Jennifer J. Hauler, DO A servant leader with a commitment to physician well-being
THE QUARTERLY PUBLICATION OF THE OHIO OSTEOPATHIC ASSOCIATION | WINTER 2019
SAVE THE DATE
OHIO OSTEOPATHIC SYMPOSIUM A collaboration of Ohio University Heritage College of Osteopathic Medicine and Ohio Osteopathic Association
APRIL 24-28, 2019 Hilton Columbus, Easton Town Center #OhioOsteo
The Quarterly Publication of the Ohio Osteopathic Association Winter 2019 • Volume 88 Number 3 • USPS 068-760
OOA Officers President Jennifer J. Hauler, DO President-Elect Charles D. Milligan, DO Vice President Sandra L. Cook, DO Treasurer Henry L. Wehrum, DO Immediate Past President Sean D. Stiltner, DO
6 CLEVELAND Student Update
Trustees District One • Toledo Nicholas G. Espinoza, DO District Two • Lima Wayne A. Feister, DO District Three • Dayton Nicklaus J. Hess, DO District Four • Cincinnati Michael E. Dietz, DO District Five • Sandusky Luis L. Perez, DO District Six • Columbus Andrew P. Eilerman, DO District Seven • Cleveland Katherine H. Eilenfeld, DO District Eight • Akron/Canton Douglas W. Harley, DO District Nine • Athens/Marietta Jennifer L. Gwilym, DO District Ten • Youngstown/ Warren John C. Baker, DO Resident Representative Ryan K. Martin, DO Student Representatives Dubem Obianagha, OMS II Adam Rabe, OMS II Noor Ramahi, OMS II
2 A SERVANT LEADER Getting to know Jennifer J. Hauler, DO 5 EXECUTIVE INSIGHT Moving forward, will AOA board certification be truly osteopathic?
12 HEALTH IS PRIMARY Nationwide public awareness campaign highlights primary care medicine 14 WHAT OHIO’S NEW STATE PLAN ON AGING MEANS FOR HEALTH CARE PROFESSIONALS
10 ACCESS THE LATEST CLINICAL DATA THROUGH CLINISYNC DEPARTMENTS
18 OOA NEWS
20 IN THE KNOW
ON THE COVER Jennifer J. Hauler, DO, of Tipp City, serves as OOA president through April 2019. photo courtesy ou-hcom
OOA Staff Executive Director Matt Harney, MBA mattharney@OhioDO.org Director of Accounting and Membership Joanne Barnhart jbarnhart@OhioDO.org Director of Communications Cheryl Markino cmarkino@OhioDO.org Administrative Assistant Carol C. Tatman ctatman@OhioDO.org Executive Director Emeritus Jon F. Wills
Buckeye Osteopathic Physician Magazine
Buckeye Osteopathic Physician (08983070) is published quarterly for the Ohio Osteopathic Association, 53 W. Third Avenue, Columbus, Ohio 43201. Phone 614-299-2107; Fax 614-294-0457; www.OhioDO.org. Subscription price for non-members is $25 per year. Periodicals postage paid at Columbus, Ohio. Send address changes to Buckeye Osteopathic Physician, PO Box 8130, Columbus, Ohio 43201.
Editor: Cheryl Markino For advertising information: 614-299-2107, cmarkino@OhioDO.org
WINTER 2019 ISSUE 1
LEADER 2 BUCKEYE OSTEOPATHIC PHYSICIAN
Getting to Know Dr. Hauler
hen she was installed as president of the Ohio Osteopathic Association in April, Jennifer J. Hauler, DO, talked about one of her favorite sayings: “A job is what you are paid for, but a calling is what you are made for.” By all accounts of those who know her, leadership is Hauler’s calling. And servant leadership defines her best, as she is someone who shares power, puts the needs of others first, and helps people develop and perform as highly as possible. A servant leader with a strong commitment to the health and wellbeing of physicians, she has made caring for her colleagues a priority. Hauler believes a healthy spirit benefits patient care. She notes that osteopathic medicine teaches that a person is a unit made up of body, mind, and spirit and that true wellness requires attention to all three components. “Physicians spend countless hours attending to the needs and wellness of their patients, many times neglecting their own health,” she wrote in a Dayton Daily News editorial. “Increasing regulatory demands and workload, loss of autonomy, decreased reimbursement, and constant pressure to achieve high marks for patient satisfaction have led to intolerable rates of physician burnout and suicide. In order to lead patients to wellness, the physician community must learn to take care of their own.” She has been taking care of OOA members in other ways too. Ensuring the physician is the leader of the health care team. Protecting the autonomy and sanctity of the doctor-
Jennifer J. Hauler DO Specialty: Emergency Medicine and Family Medicine Medical Education: Ohio University Heritage College of Osteopathic Medicine, 2001 Residency: Grandview Medical Center Undergraduate Degree: The College of William & Mary MBA: Indiana University Kelley School of Business Current Position: System Vice President of Operations/Chief Medical Officer for Premier Health Community Involvement: Medical Director Vandalia Fire Department Leadership Positions: OOA Board of Trustees since 2009; Ohio ACOFP Board of Governors; past president of Dayton District Academy of Osteopathic Medicine Family: husband Josh, son Jonathan (age 6) Pets: Ozzie the cat, and Kimber the yellow lab Hobbies: spending time with family and friends, traveling, reading Resides In: Tipp City, Ohio Born In: Garfield Heights, Ohio
patient relationship. Preparing physicians for the transition to value-based health care. Promoting osteopathic distinctiveness. Leading monthly conference calls with the four physicians who serve on the OOA Executive Committee, weekly calls with OOA Executive Director Matt Harney, and quarterly Board meetings held in Cleveland and Athens, Hauler has worked on these and other issues important to physicians. Midway through her presidential term, she took time to reflect on the organization’s goals and the future of the profession.
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REGARDING THE OOA
Why did you take on a leadership role? I believe that serving on the Board of Trustees, and particularly in the role of president, provides a wonderful opportunity for me to give back to the profession that has given so much to me. What inspired your involvement? During my senior year as a resident, I was encouraged by a mentor to become involved in the organization. It provided a unique way for me to serve the profession. What are your goals for the organization? I want the organization to continue to grow and thrive. It is important that we continuously adjust to meet the needs of our physicians. What OOA presidential legacy do you want to leave? I hope to have made the organization better in my time as president by reversing the downward trend in membership, improving the financial well-being of the organization, and expanding services to best meet the needs of our members during the year. What don’t people know about the OOA that you wish they did? I wish that all osteopathic physicians understood how very important advocacy is to the profession. The OOA is constantly working with legislators and government agencies to monitor policy changes, provide testimony, and
Three things we (probably) don’t know about you: I love playing volleyball, boating, and snow skiing. I interviewed to be a flight attendant after graduating college but was turned down because I didn’t meet the height requirement. I attended a Christmas party at the Hungarian embassy as a child. Five places you’ve visited: Moscow, Beijing, Salzburg, Tokyo, Madrid What do you... read? watch? listen to? I love to read or watch mysteries. My favorite author is Patricia Cornwell. I have eclectic taste in music.
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protect the profession. Practicing physicians do not have the time to step away from patients to do this so it is vital to have someone advocating on behalf of the physician.
What is the biggest challenge DOs face today? In my opinion, the largest challenge facing DOs today is the struggle to remain the distinctive leader of the health care team. ISSUES THAT MATTER TO YOU PROFESSIONALLY
What are your passions/special projects? I have a strong focus on patient-centered care. I truly believe that if the patient is at the center of the decision-making process, then the results will always turn out right. I am also passionate about caring for our colleagues. Medicine is incredibly rewarding, but it is tough. We must take care of one another to be able to take care of our patients. We have to help our doctors re-connect with the passion and joy in medicine. Any special or poignant stories (patient, clinical, academic) to share? There are so very many stories that have touched my heart over the years. There is nothing more rewarding that knowing you have helped another human being. What is your typical day? I am currently working in an administrative capacity. My days involve working to bridge the gap between medicine and administration. Why did you choose osteopathic medicine? I truly believe in the tenets of osteopathic medicine. I believe that the body is a unit; the person is a unit of body, mind, and spirit. I believe that the body is capable of selfregulation, self-healing, and health maintenance. I believe there is an interrelationship between structure and function. I believe in the power of touch and osteopathic manipulative medicine. GETTING PERSONAL
Who inspires you? My parents have been my biggest source of inspiration. They raised my brother and me to believe that anything is possible if you are willing to work hard enough for it. What is your leadership style? I am a servant leader. How do you turn around a bad day? A simple walk through the ICU reminds me how lucky I am.
e v i t u c Exe
T H G I S IN
Moving forward, will AOA board certification be truly osteopathic? By Matt Harney, MBA
may have heard the recent uproar regarding AOA board certification. In short order, the AOA is revising board certification as we know it--both for initial certification and osteopathic continuing certification. At the time of this writing, the AOA and its Department of Certifying Board Services are proposing a three-pathway system to initial board certification that would make osteopathic philosophy and principles optional. The three options are: 1. Core exam & osteopathic written exam 2. Core exam & osteopathic written exam & OMT 3. Core exam only (no osteopathic content) The first two options are aligned with the profession, allowing for physicians who incorporate OMT in their practice and for those who do not. The third option has generated considerable attention--even animus--within osteopathic circles. The concept of osteopathic certification being granted for content that omits osteopathic principles has created uncertainty and frustration for the osteopathic community. The movement toward this possible watered-down version of osteopathic certification initiated the resignation of Ohio’s own Dawn Dillinger, DO, from her position as Chair of the American Osteopathic Board of Pediatrics on November 12. Dr. Dillinger had served on the AOBP since 2008. In a widely-circulated resignation letter, Dr. Dillinger states, “I have seen osteopathic continuing certification go from the concept that everything needed to have an osteopathic focus, to eliminating any osteopathic components.” She continued, “I have heard the AOA is more interested in MDs who show interest in osteopathic certification than DOs who rely on the same certification for distinction. I have been yelled at by the AOA and told to resign if I cannot support the current vision of the AOA. I can tolerate all of this. I cannot tolerate being told by an allopathic physician that in order to convert MDs to our exam we will have to make the osteopathic component optional.” Worth noting, following Dr. Dillinger’s resignation the AOBP’s Vice Chair, Kayse Shrum, DO, has also resigned. While Dr. Dillinger’s experience is unique and may or may not be shared by others, it’s clear we’re at a moment of introspection for the profession. In times like these, it’s important remind ourselves of the mission of the American Osteopathic Association: to advance the distinctive philosophy and practice of osteopathic medicine. How osteopathic is a certification exam that excludes osteopathic content? I
presume that question will be central to the conversation moving forward. No doubt a conversation that should be had at the AOA House of Delegates meetings. Issues such as this broadly impacting the profession should be considered carefully, by the full profession. What the profession deserves and needs is deliberate action—a thorough debate and exchange of ideas and values. All voices must be heard. Those perspectives should then be carried forward to the full AOA House of Delegates--the true decision-making body of the American Osteopathic Association. These delegates are elected by their peers from every state/divisional society and serve to consider issues of importance to the profession, with board certification being a perfect example. We all know the health care landscape changes even more rapidly than weather in Ohio. The constant churn of change is also true for the osteopathic profession. I certainly understand the importance of remaining nimble and responsive to evolving environmental and professional changes, but it’s even more important to be mindful of a purposeful future void of reactivity and shortsightedness. The AOA states the proposed changes to board certification are largely based on the results of a large nationwide survey. The survey included 1,200 physicians—both DOs and MDs (and thereby included mixed board certification of both the AOA and ABMS)— under the age of 45. The ultimate goal was to understand the process through which residents choose their board certification. While the survey results can provide useful insight, it seems it should serve the role as one of many ingredients for a tasty dish rather than validation to become the entree. Undoubtedly, AOA board certification will benefit from considerations such as improving testing convenience, increasing relevance to practice, and providing options for shorter intervals that counter the high stakes testing once a decade. Further, pricing is another component that must be carefully considered in order to ensure competitiveness. These items are all crucial to the profession as well as patient care—and for that the AOA should be applauded. Yet, the AOA is the first to admit the timeframe to weigh in on these changes is incredibly tight. Graduating residents already have a choice for their boards. Nonetheless the question remains, will AOA board certification be truly osteopathic?
WINTER 2019 ISSUE 5
CAMPUS Medical school is a busy, often overwhelming time. But students at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) make time for their peers, for their community, and for their profession. In the last issue of Buckeye Osteopathic Physician, we had an update from the OU-HCOM Athens campus. This issue, we invite leaders from the Cleveland campusâ€”specifically the presidents of the Student Government Association (SGA) and Student Osteopathic Medical Association (SOMA)â€”to share news about their activities and goals for the academic year.
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Greetings from the OU-HCOM Cleveland Campus! We have exciting news coming from our campus. The Student Government Association has been working with faculty, staff, and several campus organizations to engage our students in a plethora of activities to edify their professional, academic, and social lives as well as mental health. For Halloween, HCOM Cleveland, South Pointe Hospital, and the City of Warrensville Heights hosted our 4th Annual Trunk or Treat. Several students, faculty, and employees of South Pointe participated and made some festive trunks. There were over 350 kids in attendance who enjoyed going from car to car collecting candy and seeing costumes. On October 13 and November 10, first and second year students took time on a Saturday morning to volunteer at the Warrensville Heights food bank. The pantry, open the second Saturday of the month, helps provide nutritious meals to hundreds of individuals in and around Cuyahoga County. The initiative is operated in partnership with the Greater Cleveland Food Bank, which last year made possible over 57 million meals to those in need. Second year medical students have been participating in the Be Well Program, an initiative of Cleveland Clinic and the City of Warrensville Heights, where they coach community members to change certain lifestyle habits like lowering their blood pressure, cholesterol, or BMI. A new event was added to the Cleveland campus schedule this academic year. The first Cleveland Heritage Gala took place on November 30, 2018. Sponsored by the Student ACOFP and Student American Academy of Osteopathy, the evening included dinner, auction, live entertainment, and much more! In October, I participated at the Council of Osteopathic Student Government Presidents (COSGP), an official committee of the American Association of Colleges of Osteopathic Medicine (AACOM), met in San Diego during OMED for our quarterly business meetings. There, we listened to several presentations from the ACGME, NBOME, AOA, AACOM, and a variety of other presenters. The topics of the meeting covered a lot of material and were of particular interest to 1st and 2nd year students. AACOM composed a 2018 midterm elections PowerPoint and COSGP developed a list of international volunteer opportunities. Several special speakers have been on campus to discuss topics relevant for students as well as our future patients. During Love Yourself Week 2018, the Student National Medical Association, in collaboration with Ohio University Women’s Center, HCOM’s Office of Inclusion, and many other sponsors, organized a talk with Beverly Gooden that was broadcast across
NOOR RAMAHI, MPH, OMS-II SGA President, Cleveland Campus
all three campuses. Gooden is a renowned social activist and creator of the #WhyIStayed hashtag and global movement. In this radical talk, Gooden challenges the question “Why did he/ she stay?” and reveals how the current way we interact with survivors is a house of cards. From faulty blame attribution, to designating only men as abusers, it’s easy to overlook the sheer volume of domestic violence when the issue has historically been framed as “them” and not “us.” OOA Past President Robert W. Hostoffer, Jr., DO, an allergist-immunologist in Mayfield Heights, came to the campus in November to discuss Scholar Series, a succession of video workshops that he developed outlining the research process. His talk was also broadcast to all three campuses. SGA, the Family Medicine Club, and the Transformative Care Continuum (TCC) faculty held a voluntary activity to learn more about the interactions between food insecurity, health, and the effect this connection may have on patients. Over a three-day period in October, students were asked to participate in a challenge where they lived as if they were reliant on the Supplemental Nutrition Assistance Program (SNAP), commonly referred to as food stamps. Over a million Ohioans currently participate in this national program, and this activity was a way to gain a better understanding of the challenges families face on a food stamp budget. Students pledged to learn more about food insecurity and the impact it may have on the patients. As a follow-up, TCC hosted a brown bag “lunch and learn” panel that was broadcasted across the three campuses where TCC students shared their experiences participating in the challenge. Also of special note is a unique program for students to hone their OMM skills. Through the generosity of the Student American Academy of Osteopathy and individual students, Cleveland campus students may now check out OMM tables from the library, allowing them to practice at a time and place convenient to them.
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The Student Osteopathic Medical Association chapter at OU-HCOM Cleveland is now in its fourth year, and we are excited to see our inaugural members graduate from the Cleveland campus this coming spring! While there are many student groups on campus, SOMA is unique in that it provides avenues to network nationally, develop as leaders, and advocate for our medical education and profession. As an AOA-affiliated, student-led organization with direct representation in the American Osteopathic Association, we can help shape the osteopathic profession directly through resolution proposals. As a club, we encourage our members to write resolutions about health policy and medical education. All resolutions are debated and voted on by SOMA leaders at the spring conference in Washington, DC and then escalated to the AOA House of Delegates summer meeting in Chicago if they pass. Our members are also invited to attend DO Day on the Hill every March. This is truly an extraordinary opportunity to meet with elected officials and advocate for osteopathic medicine. The event coincides with SOMAâ€™s annual spring meeting, where chapter leaders gather for professional workshops, listen to various thought leaders, discuss resolutions, and network with osteopathic medical students and physicians from across the country. On the local level, SOMA members are instrumental in the community garden we have on the Cleveland campus. Over the last two and a half years, SOMA has collaborated with the Student Government Association and the Lifestyle Medicine
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NATHAN REYNOLDS, MPH, OMS-II SOMA President Cleveland Campus
Club to create and maintain a community garden. In the spring, our members cultivate the soil and plant various vegetables in our four raised garden beds. Students also volunteer their time over the summer to water and weed the garden. Upon returning to campus, the produce is harvested and distributed to our student body. The garden project has fostered a sense of community, and students really have rallied around the idea. As a club, nothing is more satisfying than working on projects that create a sense of community on campus and endure year over year. We are still a relatively new club and are always looking for new speakers to discuss issues pertinent to the osteopathic profession. As a result, our club welcomes any Buckeye Osteopathic Physician reader in the Cleveland area, or those willing to travel to Cleveland, to reach out to the chapter president to schedule a lunch lecture.
Student Leaders Student Government Association, Cleveland Noor Ramahi, President firstname.lastname@example.org Mark Zemenak, Vice President Abigail Stanec, Secretary/Treasurer Jordan Vojtush, Director of Community Outreach Student Osteopathic Medical Association, Cleveland Nathan Reynolds, President email@example.com Jordan Vojtush, National Liaison Officer Kristen Ruckstuhl, Vice President Charles Doolittle, Treasurer/Secretary Mackenzie Reece, Resolution Chair Gwendolyn Kuzmishin, First Year Liaison
WINTER 2019 ISSUE 9
Access the latest clinical data through By Dorothea Howe Communications Director, Ohio Health Information Partnership
magine learning your patient is in the Emergency Department at a hospital outside of your health system, no matter what hospital the patient visits. Now imagine being able to view that information on the spot. Here’s how it works: First you receive the alert. Then you search for the patient and find detailed health information on that encounter immediately. If you’re the patient’s cardiologist, you can view the results of an echocardiogram taken in the hospital, eliminating the need to order another one.
As a primary care physician, you also will know when that patient is discharged so you can immediately follow up within the requirements of your transitional care or payment plan. That’s the efficiency and timeliness of CliniSync, Ohio’s Health Information Exchange (HIE), which currently connects 151 hospitals across Ohio. The Notify solution allows you to submit a patient panel to CliniSync – perhaps of highrisk diabetic or hypertensive patients – and then you will receive alerts if one of those patients is hospitalized or visits the ED.
Your link to the outside world
“CliniSync is our link to the outside world,” says Crystal Mosca, MD, associate chief medical information officer at University Hospitals in Cleveland. In her practice, she has access to Notify as well as what’s known as a Community Health Record, which is a single, longitudinal record that summarizes data from disparate hospitals on a patient. An elderly patient visits her office the day after an ED visit to a hospital outside of the University Hospital system. Without access to CliniSync, Mosca would have no idea what prompted that ED visit, nor would she know the diagnosis, procedures, medications or discharge instructions. Without access to any patient health records, she says, “It’s like flying blind.” With CliniSync’s Community Health Record, she can immediately look up the patient’s name and other identifying information and view the detailed encounter at that outside hospital. For stroke patients at Ohio State University Wexner Medical Center, their care also can be coordinated through the sharing and exchange of health information from different institutions. “As part of our stroke program, we receive referrals from spoke hospitals for patients presenting with symptoms of a stroke,” says Cheryl Link, manager of IT Integration. “CliniSync has allowed us to integrate this patient information from other hospitals into our EHR (electronic health record system), which is of great benefit to our program and our patients.” Access to real-time records also can reduce hospital admission rates. University Hospitals of Cleveland is working
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CliniSync By the Numbers (as of October 2018)
• • • • • •
14 million unique patient records 156 contracted hospitals 151 live hospitals 500 long-term and post-acute care 15,000 independent and hospital-employed physicians 7 health plans, including 5 Medicaid plans
with community nephrologists and the Centers for Dialysis Care to coordinate care of more than 1,200 dialysis patients through CliniSync. This work can improve care quality and cost by moving patients to a nearby dialysis center, reducing thousands of inpatient stays. Solutions to solve your problems
Whether you’re a clinician in a hospital, practice, behavioral health or long-term care facility, CliniSync has solutions that fit your needs, such as: • Results Delivery – CliniSync connects 151 hospitals and five state reference labs with more than 60 electronic health record systems so that clinicians throughout the state can seamlessly receive lab and radiology results and other clinical reports in near real-time.
• Community Health Record – Provides authorized, treating providers with access to a single, longitudinal record of a patient’s treatment history including tests results, care summaries, and encounters. • Notify – Automatically alerts providers and others accountable to a patient’s care when a patient is admitted to or discharged from a hospital or Emergency Department. • Direct, Secure Messages – Helps providers connect and communicate directly, securely—and instantly— to coordinate care and ensure quality outcomes. • Contribute – Allows providers to electronically share Continuity of Care documents through a single connection with other treating providers for transitional care management, extended team coordination and quality improvement. • Referrals – Automates the process of referring patients for medical, behavioral or social services within a community. • Care Coordination and Quality – Provides a platform to bring data together to manage quality metrics and emerging, high or intensive risk cases. Recently, CliniSync has been working with fire department and emergency management services personnel to create a way for them to see patient health records while in transit. The Ohio Health Information Partnership also is exploring ways to use data to assist with the opioid crisis throughout the state, so information can be shared among first responders, social services, behavioral and mental health, public health departments and healthcare organizations. In Central Ohio, the Health Collaborative of Greater Columbus is working with CliniSync to connect social service agencies with medical practices through the CliniSync Referral Tool to help when patients need meals, counseling, transportation and other community services. CliniSync also is emerging as a community data hub, where in-depth data can be used by organizations for analysis and population health. Nurses, care navigators, and physicians can manage patients and spot population health trends through the CliniSync HIE, says Bradley Hillard, DO, senior medical director of University Hospital’s Quality Care Network. “They do a lot of transition of care calls and care management,” he says. Hillard explains: “They will actually know that a patient was discharged from one of the competing health systems here in the city, and they will go onto the HIE to see what has happened with that patient. This really helps with transitions of care. Not only do the care navigators follow up with scheduling visits, they can save the patient money and discomfort by not having to order additional and unnecessary tests and procedures.” CliniSync also has a team who can assist as consultants in quality reporting. With new interoperability measures replacing Meaningful Use 3, requirements have changed. Payment reform and alternative payment models sometimes can be confusing. Check out CliniSync’s data volume
Information Exchanges in the nation. While the organization originated with federal funding in 2009, today it’s financially independent. The Ohio Osteopathic Association is one of its founding members, along with the Ohio Hospital Association, Ohio State Medical Association and Ohio Department of Insurance. While hospitals and health plans sustain its financial health, most services for physicians are free or at a low cost. CliniSync’s data volume keeps growing. The latest statistics, as of October 2018, show that: • More than 1,300 organizations belong to CliniSync. • 5.9 million Community Health Records have been accessed at the point of care during the year. • More than 9.3 million results were delivered year-todate. • 8.3 million hospital and ED admission and discharge notifications were sent. • 4.3 million clinical documents have been published since August 2017. • 60,000 direct messages were exchanged per month. CliniSync also is a vehicle for the exchange of Continuity of Care Cocuments (CCDs) through a solution that allows a physician to directly query a patient and retrieve the document. To date, clinicians made 9.3 million queries, largely so staff could prepare a physician ahead of time for scheduled patient appointments. The CliniSync HIE’s purpose is to make sure health data follows the patient at the point of care, no matter where that patient goes. And conversely, the exchange seeks to make sure that the right data is delivered to the physician at the right place, at the right time. Find Out More www.clinisync.com 614-664-2600 firstname.lastname@example.org
http://eepurl.com/k80sj Sign up for the free monthly newsletter
www.clinisync.com/videos-webinars Listen to recent testimony from University Hospitals of Cleveland leadership
CliniSync is one of the largest and most successful Health
WINTER 2019 ISSUE 11
A nationwide communications campaign designed to engage patients and demonstrate the benefits of primary care is underway thanks to Family Medicine for America’s Health, a collaboration between the eight leading family medicine organizations, including the osteopathic profession.
FMAHealth’s Health is Primary campaign focus is to build a primary care system that reflects the values of family medicine, puts patients at the center of their care, and improves the health of all Americans. The effort uses a variety of communications vehicles to raise awareness: a special website, (healthisprimary.org), videos on a dedicated YouTube channel, social media, t-shirts, public service announcements, magazine and billboard advertising in major markets, posters, city tours, conferences, and more. Now in its fourth year, the campaign offers specific resources for physicians, like patient information sheets as well as monthly toolkits highlighting select topics. Last year, the Health is Primary campaign conducted a national survey that showed 89 percent of Americans said it’s important to have a relationship with a physician who knows their health background and family and medical history. And 86 percent agreed that primary care leads to healthier patients, higher quality health care, and lower costs. Other findings: • 88 percent said it’s important to ensure coverage for preventive and wellness care to keep patients healthy. • 91 percent said it’s important that health care is affordable. • 85 percent said physicians should be paid based on the value of the care they provide and not on the number of procedures they perform. • 88 percent said it should be a priority of the country to ensure access to family and primary care physicians. This year, the campaign and FMAHealth is looking to grow student choice of family medicine with a goal to increase the percentage of allopathic and osteopathic medical students choosing family medicine from 12 percent to 25 percent by the year 2030 (25 x 30). Paul A. Martin, DO, of Dayton, a past president of the American College of Osteopathic Family Physicians (ACOFP) and OOA, has served on the FMAHealth board as secretary/ treasurer since 2014. He said it’s important for the profession to be involved. “As the largest organization representing osteopathic family physician, ACOFP recognized early on that financial participation in this multimillion-dollar media campaign and strategic osteopathic representation on the FMAHealth Board was paramount in raising awareness of the value of primary care and most especially reinforcing the value of osteopathic family medicine in the health care system,” he said. In addition to ACOFP, other FMAHealth partnering organizations include the American Academy of Family Physicians; American Academy of Family Physicians Foundation; American Board of Family Medicine; Association of Departments of Family Medicine; Association of Family Medicine Residency Directors; North American Primary Care Research Group; and Society of Teachers of Family Medicine.
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What Ohio’s new State Plan on Aging means for health care professionals Four-year plan strengthens community partnerships for healthier, more independent older adults By Beverley L. Laubert Director, Ohio Department of Aging There are approximately 2.5 million Ohioans age 60 and older today. They make up about 20 percent of our population and is changing rapidly. According to the Scripps Gerontology Center at Miami University, Ohio’s older adult population is growing more than 20 times faster than our overall population. By 2040, nearly one in three Ohioans will be age 60 or older. These trends present challenges for Ohio and our communities, but they also give us unprecedented opportunities. Our elders play vital roles in their families, our communities and our state. The Ohio Department of Aging is prioritizing strategic and innovative initiatives that empower elders to contribute in meaningful ways. At the same time, we are working to strengthen communities to better anticipate and respond to the needs of their older neighbors and include them in addressing some of the most pressing local issues. As Ohio’s designated state unit on aging by the US Administration for Community Living, the Ohio Department of Aging is required to develop and maintain a state plan on aging. Our plan for 2019-2022 was approved this fall and represents the most expansive and innovative plan in recent history. It stands as a testament of Ohio’s continued commitment to our elders. To execute the plan, we are working with Ohio’s 12 area agencies on aging, senior centers, providers, non-profit organizations, advocacy groups and other partners. The plan is built upon a comprehensive statewide needs assessment that provided a clear perspective of older
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aging in place.
adult needs. We found that the most significant gaps represent basic needs that can interfere with independence and ability to age in place. The plan contains goals, strategies and objectives organized into five primary focus areas: access to information and advocacy services, population health, caregiving, civic engagement, and
Access to information and advocacy services
Finding the right services can be daunting for individuals and their family members. The biggest barriers to access include a lack of awareness of what is available and not knowing where or how to apply for programs. Most older adults rely on family and friends as their main source of information about available programs and services. Ohioans in the baby-boom generation and younger seniors may also seek information from health fairs, telephone hotlines and websites, while those who are older are less likely to seek information about available support at all. Your patients and their families face many issues that impact their health and their ability to access treatment. For example, a patient may not have transportation to appointments or may not be able to afford the tests, treatments and medications prescribed. You and your staff probably get questions about an array of older adult
concerns and needs, which is why you should be very familiar with your area agency on aging. Each area agency on aging operates an aging and disability resource network that provides reliable and objective information, assistance and referrals for older adults and their families. Available assistance includes rides to their doctors, reliable home care services, Medicare education and other services. The state plan, in conjunction with region-specific area plans, strengthens these networks and grows meaningful local partnerships. Population health
Nearly four out of five older Ohioans have at least one chronic health condition such as heart disease, cancer, stroke, diabetes and kidney disease, and 45 percent live with two or more. While 95 percent of health care costs for older adults can be attributed to chronic conditions, less than five percent is spent on prevention strategies to improve health and stave off disability. Further, as many as half of all older adults living in the community are malnourished, but relatively few take advantage of programs such as the Supplemental Nutrition Assistance Program and food pantries. Falls and injuries, pain management and substance abuse, vision, hearing, dental health and mental health are also population health concerns that must be addressed to improve the lives and health of older Ohioans. As a health care provider, you understand that healthy lifestyle choices can delay or prevent chronic conditions and can help manage symptoms to lessen disability. Area agencies on aging and other partners offer evidence-based interventions that help older adults prevent chronic disease and reduce and control symptoms that would otherwise lower their quality of life. Free or low-cost programs to manage chronic disease, pain, diabetes and falls risks are
available statewide, as are services to increase access to nutritious food and nutrition education. The state plan improves access to regular dental, vision and hearing screenings and care, and raises awareness of mental health resources and substance abuse and addiction services, especially for older adults with limited incomes. Another concern for older adults is the epidemic of opioid dependence, abuse and misuse. In addition to monitoring the effectiveness of opioids and identifying less risky alternatives, knowing your patients is helpful. For example, an older adult living alone is at greater risk of exploitation, including theft of drugs. An older adult with memory impairment may need support to ensure taking medication as prescribed. The state plan includes partnerships for education, prevention of abuse and exploitation and technology solutions. Dementia is an area of population health that is integrated into the state plan. Dementia significantly impacts an individual’s ability to think independently and apply reason to common situations, which also affects their ability to live independently. Alzheimer’s Disease is the best-known type of dementia and is the sixth leading cause of death in Ohio. Since the leading risk factor for dementia is age, we can expect the number of people living with dementia to grow as Ohio ages. There is strong evidence that people can reduce their risk of a decline in brain health by making key lifestyle changes, including participating in regular physical activity, staying socially engaged, and maintaining good heart health. Finding a cure and more effective treatments for symptoms is important; additionally, hundreds of thousands of older Ohioans struggle with the day-to-day challenges of living with or caring for someone with dementia. Emphasizing care and services empowers people living with dementia by assessing the demand and potential strain on caregivers
While 95 percent of health care costs for older adults can be attributed to chronic conditions, less than five percent is spent on prevention strategies to improve health and stave off disability.
WINTER 2019 ISSUE 15
as they treat the patient in their practices. Area agencies on aging are resources for caregiver education and support. While many states have a stand-alone dementia plan, Ohio has chosen to include dementia strategies in our comprehensive state plan on aging. Infusing brain and cognitive health into overall population health will reduce the stigma of brain failure by educating and empowering Ohioans to learn more about their brains, how their brains play a crucial role in health, and how to have conversations with providers when their brains may not perform optimally. Incorporating dementia strategies into the broader State Plan on Aging allows us to leverage progress in other areas of the plan, such as caregiver support, access to information, aging in place and even civic engagement for a more integrated approach. Caregiving
More older adults are remaining in their homes and communities even as rates of disability are climbing. What makes this possible is the often-unsung contribution of approximately 1.7 million Ohioans who provide unpaid long-term care to older loved ones, friends and neighbors. AARP estimates that the care provided by these informal caregivers is valued at more than $16.5 billion annually. With an aging population, family caregivers are growing more important at the same time they are shrinking in numbers. In 2010, there were seven potential caregivers for each person over 80. By 2030, that ratio will shrink to 4:1. In addition to their caregiving duties, many caregivers hold jobs, with more than two-thirds reporting that they’ve had to adjust their work lives to accommodate their caregiving responsibilities. When older adults have family caregivers who are empowered to help coordinate aspects of their health care and their long-term care needs, they are more able to avoid unnecessary hospitalization and prevent or delay nursing home care. Family caregivers should be considered as a vital part of an older adult’s care team. When they receive support tailored to their needs – care consultation, education and training, counseling, support groups and respite care — both they and the person for whom they care report better health outcomes. The state plan establishes
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State law requires physicians to report suspected elder abuse Effective September 29, 2018, section 5101.63 of the Ohio Revised Code specifies that physicians— along with chiropractors, nurses, EMTs, social workers, and others who have contact with seniors—are mandated to report suspected elder abuse. Elder abuse can include physical, sexual or psychological abuse, as well as neglect, abandonment or financial exploitation. In addition to physical injuries, the following are a few of the possible indicators: missing appointments, appearing frightened or avoiding specific people, changes in mood or temperament, changes in personal hygiene, or being resistant to touch.
a coordinated system to ensure that caregivers, including working caregivers and grandparents in kinship situations, have access to the information, education and services they need. Looking at caregiving from yet another angle, an increasing number of older Ohioans are the primary caregivers to one or more family members under age 18 as they fill gaps caused by a variety of societal factors such as the opioid epidemic that tragically affects families. These families often face unique challenges in accessing available programs and navigating complicated support and legal systems and essential health care. The state plan includes strategies to support older adults in these kinship situations. Civic engagement
Researchers at Brigham Young University found that social isolation increases the risk of premature death by about 30 percent and is as dangerous as smoking 15 cigarettes a day. AARP found that having meaningful
relationships and access to support and resources not only reduces stress and delays or avoids nursing home admission, but also decreases the risk of cognitive decline in older adults. Older volunteers help fill service gaps in the community and benefit from a link between community service and mental and physical health. Further, more older adults are choosing to remain in or return to the workforce after traditional retirement age. Our elders have much to contribute, and part of helping them remain independent and healthy in their communities is providing meaningful opportunities for engagement. However, ageist attitudes and misconceptions about older workers and volunteers persist. The state plan battles these attitudes and improves awareness of the important roles of senior centers, community facilities, wellness programs and volunteer opportunities. Aging in place
Homes that have been the source of safety and security for decades can present challenges to an individual’s independence and access to necessary care. Many factors come together to help support an older adult’s ability and desire to remain safely at home, including the availability of affordable housing, home repairs and modifications, emergency preparedness at home and within the community, transportation options, advance care planning, capacity in the caregiving workforce, availability of care management services and more. Most of your older patients will tell you they want to stay in their own homes and communities as they age. The state plan builds on other agencies’ planning to expand local transportation options and promote interventions that support affordable housing options. The plan also promotes the importance of advance planning for older Ohioans to support their choice to age in place. We also will explore and promote innovative technology to help people
maximize their independence, live safely and facilitate family caregiving. As a health care provider, you are an important partner in the success of Ohio’s State Plan on Aging. Each area agency on aging has a strategic area plan that ties into key goals, strategies and objectives of our state plan. I encourage you to connect with your area agency to learn about local goals and objectives for older adult services and what role you and your practice can play in empowering local elders and strengthening your community’s ability to meet their needs.
Call 1-866-243-5678 to be connected to the agency serving your community and visit www.aging.ohio.gov/stateplan for more information.
WINTER 2019 ISSUE 17
OOA NEWS Ohio Osteopathic Foundation Donors
The list below reflects giving for the period of November 1, 2017, to October 31, 2018. To make a contribution, go to www. OhioDO.org or send your check to OOF, 53 W. Third Avenue, PO Box 8130, Columbus, Ohio 43201. For memorial donations, an acknowledgement of your gift is sent to the family of the deceased. No amounts are mentioned. General Fund Beth H.K. Mulvihill, DO Joseph S. Scheidler, DO Nelson J. Musson, DO, Fund Linda Guipe OOF Memorials In Memory of Donald G. Burns, DO Ohio Osteopathic Association In Memory of Paul R. Gutheil, DO Ohio Osteopathic Association In Memory of Lawrence A. Hennessey, DO Ohio Osteopathic Association In Memory of Carl F. Hoyng, DO Ohio Osteopathic Association In Memory of Ross W. Kingsley, DO Ohio Osteopathic Association In Memory of Robert J. Kromer, DO Ohio Osteopathic Association In Memory of Carl L. Neufeld, DO Ohio Osteopathic Association In Memory of Kevin Olson, DO Ohio Osteopathic Association In Memory of George Q. Seese III, DO Ohio Osteopathic Association In Memory of Charles A. Slagle, DO Ohio Osteopathic Association In Memory of Edward M. Slowik, DO Ohio Osteopathic Association In Memory of Tony D. Starr, DO Ohio Osteopathic Association Amy G. Tunanidas, DO Arthur S. Ulatowski, DO In Memory of Donald E. Waite, DO Ohio Osteopathic Association
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In Memory of Frank A. Wendling, DO Ohio Osteopathic Association Ohio Osteopathic Political Action Committee Contributors
The following is based on contributions from April 15, 2017, to April 20, 2018. OOPAC’s purpose is to support candidates who have demonstrated beliefs in and the principles to which osteopathic medicine is dedicated. The primary goal is to help shape health care policy by educating legislators and explaining how proposed legislation will affect our patients and the communities we serve. A strong PAC helps to open doors and strengthen the osteopathic voice at the Ohio Statehouse. To make a contribution, go to www.OhioDO.org. Governor’s Circle ($1,000 or more) Roberta J. Guibord, DO, Perrysburg Robert S. Juhasz, DO, Concord Township Eugene D. Pogorelec, DO, Massillon Anita M. Steinbergh, DO, Columbus Geraldine N. Urse, DO, Columbus Rotunda Club ($500 to $999) William J. Burke, DO, New Albany Jennifer L. Gwilym, DO, Athens Douglas W. Harley, DO, Fowler Edward E. Hosbach II, DO, Coldwater Charles D. Milligan, DO, Orrville John F. Ramey, DO, Huron Chairman’s Club ($250 to $499) Victor D. Angel, DO, Maineville Barbara A. Bennett, DO, Kettering David A. Bitonte, DO, Uniontown Anthony G. Chila, DO, Athens Mark S. Jeffries, DO, Dayton Isaac J. Kirstein, DO, Pepper Pike Paul A. Martin, DO, Beavercreek Thomas J. Mucci, DO, Poland Dana F. Parsons, DO, Wellington Kelly L. Ramey, DO, Huron M. Terrance Simon, DO, Massillon John F. Uslick, DO, Canton John J. Vargo, DO, North Jackson Patrons (Up to $249) Angela L. Brinkman, DO, Chardon David L. Brown, DO, Dover William D. Bruner, DO, Sandusky Charles H. Curtiss, DO, Warren Jeffrey D. Cushman, DO, Xenia Melinda E. Ford, DO, Athens E. Lee Foster, DO, Cortland David D. Goldberg, DO, Dayton Paige S. Gutheil, DO, Hilliard
Hilary S. Haack, DO, Marietta Thomas H. Henderson, DO, Dayton Jennifer Horvath, Dayton Robert W. Hostoffer Jr., DO, Cleveland Dana M. Kromer, DO, Dublin Kristopher L. Lindbloom, DO, Toledo Christopher T. Marazon, DO, Bidwell Elizabeth L. Myer, DO, Youngstown Luis L. Perez, DO, Huron Daniel J. Raub, DO, Aurora Jean S. Rettos, DO, Athens Judith A. Roulier, Sylvania Albert M. Salomon, DO, Gahanna Paul T. Scheatzle, DO, Canton Edward W. Schreck, DO, Athens Richard F. Sulek, DO, Cincinnati Robert J. Thomas, DO, Upper Arlington Naomi F. Wriston, DO, Westerville Welcome New Members!
Ohio Osteopathic Association members pledge to serve as advocates for their patients and subscribe to the mission of maintaining the highest standards of ethical conduct in all phases of medicine and surgery. We applaud these physicians who, over the past year, have joined the OOA, the only statewide organization exclusively dedicated to representing osteopathic physicians. Justin R. Andes, DO OUHCOM-2010 Emergency Medicine Stark County - Akron/Canton District Jacob A. Bair, DO LECOM-2012 Family Practice Trumbull County - Western Reserve District Nicholas T. Barnes, DO OU-HCOM-2015 Family Practice Fulton County - Northwest Ohio District Jed A. Bell, DO NYCOM-2004 Physical Medicine & Rehabilitation Fairfield County - Columbus District Nicholas A. Benner, DO OUHCOM-2010 Dermatology Pickaway County - Columbus District Courtney Deselm Bonner, DO OUHCOM-1996 Internal Medicine Muskingum County - Marietta District Samuel H. Byron, DO PCSOM-2011 Family Practice Montgomery County - Dayton District
Katherine C. Carmichael, DO OUHCOM-2013 Family Practice Medina County - Akron/Canton District
Kenneth L. Reed, DO WVSOM-2002 Gastroenterology Miami County - Dayton District Amber L. Richardson, DO LMU-DCOM-2013 Internal Medicine Clark County - Dayton District
Kevin L. Castillo, DO UNTHSC/TCOM-2011 Gastroenterology Trumbull County - Western Reserve District
Kelly M. Rosborough, DO LECOM/Bradenton-2014 Obstetrics & Gynecology Franklin County - Columbus District
Paul D. Chenowith, DO LECOM-2014 Family Practice Summit County - Akron/Canton District
Benjamin T. Rose, DO KCUMB/COM-2015 Family Practice Montgomery County - Dayton District
Jonathan A. Clifford, DO MWU/CCOM-2014 Family Practice Greene County - Dayton District David A. Delliquadri, DO OUHCOM-2014 Family Practice Trumbull County - Western Reserve District Robin C. Devine, DO OUHCOM-1997 Sports Medicine-Family Practice Franklin County - Columbus District Diana E. Drogalis-Kim, DO PCOM-2010 Pediatric Cardiology Cuyahoga County - Cleveland District Julie Forbush, DO VCOM-2007 Family Practice Franklin County - Columbus District Craig W. Fortman, DO LECOM-2012 Sports Medicine-Family Practice Richland County - Columbus District Alanna M. Fostyk, DO OUHCOM-2012 Plastic & Reconstructive Surgery Cuyahoga County - Cleveland District Mark R. Gazall, DO DMUCOM-1986 General Vascular Surgery Franklin County - Columbus District Nicole M. Goddard, DO WVSOM-2012 Sports Medicine-Family Practice Clinton County - Cincinnati District Scott A. Greenberg, DO PCOM-2012 Obstetrics & Gynecology Cuyahoga County - Cleveland District
Richard S. Scarborough, DO OUHCOM-2013 Pathology Cuyahoga County - Cleveland District Brandy M. Griffith, DO LECOM-2007 Diagnostic Radiology Franklin County - Columbus District Deron J. Hammack, DO WVSOM-2007 Family Practice Lawrence County - Marietta District Deanna S. Holdren, DO OUHCOM-1996 Family Practice Muskingum County - Marietta District Janell D. Ison, DO OUHCOM-2013 Psychiatry Pike County - Columbus District Matthew B. Johnston, DO OUHCOM-2014 Family Practice Pickaway County - Columbus District Kimbra L. Joyce, DO OU-HCOM-2014 Family Practice Greene County - Dayton District Scott B. Kanagy, DO MWU/CCOM-1997 Emergency Medicine Miami County - Dayton District Gregory M. Lam, DO MWU/AZCOM-2003 Gastroenterology Clermont County - Cincinnati District Pallavi R. Mandiga, DO DMUCOM-2013
Family Practice Franklin County - Columbus District Nathan M. Melton, DO OSUCOM-2001 Foot and Ankle Surgery Montgomery County - Dayton District Scott E. Morris, DO LECOM-2014 Family Practice Franklin County - Columbus District Laurel Meteer Nemunaitis, DO LECOM-2014 Emergency Medicine Cuyahoga County - Cleveland District Ryan A. Nemunaitis, DO LECOM-2013 Emergency Medicine Cuyahoga County - Cleveland District Jeremy R. Parsons, DO OUHCOM-2009 Family Practice Ross County - Marietta District Charles E. Pugar, DO OUHCOM-2008 General Vascular Surgery Franklin County - Columbus District Kenneth Douglas Pugar, DO OU-HCOM-2013 Neurology Montgomery County - Dayton District Brandon L. Raudenbush, DO PCOM-2009 Orthopedic Surgery Geauga County - Cleveland District
Chase A. Scarbrough, DO OUHCOM-2012 Dermatology Hancock County - Northwest Ohio District Mikael P. Schilb, DO OUHCOM-2011 Family Practice Fairfield County - Columbus District James C. Schneller, DO KCOM/ATSU-2012 Emergency Medicine Franklin County - Columbus District Laine D. Sommers, DO KCUMB/COM-2014 Family Practice Montgomery County - Dayton District Amanda R. Stover, DO OUHCOM-2011 Family Practice Fairfield County - Columbus District Justin D. Thomas, DO KCUMB/COM-2014 Internal Medicine Montgomery County - Dayton District Tiffany L. Victor, DO OUHCOM-2010 Internal Medicine Mahoning County - Western Reserve District Thomas P. Wolski Jr., DO LECOM-2012 Pediatric Emergency Medicine Summit County - Akron/Canton District
WINTER 2019 ISSUE 19
IN THE KNOW @ Ohio Osteopathic Association
Bill Burke, DO @DrBillDO
We are excited too, but not sure how to treat Kermit’s somatic dysfunction...
Columbus #Osteopathic Association and @OUHCOM-Dublin are teaming up tonight for a mentoring-networking event. (Yes, we’re pretty excited about it. )
Nov. 3, 2018
Your OOA Board of Trustees are hard at work discussing ways to benefit the osteopathic profession and patient care throughout Ohio! — at Ohio University
Call for Abstracts: Deadline is January 31 for the Ohio Osteopathic Symposium Poster Competition & Exhibition. Over $3,000 in cash prizes. OhioDO.org
Physicians who have problems with a managed care plan are encouraged to use the Ohio Department of Medicaid’s online form. medicaid.ohio.gov
David Pugach @DavidPugach
This article is a great description of why so many people seek out physicians who are DOs. A focus on wellness and patient-centered care are foundational principles of the profession. @AOAforDOs What’s It Mean if My Doctor Is a DO?
20 BUCKEYE OSTEOPATHIC PHYSICIAN
Nationwide, more than 6,600 AOA residency positions are now ACGME-accredited. The transition is complete for pediatrics and anesthesiology and nearly complete for seven other specialties. TheDO.osteopathic.org
HAPPY NEW YEAR! The OOA board and staff wish you the best for 2019.
MAKE A DIFFERENCE ON THE U.S. ARMY HEALTH CARE TEAM. As a physician or surgeon on the U.S. Army or Army Reserve health care team, you’ll create and implement treatments of osteopathic techniques to diagnose and treat Soldiers and their family members. You’ll distinguish yourself as a leader in your specialty while working at one of our state-of-the-art facilities. And, if you choose the Army Reserve, you can continue to practice in your community and serve when needed. Whichever you choose, you will play an important role in the treatment and care of our nation’s heroes. To learn more about Army medicine opportunities, visit us at healthcare.goarmy.com or contact your local U.S. Army Recruiting Station.
Buckeye Osteopathic Physician Ohio Osteopathic Association 53 West Third Avenue Columbus, Ohio 43201-0130 www.OhioDO.org ELECTRONIC SERVICE REQUESTED
Here’s to another
On December 31, 1898, a small group of Ohio DOs formed the Ohio Osteopathic Association. What a way to bring in the new year!
A Distinguished Past . . . A Dynamic Future There’s no better way to celebrate the OOA than by renewing your OOA membership!