AOMA members allows for one time and ongoing discounts based on using two or more ISD services.

MD Tech Pro IT & EMR Solutions for Medical Practices Libby Murphy (480) 463-4638 | (888) 638-3242 libby.murphy@mdtechpro.com www.mdtechpro.com Based in Phoenix AZ, MD Tech Pro is the national leader in IT and EHR solutions for medical practices and your strategic partner for all healthcare technology needs. They have been providing pro-active, top-flight technical services in the medical community since 1997 and focus

exclusively on working with healthcare clients. You get enterprise-level IT support with comprehensive expertise to tackle any challenge, without the overhead. We are pleased to extend the following special pricing for valued AOMA members: 10% off all support agreements and free IT or EMR evaluation consultation.

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

INSURANCE

AFLAC Karen Jones, Independent Agent (602) 229-1970 x213 No Deductible, No Copay, No Preauthorization.

AFLAC supplemental insurance policies are available at special Association Rates for AOMA members and their families.

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

7jh^cZhh EVgicZg A^hi^c\h LEGAL – DISABILITY INSURANCE CLAIMS & HEALTHCARE LITIGATION

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

MEDICAL RECORD SCANNING & MANAGEMENT

Access Information Management Woody Colebank (623) 478-9393 Fax (623) 478-0777 wcolebank@accesscorp.com Access Information Management of Phoenix is a national Information Security and Records Management company with services including records storage and management on both a box level and chart/file level, certified document destruction, scanning (for both independent files or to electronic record management systems), and data/media storage and rotation services. Call for a no-obligation cost analysis to see what ways they can help you efficiently and securely manage your records today. Docusafe offers a 10% discount for AOMA members.

Services, Administrative Services, Organizations (ASO) Services, and Payroll Services. Managing every aspect of payroll, human resources, taxes, employee benefits, 401(k) plans and workers’ compensation management is what makes Human Capital Strategies “the next best thing to no employees!” Human Capital Strategies offers a 10% discount and $0 setup fees for AOMA Members.

be reviewed at www.wolfeconsultinggroup.com. Real Estate services from Office Leasing to Building Purchase are also available through a wholly owned subsidiary of Wolfe Consulting Group, Ltd., Healthcare Realty Advisors, Inc., at no direct cost to AOMA’s members.

Payroll Strategies Group

Aaron Kuhl, Designated Broker (480) 947-5845 aaron@arizonamob.com www.arizonamob.com

Nick Mawrenko (480)577-2552 Payroll Strategies Group is a local payroll service that is designed for the small medical practice. If you have one employee and don’t want to do your own payroll, call Nick. Our custom service enables us to reduce overhead and pass the savings on to you. Call Nick to see if our approach will fit your practice. Payroll Strategies Group offers AOMA members a $0 setup fee.

PRACTICE MANAGEMENT

Wolfe Consulting Group Patrick Hayden, Consultant (602) 324-0416 patrick.hayden@wolfecon.com AOMA members will receive a free initial problem definition meeting and also receive a discount on a wide array of business consulting services.

Services, from Improving Income to Practice Sale for Retirement, will serve as the basis for the free initial consultation. A listing of these services can

REAL ESTATE

Medical Office Brokers

Medical Office Brokers (“M.O.B.”) is focused exclusively on representing medical tenants and buyers in their commercial real estate transactions and does not represent owners.

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

ASDD Document Destruction Ryan Shann (480) 730-4233 ryanshann@tch-az.com www.assuredsecurityaz.com ASDD Company is an offsite and onsite “AAA” certified document shredding, electronic media and x-ray destruction. We are HIPPA and FACTA compliant. We offer AOMA members discounts on offsite and onsite services.

PAYROLL PROCESSING

Human Capital Strategies Nick.Mawrenko (480)577-2552 nick.mawrenko@hcscando.com www.hcscando.com Human Capital Strategies is a national provider of Professional Employer Organizations (PEO)

21

AOMA Digest Spring 2013

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AOMA Hosts its 32nd Annual Fall Seminar

I

he AOMA hosted its 32nd Annual Fall Seminar at a new location – the beautiful Hilton El Conquistador on November 10 & 11, 2012.

This well attended seminar featured lectures on dermatology, women’s health, ethics, leadership and more. Seating for the conference was at round tables which facilitated wonderful interaction among the audience and presenters. The Fall Seminar also hosted a bustling

Exhibit Hall, full of great exhibitors, who are listed below.

Mark your calendars for the 2013 Fall Seminar – November 9 – 10 at the Hilton El Conquistador in Tucson.

1

2 1. Stephen Scheinthal, D.O. represented the

American Osteopathic Association in the exhibit hall to discuss the upcoming Osteopathic Continuous Certification (OCC) program with AOMA members.

2. Michael Vanderslice with MDTechPro

exhibited his company’s services.

3. Randal Christensen, M.D. presented

during lunch on his outreach efforts to homeless youth in Phoenix.

4. AOMA Past President Karen Nichols,

3

D.O. guided an excellent workshop of fostering leadership to the attendees in the General.

4

Thank You to Our Fall Seminar Exhibitors!

American Osteopathic Association Arizona Health-e Connection Arizona Osteopathic Charities Arizona Physicians Insurance Group Arizona Society of ACOFP Calloway Labs Comitz Beethe Enterprise Medical Solutions AOMA Digest Spring 2013

22

Intellitech Communications Group IPC – The Hospitalist Company Laser Spine Institute MD Tech Pro MICA Pharmalink Pharmaceutical Sonora Quest St. Joseph’s Hospital

The Arizona Partnership for Immunization (TAPI) Tucson Osteopathic Medical Foundation U.S. Air Force Health Professions U.S. Army Healthcare Recruiting Viropharma Inc. Women’s International Pharmacy

LZaXdbZ CZl BZbWZgh

Welcome New AOMA Members Anthony Schwartz, D.O. General Surgery – Board Certified Bullhead City, AZ (928) 704-3712

Gregory Franklin, D.O. Anesthesiology Tucson, AZ Steven M. Hopkins, D.O. Emergency Medicine Las Vegas, NV Anita Kay Kalousek, D.O. Osteopathic Medical Education & Family Medicine – Board Certified Mesa, AZ (480) 265-8047 Bonnie Lee McDonald, D.O. Family Practice – Board Certified Glendale, AZ (623) 773-2848 Carlton A. Richie III, D.O. Family Practice/Sports Medicine – Board Certified Phoenix, AZ (480) 751-3771

INFORMATION UPDATES

James H. Spangler, D.O. Anesthesiology Mesa, AZ (480) 981-2400 Heidi Ungar, D.O. Family Medicine – Board Certified Phoenix, AZ (602)955-8700 Steven J. Weber, D.O. Anesthesiology – Board Certified Kingman, AZ (928) 757-2101 Jennifer Yuen, D.O. Pediatric Neurology Mesa, AZ

Try as we may, there are member updates that are missed or not updated until in print. Please note the following changes to your 2012 – 2013 Directory.

The 2012 – 2013 Membership Directory was published electronically only. It is available for all members in PDF format (please contact Flannery O’Neil at flannery@az-osteo.org if you never received an email with your Directory).

The Directory is also available online at http://www.az-osteo.org/ displaycommoncfm? an=1&subarticlenbr=201.

Samuel Sanchez, D.O. Family Practice Arizona City, AZ (623) 846-7337

IN MEMORIAM

We are all diminished when one of our number leaves us.

We will miss them and strive on for the betterment of our profession in their memory.

Michael V. Altamura, Jr., D.O. Hobart L. Alexander, D.O. Leonard A. Dumas, D.O.

23

AOMA Digest Spring 2013

DhiZdeVi]^X 8dbbjc^in CZlh

AOMA Digest Spring 2013

24

DhiZdeVi]^X 8dbbjc^in CZlh

In the News...

6bZg^XVc DhiZdeVi]^X 6hhdX^Vi^dc 6D6 :mZXji^kZ 9^gZXidg 6ccdjcXZh GZi^gZbZci

L

AOMA Past President Kelli M. Ward, D.O. elected to State Senate seat

6

fter a contentious primary race where she defeated an incumbent in the House of Representatives running for the Senate and a city councilman, Dr. Ward was elected as State Senator for Arizona Legisla-

tive District 5. She is the first female D.O. to serve in the Arizona Legislature. Senator Ward is the Vice Chair of the Senate Health Committee, a prestigious post for a freshman Senator.

AOMA hosted a reception for Senator Ward on January 10, 2013 at the

ongtime AOA Executive Director John Crosby announced his plans to retire in the summer of 2013. Mr. Crosby has served as the Executive Director for 16 years. His many achievements during his ?d]c 8gdhWn tenure include: u The implementation of periodic Unified OMED conferences, in which a great majority of osteopathic specialty organizations and their members participate. u The creation of the Osteopathic International Alliance to foster discussions among osteopathic practitioners worldwide. u The Campaign for Osteopathic Unity to make “D.O.” a household word throughout the U.S. u The AOA’s Branding Initiative establishing the AOA as the osteopathic professional family.

AOMA Office. Other attendees included leadership from Arizona Medi-

6DB6 ]dhih D[ÐXZ BVcV\Zgh >chi^ijiZ

cal Association, Arizona Chapter of the American Academy of Pediatrics, and the Arizona Academy of Family Physicians. The group discussed their priorities for the legislative session, especially as it relates to patients having access to care

Senator Ward poses with the leadership from several medical associations.

The first Office Managers Institute Lunch & Learn presentation of the New Year was held January 8, 2013, in the newly remodeled conference room at the AOMA office. Melissa Rutala, MPH, CEO of Arizona Healthe Connection, presented “Meaningful Use – Stage 2” There were 14 office managers and 4 Business Partners in attendance and they finished with a Q & A session. Details regarding the next Lunch & Learn presentation “Patient Collections” are being finalized. This session was held March 13, 2013.

Institute attendees Shayne Jones and Linda Bivins enjoy lunch during the presentation.

25

AOMA Digest Spring 2013

DhiZdeVi]^X 8dbbjc^in CZlh

Arizona Society of ACOFP President’s Perspective Jim Dearing, D.O.

BZY^XVa HijYZcih VgZ 6c >che^gVi^dc recently had the

>

large group in Phoenix. I gave them some tips regarding “going

honor of presenting

on rotations” and said that they should call the office manager

“what it means to

a few days prior to starting each rotation and ask for the top 10

be a family physician” to

procedure codes so that they would be “ready” for this practice.

both the Midwestern/

Instead of just nodding in a burrito daze, many of them were

AzCOM and the

taking notes and really hearing what I was saying. Sometimes we

A.T. Still University

might take for granted these tricks we’ve learned over the years.

medical students. I

I hope that each of you will take the time to share your best tips

was inspired by the

with young medical students. You might just find that it is not so

depth of their questions

much what you say to them, but the fact that you take the time to

and the quickness of their responses to my questions! They

talk to them at all!

?^b 9ZVg^c\! 9#D# President 2012-2014

I am happy to report that not only were these kids passionate about volunteering for AzACOFP activities, but they were

had many questions

generally passionate about their schools and about their medical

about what their lives would look like as a Family Doc. It was

careers! I think that we might have the next great generation on

wonderful to be able to report that for the first time in a long

our hands with these young people!

time, Family Medicine is at the top of the pecking order in

I encourage each of you to precept students or residents in

medicine with the advent of Patient Centered Medical Home

your offices. I challenge you to show these young people what

(PCMH) and other important initiatives. I reported to them that

is unique about your practice! We all have such busy schedules

they will be able to craft their practices and their lives around their

and lives, but I promise you that if you take the time to really talk

interests and passions. I also informed them that if they choose

with your medical students and residents that you will find that

to go into the business of medicine, there is good news; most

they will absorb and appreciate what you are saying about your

chief medical officers are either Family Physicians or Internists.

practice, your life and the way you practice Family Medicine!

It is great to be able to look at their youthful faces and see their

These kids will not disappoint you and I am very encouraged that

expressions change when I tell them that they can literally do

there will be wonderful people to take care of me when I need it

full spectrum Family Medicine in rural America, or work in a

(hopefully a while from now)!

AOMA Digest Spring 2013

26

DhiZdeVi]^X 8dbbjc^in CZlh

Midwestern University/Arizona College of Osteopathic Medicine Midwestern University receives WESTMARC Economic Engine Award

I

he Western Maricopa Coalition (WESTMARC) awarded Midwestern University its prestigious Economic Engine Award on Thursday, November 1st, 2012, as part of its annual Best of the West Awards.

WESTMARC is a coalition of business, government, education, and communitygroup leaders that advocates for and promotes a positive image of the West Valley.

The Best of the West Awards honor groups and individuals who promote outstanding contributions to the region.

Midwestern University, home to over 2,900 students and Arizona’s largest

medical school, had an annual economic impact of over $300 million on the City of Glendale. Its 156-acre campus located at 59th Avenue and the Loop 101 freeway will be expanded starting in 2013, thanks to a $100 million construction project supporting the recentlyannounced College

of Veterinary Medicine. The University is also home to a trio of community clinics – the Multispecialty Clinic, Dental Institute, and Eye Institute – which offer comprehensive outpatient medical services.

College of Veterinary Medicine Slated for 2013 Groundbreaking

W

ith Glendale City Council and Arizona State Board of Private Postsecondary Education approvals in hand, Midwestern University will soon begin construction on Arizona’s first school offering the Doctor of Veterinary Medicine (D.V.M.) degree.

Groundbreaking for the Midwestern University College of Veterinary Medicine in planned for early 2013.

Plans call for Midwestern to invest over $100 million toward the construction of the new college, including a 76,000-square-foot academic building, a 50,000-square-foot large animal teaching facility, and a 100,000-square-foot small animal clinical building.

The College will welcome its inaugural class of 100 students beginning in the Fall of 2014. The school will help meet the rural and metropolitan demand for qualified large- and small-animal vets.

27

AOMA Digest Spring 2013

DhiZdeVi]^X 8dbbjc^in CZlh

Midwestern University Presents service awards, Spirit of Service Scholarships at annual gala

B

idwestern University and community leaders joined

presented the 2012 Shooting Star Award, which recognizes a

together on Saturday, October 20th to recognize and

community leader for outstanding contributions to healthcare

honor individuals for their commitment to helping

and education, to UMOM New Day Centers, the largest

others at the annual Bright Lights, Shining Stars gala.

Glendale resident and beloved Valley of the Sun

homeless shelter for families in Arizona.

Five Spirit of Service scholarships were awarded at the gala

broadcasting icon Al McCoy received the 2012 COMET

to students representing three Midwestern University colleges

(Community Outreach: Motivating Excellence for

for the 2012-2013 academic year. Scholarship recipients

Tomorrow) Award, which was established by Midwestern

include: Erika Anderson from the Arizona College of

University and the City of Glendale in 1999 to recognize

Optometry (AZCOPT); Gina Buiocchi and Burrell

outstanding individuals who have shown exemplary

Richards from the College of Pharmacy-Glendale (CPG);

commitment to the community. The COMET Award was

and Evelyn Height and Daniel Wright from the Arizona

presented by Kathleen H. Goeppinger, Ph.D., President and

School of Podiatric Medicine (AZPod/CHS-AZ). The

CEO of Midwestern University, and the Honorable Mayor

Spirit of Service scholarship program recognizes outstanding

Elaine M. Scruggs, City of Glendale.

Midwestern University students based on community service,

In addition to the COMET Award, Dr. Goeppinger

AOMA Digest Spring 2013

28

leadership abilities, academic standing, and ďŹ nancial need.

DhiZdeVi]^X 8dbbjc^in CZlh

Midwestern University Expands Valley Osteopathic Residencies, Opens First On-Campus Residency Program

>

NEWS and UPDATES 6EED>CIB:CIH! 6L6G9H <G6CIH

n September, Midwestern University in Glendale and Mountain Vista Medical Center in Mesa announced the establishment of three new residency programs in General Surgery,

Dana Devine, D.O. (AZCOM),

Family Medicine, and Internal Medicine that will expand postdoctoral education oppor-

Chair, Pathology, received the 2012

tunities for osteopathic physicians in Arizona.

Outstanding Mentor Award from

The residencies are the ďŹ rst postdoctoral programs to be established in Mesa in the past

the Arizona Osteopathic Medical

six years and mark the return of osteopathic residency opportunities to the Phoenix area. The

Association (AOMA) in March.

178-bed Mountain Vista Medical Center, home to the East Valleyâ&#x20AC;&#x2122;s ďŹ rst Level III Trauma Center, also hosts rotations for 17 medical students from Midwestern Universityâ&#x20AC;&#x2122;s Arizona College of Osteopathic Medicine (AZCOM).

Mansoor Jatoi (AZCOM

Midwestern also opened a new Neuromuscular Medicine (NMM/OMM) residency â&#x20AC;&#x201C; the

â&#x20AC;&#x2122;12) received the 2012 Student

Universityâ&#x20AC;&#x2122;s ďŹ rst on-campus residency program â&#x20AC;&#x201C; at its Multispecialty Clinic in September.

Distinguished Service Award from

More residencies at the Universityâ&#x20AC;&#x2122;s community clinics are slated for introduction in 2013.

the Arizona Osteopathic Medical Association (AOMA) in March.

B^YlZhiZgc Jc^kZgh^in CVbZY id EgZh^YZciĂ&#x2021;h 8dbbjc^in HZgk^XZ =dcdg Gdaa [dg ;^[i] HigV^\]i NZVg

A

s a testament to Midwestern

The award, which is the highest federal

Shannon Scott, D.O. (AZCOM),

Universityâ&#x20AC;&#x2122;s commitment to community recognition a college or university can achieve

service, the University once again earned a

for its commitment to service and civic

spot on the Presidentâ&#x20AC;&#x2122;s Higher Education

engagement, is presented by the Corporation

Community Service Honor Roll. This year

for National and Community Service

marks the ďŹ fth consecutive time Midwestern

(CNCS) in collaboration with the U.S.

has been named to this national honor

Department of Education.

roll of colleges and universities committed

Clinical Assistant Professor, was presented with the 2012 American College of Osteopathic Family Physicians (ACOFP) Young Osteopathic Family Physician of the Year Award at their national

Honorees for the Presidentâ&#x20AC;&#x2122;s Higher

to bettering their communities through

Education Community Service Honor

community service and service learning.

Roll are chosen based on a series of factors,

convention held in March.

including the scope and innovation of service

Howard Shulman, D.O., FACP,

projects, the extent to

FACOI (AZCOM), Associate

which service-learning

Dean, Postdoctoral Education,

is embedded in the

received the 2012 Excellence in

curriculum, the schoolâ&#x20AC;&#x2122;s commitment to long-

Osteopathic Medical Education

term campus-community

Award from the Arizona

partnerships, and

Osteopathic Medical Association

measurable community

(AOMA) at the Presidential Gala

outcomes as a result of

held in Scottsdale in April.

the service.

29

AOMA Digest Spring 2013

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Glendale Mayor Elaine M. Scruggs Appointed to Midwestern University Board of Trustees

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lendale Mayor Elaine M. Scruggs was appointed to the University’s Board of Trustees at the December 11 Board meeting. Her appointment was approved for a three-year term beginning in January 2013, after she leaves office with the City.

Mayor Scruggs has served as Mayor of Glendale since 1993 and has lived in Arizona for

41 years. Under her leadership, Glendale has doubled in population, transformed its historic downtown into a nationally-known tourism destination, and launched landmark neighborhood renewal and citizen participation programs.

Mayor Scruggs has held leadership positions on numerous regional organizations and committees, including the Valley Metro Regional Public Transportation Authority (RPTA), the League of Arizona Cities and Towns, and the Maricopa Association of Governments (MAG) Regional Council.

Mayor Scruggs is also the recipient of the 2011 COMET (Community Outreach: Motivating Excellence for Tomorrow) Award from Midwestern University for her role in attracting the University to Glendale in 1995.

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JeXdb^c\ BLJ :kZcih/ BVg` Ndjg 8VaZcYVgh AZCOM Commencement 2013 – May 30 Commencement for AZCOM will take place again this year in Midwestern University’s Auditorium. For more information, go to www.midwestern.edu/commencement.xml. Congratulations to the Class of 2013!

Health Careers Institute for High School Students – July 11-20, 9:00am to 4:00pm

Do you know a high school or community college student interested in careers in health care? MWU will offer its annual eight-day Health Careers Institute this summer from July 11 to 20, sponsored by the BHHS Legacy Foundation. This FREE program includes hands-on labs, lectures, and workshops about careers in health care, including osteopathic medicine. Applications for this competitive program will be accepted until May 1.

For more information, go to www.midwestern.edu/ azhealthcareersinstitute, call 623/572-3298, or send an e-mail to jreima@midwestern.edu.

AOMA Digest Spring 2013

30

DhiZdeVi]^X 8dbbjc^in CZlh

IPE session helps build professional relationships between PT and DO students

:

leven students from the A.T. Still University Arizona School of Health Sciences (ATSU-ASHS), Doctor of Physical Therapy (DPT) program and 50 students from the A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) participated in an interprofessional education (IPE) case study September 28, 2012, led by Cheri Hodges, PT, DPT, MAppSc, OCS, FAAOMPT, director, orthopedic residency program.

Designed to be a practical educational experience, the IPE session also served to help introduce the future DPT and DO practitioners to each other and provide insight into the specialized training each student receives through their ATSU coursework.

After a 30-minute review of the case study, the students broke out into a lab activity that paired a DPT student with four DO students. Each of the DO students went through a physical exam where the student physical therapist explained how they would match the exam findings to the prescribed therapeutic exercise program for patients.

The C

A

kie Doctor

ffectionately known as the “cookie doctor” to her patients, Carlann DeFontes, DO, ’12, hasn’t led a cookie-cutter life. From LPN to DO and everything in between, this adventurist helps underserved and diverse communities in the most remote locations.

Dr. DeFontes’ lifelong dream was to become a doctor. She paid her way through nursing school as a commercial fisherwoman and worked as a RN for many years, putting medical school on hold as a single mother. Encouraged by her physician brother to become a PA, Dr. DeFontes enrolled in a program focused on serving rural and underserved areas.

After graduating, she moved to Alaska and for 10 years performed minor surgeries, endured inclement weather, and participated in search and rescue missions, climbing glaciers and facing raging rivers. She served many remote villages and communities including those on the Aleutian and Pribilof Islands, an oil rig on the North Slope, and a gold mine near Juneau.

One of her fondest memories comes from early house calls to the villages. She baked cookies and took them to elderly patients and

their families as a way into their homes.

“My name is a little difficult to pronounce, so they ended up calling me the ‘cookie doctor,’” says Dr. DeFontes.

Dr. DeFontes wanted to give her patients more and understand more about medicine. She finally pursued her dream to be a doctor at A.T. Still University School of Osteopathic Medicine in Arizona and is now completing her 8VgaVcc 9Z;dciZh! 9D residency in Honolulu. Planning to stay in Hawaii, she not only remains committed to serving rural and underserved communities, but she also carries her multifaceted background and experiences with her.

“I wouldn’t have done what I did in Alaska if I had completed medical school first,” Dr. DeFontes says. “I’m so grateful for every step along the way.”

31

AOMA Digest Spring 2013

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ATSU takes the pulse of its anatomy programs

;

rom state-of-the-art computer software and a 3-D theatre to tried and true cadaver dissection and textbooks, the labs are a mighty source of knowledge and skill for students across disciplines. Both Arizona’s and Missouri’s facilities are finding new ways to integrate dissection and software, each putting student learning at the heart of its programs.

Anatomy programs at ATSU have spent the last few years in transformation mode, questioning the status quo and asking tough questions about learning.

“Realizing that the goal of our institution is to create physicians in rural programs and family practice, the argument has been whether medical students who are not going into a surgical profession actually need cadaveric dissection,” explains Jay M. Crutchfield, MD, FACS, assistant professor and administrative anatomy director, A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA).

According to Dr. Crutchfield, a general surgeon trained in classical cadaveric dissection at Mount Sinai School of Medicine in New York, using cadavers to learn 3-D anatomy isn’t a necessity.

“When students become physicians they will really see anatomy by X-rays, CT scans, and MRIs and not necessarily how a

surgeon would in the operating room,” he says. “This begs for a change in the way we teach anatomy. Cadavers are still very useful, but they’re not the only way to teach.”

“An anatomy book is well-detailed, but it is not rotatable and you cannot piece apart the structures to appreciate the depths of the body,” says fourth-year ATSU- SOMA student Joshua Menefee. “Books and cadavers may not give us sufficient structures to learn from, and we will be using radiography to look at the body during our careers anyway.”

In Missouri, full-body cadaver dissection is emphasized. The lab is one of few in the country to operate solely on a body donation program.

“The course is heavily hands-on and dissection-based,” says A.T. Still University Kirksville College of Medicine (ATSUKCOM) Anatomy Chair Peter Kondrashov, PhD. “We probably have one of the best student-per-cadaver ratios in terms of number of students and the time students spend dissecting.”

According to Dr. Kondrashov, dissection is a classical part of medical education and is an essential learning tool.

“No one has invented anything better than the human body to teach about the human body. I’ve looked into all kinds of things and still the human body is the most

McQueen named senior executive associate dean for ATSU-SOMA

G

regory McQueen, PhD, is the new senior executive associate dean for A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA). Prior to joining ATSU-SOMA, Dr. McQueen was senior executive associate dean at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif.

Dr. McQueen received his doctorate from University of North Texas in 1995. As senior executive associate dean for ATSUSOMA, he will be responsible for assisting ATSU-SOMA Dean Kay Kalousek in all aspects of the operation and planning for the medical school. Additionally, Dr. McQueen will be in charge of the accreditation process for ATSU-SOMA, organizational <gZ\dgn BXFjZZc! E]9 development, and team development.

AOMA Digest Spring 2013

32

awesome teaching tool,” he says.

While dissection is pivotal to the program, technology plays a vital role. The course was significantly restructured in the last few years, dividing students into two groups. One group dissects in the lab while the other receives a related clinical presentation by a local physician in the classroom or masters anatomical concepts using ultrasound. When possible, clinical cases incorporate medical imaging. Portable ultrasounds were also added to the curriculum, allowing students to use this cutting-edge imaging technology on almost every part of the human body to learn “living” anatomy.

“The introduction of ultrasound was very helpful,” says Thomas Rountree, OMS II. “I saw ultrasound used several times during my preceptorship.”

Both campuses use online videos and several computer programs to aid student learning, such as Cyber-Anatomy, ToLTech VH Dissector, 4D Anatomy, and Online Dissector.

Arizona’s recently updated computer system with an overhead high-definition camera and two projection screens means students can throw on a pair of 3-D glasses and get up close and personal with human anatomy without a scalpel.

“The traditional anatomy course is frequently being replaced with an integrated approach to medical education,” says ATSU-SOMA Assistant Anatomy Professor William Robinson, PhD, DPT. “An example of this is the clinical presentation curriculum that we use at SOMA.” ATSU maintains that an intelligent fusion of software and dissection is the backbone to any successful program. After all, “You can’t take a cadaver home with you, but you can study Cyber-Anatomy on your home computer,” Dr. Robinson jests.

Both Missouri’s and Arizona’s anatomy programs highlight the need for students to learn in multifaceted ways as each uniquely combines traditional and up-and-coming methods to get the job done. Collaboration across campuses has been critical to each program’s success.

Anatomy at ATSU is getting brainier – its labs unrestricted to one narrow-minded track and both programs embracing new and old, history and future, and above all, connecting with the hearts and minds of students.

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–––– Head games ––––

P

. Gunnar Brolinson, DO, ’83, FAOASM, FAAFP, FACOFP, is sports medicine chair and associate dean for clinical research at Edward Via College of Osteopathic Medicine. He is also head team physician for Virginia Tech Hokies football, as well as the U.S. Olympic Ski team.

Dr. Brolinson’s study on traumatic brain injuries (TBI) has garnered national attention.

8JGG>8JAJB >CCDK6I>DC An advanced approach to medical education, the Clinical Presentation Curriculum (CPC) teaches medicine by focusing on how patients present themselves for care. Research on the subject by ATSU-SOMA Associate Dean Frederic Schwartz, DO, ’69; Associate Chair Mara Hover, DO; Curriculum Specialist Lise McCoy, MTESL; and Data Manager Marjorie BuickKinney, BA, was published in the July 2012 edition of Medical Science Educator by the International Association of Medical Science Educators.

L]n ^h ndjg gZhZVgX] ^bedgiVci4 We surveyed medical student and faculty impressions regarding SOMA’s CP curriculum and contextual learning at Community Health Centers (CHCs) to investigate how this model was working. We wondered if students and faculty felt the model of sending students to community campuses for mentorship and training in years two through four was an effective educational approach.

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Why is your research important? TBIs are responsible for an estimated 50,000 to 75,000 deaths in the United States each year, with an additional 1.5 million suffering from various severities of head injuries. There is much debate on what biomechanical parameters induce TBI. Our previous research collected biomechanical data to characterize brain injury in high school and collegiate athletes, who are at high risk for concussive injury.

This past season we also instrumented the helmets of youth football players with a sensor capable of measuring the linear and angular acceleration that the head experiences with every impact. By collecting data from injurious and non-injurious head impacts in both practices and games, insight about thresholds and brain injury mechanisms were discovered.

How has your study made an impact? There are 3.5 million youth football players in this contry, and they are the most poorly studied of athletes particiapting in helmeted sports activities. In contrast, there are 1.3 million high school players and 100,000 collegiate players. This research allows for better characterization of head impacts, which may lead to improved helmet design, as well as rules changes to protect young athletes. Based in part on our research, significant rule changes have been implemented in Pop Warner football for the upcoming season.

The CP model was fully implemented at five medical schools: ATSU-SOMA, University of Calgary, Kansas City University, Foster School of Medicine at Texas Tech, and Ohio University College of Medicine.

ATSU- SOMA just completed its fifth year of successfully implementing early clinical experiences at community campuses. The partnership between ATSUSOMA and the National Association of Community Health Centers provides contextual learning experiences that will induce new graduate physicians to care for the medically underserved.

L]Vi ^h i]Z cZmi W^\ ^YZV4 Next is to articulate and disseminate the model to the general public and other healthcare schools interested in advancing their own curricula. For this reason, ATSU launched a new organization called the Clinical Presentation Curriculum Learning and Research (CLEAR) community. The first international meeting was held on the Arizona campus in June. When schools using this model join forces, we can collaborate on projects of benefit to all our students.

33

AOMA Digest Spring 2013

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Time Well Spent

L

hen I arrived at the Tucson Osteopathic Foundation (the word Medical was added later) in 1988 its primary program since its formation in 1986 was creating, owning and operating the Tucson Children’s Museum. It was an eminently worthwhile endeavor and today the museum is an independent cultural asset for thousands of children in Southern Arizona. One of my first challenges was to cut a hole in the exterior wall large enough to get the huge display of animatronic dinosaurs inside and up and running and then restore the wall to the satisfaction of the code inspectors. No small task.

IgVch[dgbVi^dc None of the tasks have been small over the past 25 years but they have been immensely rewarding. In the year I arrived we changed from TOF to TOMF, the Tucson Osteopathic Medical Foundation, with a Board decision to transform the mission. It was decided to dedicate the Foundation to medical education and building awareness of osteopathic medicine.

IgVch^i^dc^c\ The first step after turning the Tucson Children’s Museum over to a community board was to adopt an organized approach to promoting awareness of the osteopathic profession. A magazine for osteopathic patients was developed, a radio series created and a carefully calibrated ongoing visibility program in public media was put in place. Special newspaper sections describing how D.O.s were trained, and a 1998 program of community surveys on important issues were developed. We were becoming recognized as being integral to medicine and health, a benchmark of that recognition coming with a headline in the Arizona Daily Star stating that “Your Next Doctor May be a D.O.”

BZY^XVa :YjXVi^dc Today, the Southwestern Conference on Medicine is the trademarked premier program of the Foundation which since 1991 has been providing a primary care CME for thousands of physicians.

Last year 400 osteopathic and allopathic physicians from around the nation and Arizona attended the Conference giving it high marks for its educational content. Other programs include: Strain and Counterstrain, a program featuring Dr. Harmon Myers which over the years has exposed his training techniques to OMT practitioners nationwide. It is now integrated into the Southwestern Conference.

The Osteopathic Press. Products include a book entitled Something More… Osteopathic Medicine in Southern Arizona and the

highly successful textbook Clinical Applications of Counterstrain, now newly revised as a compendium edition. It is required by many colleges of osteopathic medicine throughout the country.

A distance learning program for medical students and residents established in cooperation with the Arizona College AZl G^\\h! :Y#9#! 86: of Osteopathic MediTOMF Executive Director cine in Glendale. Since its inception in 2009 it has served over 300 students rotating through Tucson, connecting them to lectures and tutorials at the College through videoconferencing.

Online CME which is just developing at the Foundation in cooperation with the AOA in an experimental program to expand physician education using the internet.

The Fall Primary Care Update started in 2012 for physicians in Tucson.

I]Z ;djcYVi^dc IdYVn Today, the Foundation occupies its own headquarters building located in a medical complex in central Tucson. A key feature is the TOMF Conference Center, a 1,789 square foot educational facility which since it opened has hosted 1,223 events for community and medical groups, including the AOMA, with bookings through May of 2014. It includes a videoconferencing component and two other facilities for small groups. The Foundation’s educational programs have benefited the profession at every level, and it still retains a philanthropic grant making component with its Trustee Awards program, also newly revised, which has provided grants to community organizations of over $1 million since 1991.

I will be retiring this year from the Foundation after 25 eventful and rewarding years. It has been time well spent.

35

AOMA Digest Spring 2013

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Team of Physicians for Students (TOPS) Day IDEH Just D.O. It for TOPS – Volunteers are needed for this free sports screening day for high school athletes participating in school-sponsored sports. This year’s event will be held at Sunnyslope High School in Phoenix on Saturday, April 13, 2013 from 7:00am - 5:00pm.

The AOMA is asking its member physicians to volunteer for a two or three-hour shift for this year’s TOPS event. TOPS will be held on Saturday, April 13, 2013 at Sunnyslope High School (35 W. Dunlap) in Phoenix. Osteopathic Medical Students from AZCOM and KCOM will be performing the sports screenings, ECGs, and ECHOs (when indicated) are being offered. Osteopathic Physician volunteers will supervise the students to review their work and recheck for any potential pathology. Simply complete this form with your name, phone number, and shift preference then return it to the Tiffany Tapia via fax (602) 336-0044.

Volunteering for TOPS helps:

High school students receive their free sports screenings and health tips to stay on the team; Upcoming osteopathic medical students hone their skills; and You feel good about participating in an osteopathic community outreach event.

Don’t Delay – Sign Up Today!

(Please print clearly) Name: __________________________________________________________________________________________________________________ Phone: _______________________________________________________________________________________________________________________ ________Shift 1 – 7 a.m. to 9 a.m.

________Shift 4 – 1 p.m. to 3 p.m.

________Shift 2 – 9 a.m. to 11 a.m.

________Shift 5 – 3 p.m. to 5 p.m.

________Shift 3 – 11 a.m. to 1 p.m.

[ ] I am willing to work a 3 hour shift.

TOPS needs more doctors who are willing to spend part of a Saturday, once a year to participate and supervise student doctors. The TOPS team promises to feed you, thank you and give you an experience to remember.

Return completed form to the Steingard Medical Group, Attn: Tiffany via fax at (602) 336-0044

AOMA Digest Spring 2013

36

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Arizona Osteopathic Medical Association

Ninety-First Annual Convention 6eg^a &+ Â '%! '%&(

The State of Medicine

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Convention Education Chairperson

AOMA President

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Tuesday, April 16 and Wednesday, April 17

Registration includes daily continental breakfasts, breaks, and four lunches (Tuesday, Wednesday, Thursday, and Saturday).

Be sure to visit the AOMA Convention Exhibitors during their 2 days of exhibits Exhibit Hours: Tuesday, April 16, 2013 – 7:00am to 5:00pm (Boxed lunches will be served in the Exhibit Hall) Wednesday, April 17, 2013 – 7:00am to 2:00pm (Open during lunch)

LZaXdbZ GZXZei^dc You’re invited to join us for a welcome reception on Tuesday, April 16th in the Exhibit Hall from 5:15 – 6:00pm.

8B: >c[dgbVi^dc AOMA has requested that the AOA Council on Continuing Medical Education approve this program for 34 hours of AOMA Category 1-A CME Credit. An application AAFP Credit has also been filed!

April 19, 2013 at 6:30pm All members of the Arizona Osteopathic Family are invited to come! This is a brand new event featuring fun for the whole family.

We invite you to bring your kids – special entertainment and food for them. For the adults, we will have a Western themed party complete with delicious food, great entertainment, and plenty of time to visit with your colleagues. Tickets must be reserved in advance for the party. You must reserve your tickets in advance – there will be no entry without a ticket. Please reserve your tickets on this form.

AOMA Digest Spring 2013

38

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2013 Convention Registration Form April 16–20, 2013 Hilton Scottsdale Resort & Villas, Scottsdale, Arizona Name: ____________________________________________________

AOA Number: __________________________________

(type or print name as you would like it to appear on your name badge)

Specialty: _____________________________________________________________________________ (for badge purposes only) Office Address: _____________________________________________________________________________________________ City, State, Zip: _____________________________________________________________________________________________ Telephone: _________________________________________ Fax: ___________________________________________________ E-mail: ____________________________________________________________________________________________________ Name(s) of registered spouse/guests(s): _________________________________________________________________________ Please list any special needs (dietary restrictions, accommodations, etc.): ______________________________________________ __________________________________________________________________________________________________________

REGISTRATION OPTIONS Note: Out-of-State D.O. registration applies to osteopathic physicians who are members of their respective state associations. Out-ofState and Arizona D.O.’s who are not members of their respective associations will be charged the Non-member rate. Your registration includes breakfast every morning. Lunch is included for Tuesday, Wednesday, Thursday, and Saturday. Additional luncheon tickets may be purchased for $30.00 each.

Friday night’s Osteopathic Family Party – admission is free this year to everyone. There is a limit on attendees and tickets are given out on a first come, first serve basis. Please indicate below if you wish to attend and how many guests you plan to bring.

Please check one

Registration Effective March 16, 2013

O AOMA Member

$695

O AOMA Retired, Honorary Life, or Military Member

$595

O Out-of-State D.O. Member

$695

O Non-Member (in-state or out-of-state)

$1050

O Non-Physician Clinicians (i.e. nurses, PA’s, etc.)

$595

O Spouse/Guest (per person)

$425

O Students, Interns, & Residents

No Fee

Must register for credentials. Meal tickets may be purchased onsite.

TOTAL $ _________ § Osteopathic Family Party – Friday, April 19, 2013 O Yes, I will attend. Number of adults: _______ children: _______

PAYMENT Register by: O VISA

O MasterCard

O AmEx

O Check made payable to AOMA

Amount $ ___________

VISA or MasterCard Number: ___________________________________________ Exp Date:___________ Code: ____________ Signature (for credit card): _____________________________________________________________________________________

CANCELLATION POLICY All requests for refunds must be in writing. To receive a refund, requests must be submitted by March 15, 2013. A $50 processing fee will be deducted from the amount refunded. Refunds will not be available after this date.

Return to AOMA via fax at (602) 266-1393, mail at AOMA, 5150 N. 16th St., Ste. A-122, Phoenix, AZ 85016, or email to teresa@az-osteo.org.

39

AOMA Digest Spring 2013

C^cZin";^ghi 6ccjVa 8dckZci^dc

Richard Carmona, M.D., M.P.H., FACS will join us as our keynote speaker at the Convention to discuss the critical connection between prevention and health and wellness. Dr. Carmona served as the Surgeon General of the United States from 2002 – 2006. He currently serves as the President of Canyon Ranch Institute and is a Distinguished Professor at University of Arizona. During his tenure as Surgeon General, Dr. Carmona focused on prevention, preparedness, health disparities, health literacy, and global health. He also issued many landmark Surgeon General communications during his tenure, including the definitive Surgeon General’s Report about the dangers of second-hand smoke. We are honored to have him present at the 91st Annual AOMA Convention.

The State of Medicine SCHEDULE All education sessions are held in Sonora Ballroom

Tuesday, April 16, 2013 7:00 – 8:00am

Continental Breakfast

8:00 – 9:00am Prevention, Preparedness, Plagues & Politics: The Life of the Surgeon General Richard Carmona, M.D., M.P.H., FACS 9:00 – 10:00am Military Medicine Cynthia Rasmussen, RN, MSN, CANP 10:00 – 10:30am BREAK – Visit the Exhibit Hall

5:15 – 6:00pm Wine and Cheese Reception (Exhibit Hall) 6:30 – 7:00pm

Board of Trustees Dinner

7:00 – 9:00pm

Board of Trustees Meeting

Wednesday, April 17, 2013

Student Day Infectious Diseases 7:00 – 8:00am

Continental Breakfast

8:00 – 9:00am West Nile Virus Joseph Zachariah, D.O.

Women’s Health

9:00 – 10:00am Influenza Joseph Zachariah, D.O.

10:30 – 11:30am Pertussis Karen Lewis, M.D.

10:00 – 10:30am Rocky Mountain Spotted Fever Joseph Zachariah, D.O.

11:30 – 12:30pm Medication Use During Pregnancy Peter Wong, D.O.

11:00 – 12pm Valley Fever Peter Kelly, M.D.

12:30 – 1:30pm

12 noon – 1:30pm LUNCH Preventing Violence & Mass Murder by Connecting the Dots Steven Pitt, D.O.

LUNCH

1:30 – 2:30pm Obesity in Women Diane Evans, D.O. 2:30 – 3:30pm Osteopathic Considerations in Pregnancy Gary Gailius, D.O. 4:00 – 4:15pm

BREAK

4:15 – 5:15pm Recent Trends in Breast Cancer Treatment Brenda Moorthy, D.O. AOMA Digest Spring 2013

40

1:30 – 2:30pm OMM for Infectious Diseases William Devine, D.O. 2:30 – 3:30pm Rabies Postexposure Prophylaxis (PEP) Basics Craig Levy, MA, and Laura Adams, DVM, MPH Speaker program subject to change at the sole discretion of AOMA convention management.

C^cZin";^ghi 6ccjVa 8dckZci^dc 3:30 – 3:45pm

BREAK

3:45 – 5:15pm

Clinical Case Competition

Thursday, April 18, 2013 7:00 – 8:00am

Continental Breakfast

8:00 – 9:00am Screening & Treatment of Pediatric Developmental Delays Beth Trevino, M.D. 9:00 – 10:00am Blood Disorders in Pediatric Patients Michael Graham, M.D. 10:00 – 10:15am

BREAK

10:15 – 11:15am Taking Care of Cancer Patients Laurel Mueller, D.O. 11:15am – 12:15pm The Arizona Prescription Drug Reduction Initiative Phillip Stevenson, Ph.D. 12:15 – 1:15pm LUNCH – Poster Competition

9:00 – 10:00am Enhancing Physician – Patient Communication Lori Kemper, D.O. 10:00 – 10:15am

10:15 – 11:15am Using Social Media to your Advantage Mohammed Alo, D.O. 11:15 – 12:15pm Meaningful Use – Stage 2 Melissa Rutala, MPH 12:15 – 1:30pm LUNCH (AzACOFP Luncheon) 1:30 – 2:30pm Celiac Disease and Inflammatory Bowel Disease: New and Old Gary Cornette, D.O. 2:30 – 3:30pm Incorporating Aesthetic Medicine into Your Practice Martin Blume, D.O.

1:15 – 2:15pm Traumatic Brain Injury: Current Concepts & Future Directions David Treiman, M.D.

3:30– 3:45pm

2:15 – 2:45pm Speech Therapy for TBI: Cognitive Rehabilitation Approach Jill Pfister

6:30 – 10:00pm

2:45 – 3:00pm

7:00 – 8:00am

Break

3:00 – 4:00pm Research Advances in Traumatic Brain Injury Douglas Johnson, Ph.D. 4:00 – 6:00pm AOMA House of Delegates 6:00 – 7:00pm AOMA Political Action Committee (PAC) Reception

Friday, April 19, 2013

American College of Osteopathic Family Physicians Day (ACOFP) Day 7:00 – 8:00am

Continental Breakfast

8:00 – 9:00am Using the AOA Clinical Assessment Program for PQRS & OCC Sharon McGill, M.P.H.

BREAK

BREAK

3:45 – 4:45pm Concierge Medicine: The Third Era Bryan Glick, D.O. & Susan Wilder, M.D. Osteopathic Family Party

Saturday, April 20, 2013 Continental Breakfast

8:00 – 9:00am Cutaneous Manifestations of Connective Tissue Disorders Lindsay Ackerman, M.D. 9:00 – 10:00am Concussion Javier Cardenas, M.D. 10:00 – 10:15am

BREAK

10:15 – 11:15am Headaches Eric Eross, D.O. 11:15 – 12:15pm OMM for Headaches Jonathon Kirsch, D.O. 12:15 – 1:30pm

President’s Luncheon

41

AOMA Digest Spring 2013

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2013 Meeting Dates and Locations APRIL 16 ď&#x161;ť 20, 2013 AOMA 91st Annual Convention Scottsdale Hilton Resort & Villas 6333 N. Scottsdale Road Scottsdale, AZ

Advertisersâ&#x20AC;&#x2122; Index MICA ........................................ Page 2 Comitz | Beethe ......................... Page 5

APRIL 16, 2013 AOMA Board of Trustees â&#x20AC;&#x201C; 7:00 p.m.

Catalina Medical Recruiters ..... Page 15 Hospice of the Valley ................ Page 21 Cox Business ............................ Page 34

NOVEMBER 8, 2013 Board of Trustees Hilton El Conquistador, Tucson NOVEMBER 9 & 10, 2013 33rd Annual Fall Seminar Tucson, AZ

CMS......................................... Page 37 AOMA Career Center ............. Page 42 AzHEC .................................... Page 43

AOMA Digest Spring 2013

APRIL 18, 2013 AOMA House of Delegates 3:45 â&#x20AC;&#x201C; 6:00 p.m.

PAC Reception â&#x20AC;&#x201C; 6:00 p.m.

42

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

Arizona Osteopathic Medical Association

91st Annual Convention April 16â&#x20AC;&#x201C;20, 2013 Hilton Scottsdale Resort & Villas 6333 N. Scottsdale Rd. Scottsdale, AZ 85250 Phone: 480.948.7750 Online Registration at www.az-osteo.org

For more information or to register by phone call 602.266.6699 â&#x20AC;&#x201C; toll free 888.266.6699