The Award-winning Journal of the Michigan Osteopathic Association
Summer 2011, Volume 22, Number 2
In Michigan, an emphasis on asking questions, getting answers and inspiring change, puts DOs at the forefront of medical breakthroughs.
In This Issue: • MOA Convention in Pictures & Scientific Research Exhibit Winners • Medical Spotlight: Advances in Orthopedic Surgery, Latest in Joint Replacement • Inside the Physician Payments Sunshine Act • MOA Core Grant: Whole Child, Whole Family, Whole New World
The Award-winning Journal of the Michigan Osteopathic Association
Insights into new technologies and procedures to improve implant longevity and patient outcomes after joint replacement.
Summer 2011, Volume 22, Number 2
Page 12 Advances in Orthopedic Surgery, Latest in Joint Replacement
In Michigan, an emphasis on asking questions, getting answers and inspiring change, puts DOs at the forefront of medical breakthroughs.
Page 28 MOA Announces 2011-12 Board of Trustees Meet MOA’s new board of trustees, approved May 11 at MOA’s annual House of Delegates assembly.
In ThIs Issue: • MOA Convention in Pictures & Scientific Research Exhibit Winners • Medical Spotlight: Advances in Orthopedic Surgery, Latest in Joint Replacement • Inside the Physician Payments Sunshine Act • MOA Core Grant: Whole Child, Whole Family, Whole New World
Page 16 MOA’s Scientific Research Exhibit Competition Winners Circle
Page 30 New Delta Dental Plan Designs Give MOA Members Something to Smile About! Two new plans provide quality benefits at affordable rates but with additional covered services and increased yearly benefit maximums.
A closer look at the state’s premier research event and the people and projects that inspire an entire profession.
Page 32 The Doctors Company Offers Litigation Education Retreats in Michigan
Page 20 2010 Core Grant Recipient: Whole Child, Whole Family, Whole New World
If a claim is made, The Doctors Company expert defense team supports doctors every step of the way.
MOA Core Grant funds an affordable workshop for young families on making healthy lifestyle choices. Page 22 Inside the Physician Payments Sunshine Act Drug/medical device companies are required to report financial relationships with physicians starting January 1, 2012.
departments 7 Editor’s Notebook by Bruce A. Wolf, DO
9 President’s Page by Kurt Anderson, DO
Page 24 MOA’s 112th Annual Postgraduate Convention & Scientific Seminar May 2011 This year’s convention offered nearly 1,100 DOs and physicians-in-training a variety of essential Continuing Medical Education programs, awards ceremonies and forums for information exchange.
11 AMOA News by Pam Kolinski
35 Dean’s Column by William Strampel, DO
41 Practice Manager’s Column by Rob Sawalski
39 Intern Resident Perspective by Gregory Harris, DO
Page 26 DOs Making a Difference
37 MSUCOM Student Perspective
An osteopathic physician tests a drug’s effectiveness against a rare but increasingly more common neurological disease.
45 Last Word
by Michael Joseph Burla, OMS I by Joseph K. Prinsen, OMS VI
TRIAD, Summer 2011 3
The osteopathic profession in Michigan is made up of osteopathic physicians, osteopathic hospitals and an osteopathic medical school. This TRIAD stands together to serve our patients and one another.
Summer 2011; Volume 22, Number 2
TRIAD, the official journal of the Michigan Osteopathic Association, serves Michigan’s osteopathic community, including its osteopathic physicians, hospitals, medical school and patients. The Michigan Osteopathic Association will not accept responsibility for statements made or opinions expressed by any contributor or any article or feature published in TRIAD. The views expressed are those of the writer, and not necessarily official positions of MOA. TRIAD reserves the right to accept or reject advertising. The acceptance of an advertisement from another health institution or practitioner does not indicate an endorsement by MOA. TRIAD (ISSN 1046-4948; USPS 301-150) is published under the direction of the MOA Editorial Committee. The committee develops policies regarding the content, advertising and format of all MOA publications. TRIAD is published quarterly. Periodical postage paid at Okemos, MI 48864 and other post offices. Subscription rate: $50 per year for non-members (includes UPDATE newsletter). All correspondence should be addressed to: Communications Department, Michigan Osteopathic Association, 2445 Woodlake Circle, Okemos, MI 48864. Phone: 517/347-1555 Fax: 517/347-1566 Website: www.mi-osteopathic.org E-mail: email@example.com POSTMASTER: send address changes to TRIAD, 2445 Woodlake Circle, Okemos, MI 48864. ©2011 Michigan Osteopathic Association 4 TRIAD, Summer 2011
TRIAD Staff Editors-in-Chief Draion Burch, D.O. John Sealey, D.O. Managing Editor Andrea Messinger Contributing Editors John Bodell, D.O. Vance Powell, D.O. William Strampel, D.O.
Executive Director Director of Administration Manager of Communications Director, MOA Service Corp. Manager of Membership Advertising Representative Layout and Cover Design
Kris T. Nicholoff Lisa Neufer Ryan Knott Cindy Earles Shelly M. Madden Gretchen Christensen Ellen Weeks, Village Press, Inc.
2011-2012 Michigan Osteopathic Association Board of Trustees
President President-Elect Immediate Past President Secretary-Treasurer
Kurt Anderson, D.O. Edward J. Canfield, D.O. George Sawabini, D.O. Michael D. Weiss, D.O.
Trustees Bruce A. Wolf, D.O. & John Sealey, D.O. Department of Continuing Education Sonbol A. Shahid-Salles, D.O. & Lawrence J. Abramson, D.O. Department of Insurance Donna R. Moyer, D.O. Department of Judiciary and Ethics Lawrence L. Prokop, D.O. & Myral R. Robbins, D.O. Department of Membership George T. Sawabini, D.O. Department of Professional Affairs Jesse A. Park, Student & Robert G. Piccinni, D.O. Department of Public Affairs
by Bruce A. Wolf, DO
hile outside entities and patients seek out evidencebased medicine, many of us still favor traditional techniques that are time tested and accepted as fact. But, times are changing. As the demand for evidence-based treatments
continues to rise along with the number of osteopathic medical schools and branch campuses, so too will opportunities for medical research. As difficult as change may be, embracing an evidence-based philosophy is an opportunity to re-examine our way of practice and develop a new appreciation for what works and what doesn’t. Research started by some of the profession’s pioneers (Fryman, Johnston, Kelso, Korr, Kappler) speaks to the legitimacy of osteopathic medicine as does the way it was conducted – often through teamwork and collaboration. Take Dr. Johnston for example. He worked with others in the field on his research at Michigan State University. Today, on that same campus, students are collaborating on research in their preclinical and clinical years of training, fostering a renewed sense of vitality within our profession. My fervor for promoting evidence-based research stems from an experience I had one summer as a student at the Chicago College of Osteopathic Medicine. Working with Dr. Dennis Paulson, I participated in a research project that involved evaluating sodium pivalate and carnitine with glucose utilization in the heart. Through the work, I earned a small scholarship and the opportunity to
Bruce A. Wolf, DO, is TRIAD co-editor-in-chief and a member of the MOA Board of Trustees. He can be reached at BWolf@dmc.org.
present at an American Osteopathic Association convention. The research was also published. The experience taught me to evaluate data more critically and to take an analytical approach when interpreting research articles – valuable lessons I still use today. m
TRIAD, Summer 2011 7
president’s page by Kurt Anderson, DO
MOA President Kurt C. Anderson, DO, is a private practice family physician and medical director for sports medicine at Central Michigan University. He can be reached at firstname.lastname@example.org.
t is with great honor that I greet you as the 113th president of the Michigan Osteopathic Association (MOA). My goal as president is simple: to inform and guide legislators through an increase in membership activity. My involvement with MOA began nearly 28 years ago when I purchased a family practice in Shepherd. My practice was not located near any osteopathic institution, but my membership in MOA has allowed me to maintain a link with the people who hold the same values and ideals as a physician as I do. Six years ago, knowing I had previously served as president of MAOFP, several MOA board members asked me to increase my involvement with MOA. I sought the nomination to become a board member and have served in multiple capacities on the board. Now I bring this experience to my MOA presidency. Throughout my service to MOA and in my practice, I have come to realize that medicine has become a business, and the business of medicine is changing. Today’s physicians face challenges to our practice rights, to the quality of care we are able to provide and, with the ever-growing popularity of mid-levels in place of physicians, to the integrity of the title “doctor.” Each day, insurance companies challenge our ability to deem what is appropriate for our patients. We are swimming in a sea of rules and regulations which regularly impede our ability to practice medicine with the best interest of our patients in mind. In addition to medical regulators, the hand of the government constantly imple ments new mandates which directly affect our practices. Some of these legislative moves have clear and obvious benefits. Some of them, just as clearly, do not. Many of our legislators have little more medical experience than what they have gained as a patient. However, they are charged with making decisions that affect us all. It stands to reason that if we’re losing ground with regard to practice rights, reimburse ment and scope of practice, it’s because we are not doing our part to educate our local legislators. Six years ago I was asked to increase my activity with MOA. Today, I ask you to do the same. Over the next year, I will attend a meeting of each component society and I invite you to attend, as well. I ask you to give me the opportunity to demonstrate what we are doing about pushing the business of medicine in the right direction. Particularly if you are just paying your dues and are unsure what you are getting from your membership, I invite you to come to just one meeting and find out what opportunities and benefits MOA can offer. In turn, I ask that you consider what impact you can make with a more active level of participation in this, our professional society. We will also invite local legislators to these meetings so we might explain to them the concerns and issues facing today’s physicians. We cannot expect a contingent of uninformed legislators to consider the weight of their lawmaking on our profession if we do not tell them. Let us make this the year that MOA members make known to our patients, our colleagues and our legislators what it means to be a doctor of osteopathic medicine. Let us make this the year they understand we take seriously this business of health and that our success requires the commitment and participation of all. m TRIAD, Summer 2011 9
POH Regional Medical Center combines the holistic heritage of osteopathic medicine with progressive medical education programs and practical patient care experiences. We Offer: n Medical Student Electives in Numerous Specialties and Subspecialties n Traditional Rotating and Specialty Internships n 17 Residency Programs
amoa news by Pam Kolinski
rom participating in professional networking events to planning fundraising parties on your behalf, Advocates for the Michigan Osteopathic Association (AMOA) remains a driving force behind efforts to promote Michigan’s DOs and their health care initiatives. We provide flash drives to incoming Michigan State University College
of Osteopathic Medicine students, donate gift cards and financial support to student, spouse and family groups and raise awareness of initiatives like the International Yellow Ribbon Suicide Prevention program across Michigan and nationwide. To put it simply, our work allows physicians and physicians-in-training more time and energy to focus on the things they do best such as treating patients and medical research. We are the cheerleaders and information-gatherers, the behind-the-scenes laborers and the networking crew for the profession. For years, AMOA has been going about its business, doing what needs to be done. Now it’s time for me to ask Michigan Osteopathic Association (MOA) members — what can AMOA do for you? As you start setting goals for the next 12 months, please consider including AMOA in your plans. We are dedicated to promoting and supporting you, the osteopathic physician, and the profession as a whole. We are proud to be a part of the MOA family and will continue to assist in any way we can. Just, let us know how we can help. To learn more about AMOA and its initiatives, visit us online in the committee section of mi-osteopathic.org or contact me today! I look forward to the next year as it promises to be a great one! m
Pam Kolinski is president of Advocates for the Michigan Osteopathic Association. She can be reached at email@example.com. TRIAD, Summer 2011 11
Advances in Orthopedic Surgery, Latest in Joint Replacement by Jiab Suleiman, DO, MS & Samer Suleiman, MS
oint replacement surgery is one of most common orthopedic surgical procedures performed today. There has been a huge upswing in the number of baby boomers
requiring joint replacement at a younger age. Historically, these patients are not good candidates for joint replacement surgery because artificial joints tend to wear out within 15 to 20 years. This means most patients would outlive their prosthesis, thus requiring more revision surgery. Revision surgery is associated with many more complications than primary surgery. The primary goal of joint replacement surgery is to satisfy the patient by relieving pain and restoring stability, alignment and normal function. The past decade has witnessed many new technologies and procedures aimed at improving implant longevity and patient outcomes following joint replacement. Some have proven to be clinically relevant while others remain controversial. This article reviews some of these advances and their advantages. 12 TRIAD, Summer 2011
There has been a huge upswing in the number of baby boomers requiring joint replacement at a younger age.
Minimally Invasive Surgery This topic relates to using small incisions when performing joint replacement surgery. Historically, joint replacement required large skin incisions 10-18 inches in size depending on the joint (knee vs. hip). In recent years, surgeons have been using smaller incisions with great success. The main premise behind this concept is minimizing skin and deep tissue dissection because it involves less cutting of muscle, tendons and ligaments. Studies show this concept in knee replacement surgery to be quite beneficial. It decreases blood loss and length-of-stay while improving range of motion. Therefore, patients develop less scar tissue and less pain postoperatively. In hip replacement surgery, both incision techniques remain a challenge since small incisions come with a steep learning curve and many complications including alignment issues, increased dislocation and longer procedure times compared to standard incisions. In addition, patient size and body habitus can impact the choice of small incision procedures. In summary, minimally invasive surgery has great advantages in patients with appropriate body mass index and appropriate anatomy. Computer Assisted Navigation The use of computer navigation systems in joint arthroplasty has gained popularity in the past decade. This advanced technology allows surgeons to use computers to provide more accurate data about com ponent placement than is possible with the naked eye. Proponents hoped that the use of navigation will enhance joint alignment and improve procedure
reproducibility in the face of anatomic variations and deformity as well as the imprecision of surgical technique. Lately, navigation has been further expanded to include the use of robotics for specific knee arthroplasty procedures, such as unicompartmental and patellofemoral arthroplasty. The proposition that enhancing alignment improves implant longevity has been disputed by many studies. Furthermore, the use of computers to collect data pre- and intra-operartively is technically more demanding, adding to a surgeon’s operative time. Therefore, while some U.S. centers utilize navigation routinely, it has not been widely adopted by the surgical community. Implant Design Several advances have occurred in implant design since the introduction of joint replacement in the 1940s by Fred Thompson and Austin Moore. At the knee, kinematics has been more difficult to replicate as compared to hip biomechanics. One reason for this discrepancy is based on the need to sacrifice the anterior cruciate ligament at the time of knee replacement in the vast majority of implant designs. Currently, research is underway with several implant manufacturers to develop a bicruciate retaining knee prosthesis that would better reproduce normal knee kinematics, allow for better joint proprioception and improve function. Despite enthusiasm surrounding gender-specific total knee implants, these designs never gained popularity given lack of significant clinical benefit. Major advances have also been made in the development of polyethylene liners or inserts. TRIAD, Summer 2011 13
In all joint replacement surgery, the main cause of failure is wearing of the polyethylene inserts. Such wear causes the release of particles in the joint that produce a phenomenon known as osteolysis or loosening of the metal components. Currently, liners and inserts used in joint replacement are made of ultra-high molecularweight polyethylene. Such polyethylene has the best and most extreme durability. Alternative bearing surfaces have also gained acceptance in the field of hip replacement. Ceramics and metal-on-metal bearings are of particular importance, especially in young patients. Such bearings have the advantage of less wear, prolonging the life of hip implant in younger patients. However, these implants have inherent problems. Ceramic surfaces are very brittle and prone for breaking which requires extensive revision surgery. Metal-on-metal bearings have come under extensive scrutiny lately due to metal ion release in the blood stream and the long-term effects of such are under intense research and debate. Hip Resurfacing Hip resurfacing — hip replacements that minimize bone resection — involves implanting a cap on the femoral head instead of reaming the femoral canal and
14 TRIAD, Summer 2011
inserting a long stem. The procedure gained popularity in Europe over the past decade then faded away due to many complications and the high rate of revision surgery. In 2006, the Food and Drug Administration approved hip resurfacing in the U.S. This approach has many advantages. Because much of the bone is preserved, a patient can have a repeat traditional hip replacement if the implant wears out. High impact sports and other activities are possible as well. Dislocation rates are much lower in resurfaced hips compared to standard replacements due to the large implant sizes used. Hip resurfacing is not recommended in older patients or women, however, due to weaker bone quality and high risk of failure. Patients with metal sensitivity or kidney disease are not good candidates due to increased metal toxicity from ion released in the blood stream. Another disadvantage is increased risk of fracture following hip resurfacing.
Potential Risks Infection Infection following joint replacement is a dreadful, uncommon complication. There has been a rise in the number of methicillin-resistant staphylococcus aureus cases. Preoperative antibiotic prophylaxis and attention
to improving the external environment in which the surgery is performed has led to a decrease in the overall rate of infection after primary arthroplasty. Current methods to diagnose and treat these infections have also improved. New diagnostic imaging methods have been introduced to diagnose infections. Positron emission tomography and immunoglobulin labeled white blood cells are available to address the low specificity of traditional technetium bone scans. Additionally, a novel route of antibiotic delivery has been developed by which antibiotics are covalently bonded to the prosthesis. Deep Vein Thrombosis Although rare, deep vein thrombosis (DVT) and pulmonary embolism are another main complication of joint arthroplasty. Both are associated with significant morbidity and mortality. The topic of DVT prophylaxis following joint replacement carries extensive variation amongst various centers. In Europe, many centers still use mechanical and chemical prophylaxis - compression devices and aspirin are the gold standard. In the U.S., mechanical devices are used routinely. These include compression stockings and pneumatic devices. Chemical prophylaxis with Coumadin has been the mainstay
treatment for years. Difficulties with international normalized ratio monitoring and continuous need for measurements of blood levels have lead many centers and surgeons to use alternatives. These include Lovenox, a low molecular weight heparin, and Arixtra, a factor Xa inhibitor. Lovenox does not require any monitoring and is used for two to three weeks verses six weeks of Coumadin. However, some studies show Lovenox carries a higher risk of surgical site bleeding and hematoma formation. The much higher cost of Lovenox is also an issue. Recently developed Arixtra is a new class of anticoagulants; it has the same benefits as Lovenox but lacks reversible agents in case of excessive bleeding. m
Jiab Suleiman, DO, MS, is chief of orthopedics at Sinai Grace Hospital. He can be reached at firstname.lastname@example.org.
TRIAD, Summer 2011 15
MOA’s Scientific Research Exhibit
A Spirited Competition to Promote Osteopathic Principals by Andrea Messinger
he 2011 Scientific Research Exhibit Competition show cased 51 outstanding poster projects submitted
by students, residents and physicians from across the state during MOA’s 112th Annual Postgraduate Convention and Scientific Seminar.
“Each year I’m amazed by the increased sophistication of the poster presentations,” said Larry Abramson, DO, a competition judge. “This event represents the very best of what osteo pathic medicine is and confirms that our profession will be in good hands.” The exhibit engages judges and onlookers alike. While some of Michigan’s top medical minds vie for peer recognition and cash prizes, the rest of us admire their work and learn from their findings. For competition judge Anthony Ognjan, DO, studying the poster displays is an educational experi ence that rivals traditional journals or lectures. “I learn so much from visiting each poster. They get better and stronger every year,” he said. Ognjan, Abramson and the seven other judges are not the only people who have a say in the competition. MOA added a peernominated People’s Choice Award to the 2011 list of cash prizes, allowing convention attendees to vote for their favorite projects. Before interviewing exhibitors, judges work in teams of three to evaluate the exhibits based on Contestants cheer as Anthony Ogjan, DO, announces the winning posters and case studies. 16 TRIAD, Summer 2011
criteria in four main scoring categories – setup (background/hypothesis), work (measurement/data collection), analysis (results/medical application) and presentation (effective organi zation/illustration of research). The pro cess for judging case reports follows a similar set of weighted criteria. Participating in the competition also means a shot at the prestigious Andrew Taylor Still Achievement (ANDY) Award and $1,500. Last presented in 2007, the ANDY Award is reserved for ground-breaking osteo pathic research that exemplifies the profession’s founding principles. “It’s the first thing we look for as judges,” Ognjan noted. “You just never know when an ANDY could happen, when someone will show up with an idea so grounded in osteopathic medicine it deserves this award.” While no ANDY was awarded this year, it remains motivation for next year’s contenders. Look for infor mation about the 2012 competition from MOA in January or contact MOA’s Melissa Budd for details at email@example.com.
2011 Scientific Research Exhibit Competition Winners 1 First Place – $1000 m
Evaluation of Limb Alignment, Component Positioning and Function in Primary Total Knee Arthroplasty Using a Pinless Navigation Technique Compared with Conventional Methods. – Brian Keyes, DO, Orthopedic Surgery Resident, St. John Providence Health System
Brian Keyes, DO, takes home first place for his outstanding research on total knee arthroplasty using a pinless navigation technique.
Medical literature had yet to cover Keyes’s topic on orthopedic adult reconstruction when he decided to make it the focus of his research paper for publication during his residency. After more than one year, he submitted his paper to MOA’s contest. “It was an opportunity to hear what independent reviewers would say about my work,” he said. “And prize money is always a plus.” Humbled and appreciative of his first place honor, Keyes is thankful to MOA and its judges for recognizing his efforts. Summary: Complications with pinned total knee navigation systems were concerning enough to warrant development of a pinless navigation system. This study examines component positioning, limb alignment and the early functional range of motion of a pinless image-free computer-assisted navigation system, compar ing it to conventional methods. Contributor: David Markel, MD.
Inspired to assist patients faced with choosing between conflicting mammogram guidelines, Brandon Behjatnia’s, DO, research hit home when a friend was diagnosed with breast cancer in 2010. After winning numerous awards from organizations across the country, Behjatnia submitted his project to MOA. “This was an opportunity to present my research to a large number of students and practicing physicians in Michigan,” said Behjatnia, who hopes his findings are adopted by others to make a difference. “I am so grateful the judges appreciated the importance of this topic.” Summary: In 2009, the U.S. Preventive Services Task Force withdrew its support for screening mammography for women aged 40-49 years. Reviewing results of 3,379 screening mammo graphy in a 24-month period at Oakwood Southshore Medical Center, this study determined the breast cancer detection rates to be 3.8/1000 patients in women 40-49 and 3.9/1000 in women 50-59. These numbers were comparable, concluding breast cancer in women 40-49 can be detected with no difference in rate than in women 50-59 years old. Therefore, women should follow the American Cancer Society and American College of Radiology guidelines for starting screening mammography at age 40. Contributors: Michael Arsenault, DO and John Kish, PhD.
3 Third Place $500 m
Analysis of Cosmesis, Dosimetric End Points and Local Control Using the Contura Multi-Lumen and MammoSite Balloon Catheters for Accelerated Partial Breast Irradiation – Elizabeth Hanlon, DO, Mount Clemens Regional Medical Center
2 Second Place – $750 m
Screening Mammography: Breast Cancer Detection Rate in Women 40-49 Years Old – Brandon A. Behjatnia, DO, MPT, Chief Radiology Resident, Oakwood Southshore Medical Center; Clinical Instructor, Michigan State University
Brandon A. Behjatnia, DO, places second for research on breast cancer detection.
Third place recipient Elizabeth Hanlon, DO, with her research on balloon catheters Recognizing the importance of exploring and sharing the good outcomes discovered at the community hospital cancer center, Elizabeth Hanlon’s, DO, goal was to demonstrate the advances in oncologic management and the accessibility of new treatments to the local community. “I submitted this research for the MOA contest to bring awareness to the medical community about what Mount Clemens Regional Medical Center has to offer in terms of cancer care,” she said. Summary: A retrospective analysis of Mount Clemens Regional Medical Center‘s experience using the Contura MultiLumen and MammoSite balloon catheters to deliver accelerated partial breast irradiation (APBI), this study investigated cosmesis, dosimetric end points and local control, demonstrating APBI provides good local control and good/excellent cosmetic results in early stage breast cancer. Contributors: Mark Yudelev, PhD, Praveen Dalmia, MS, Kaitlin Hanlon, OMS III, Stephen Cahill, DO, Lynn Mathia, DO and Arthur Frazier, MD. TRIAD, Summer 2011 17
4 Outstanding Case Report $250 m
Anomalous Right Coronary Artery: A Case Report of 17-Year-Old Caucasian Female with Shortness of Breath on Exertion and Syncope – Nicholas S. Hoeve, DO, Resident, Metro Health Hospital
“The most interesting aspect of our case was the source of the patient’s symptoms,” said Nicholas Hoeve, DO, who submitted his research in response to the controversy surrounding preparticipation screening for young athletes. Physicians are quick to attribute chest pain, syncope, dyspnea and palpitations while exercising to disease processes such as Hypertrophic Cardiomyopathy, Long QT Syndrome and Brugada Syndrome. However, Hoeve’s research illustrates the importance of considering coronary circulation anomalies, which account for up to 12 percent of sudden cardiac death in young athletes (Smulevitz et al and Von Kodolitsch et al). “I feel very privileged to receive the award for outstanding case report this year given there were so many interesting cases at the competition,” Hoeve said. “It was great to see so many young physicians interested in research as well.” Summary: Sudden cardiac death in young athletes frequently makes news headlines. Studies suggest coronary artery anomalies may account for a number of sports-related deaths. Such patients may experience episodes of syncope or chest pain as experienced by the research subject who was discovered to have an anomalous origin of the right coronary artery. Contributors: Lauren Chung, DO, Resident and Matthew Sevensma, DO.
5 People’s Choice Award $100 m
Assessing Pediatric Anthropometry of Peru – Shane R. Sergent, MSUCOM OMS II, Botsford Hospital
Students with Michigan State University College of Osteo pathic Medicine (MSUCOM) travel annually to Huamachuco, Peru, with faculty supervisors as part of their medical service elective. The trip provides an opportunity for students to give much needed medical attention to the indigent Inca population while examining options for preventative care in a country where poor hygiene, limited nutrition and lack of sanitation abide. “Winning the Peoples’ Choice Award demonstrates the interest and support of our work by the osteopathic community, an immeasurable honor to us,” said Shane Sergent. Sergent and MSUCOM are always looking for physicians to join them in Peru each August; for more information or to get involved, contact Sergent at firstname.lastname@example.org. Summary: The prevalence of overweight and obesity as assessed by the body mass index is increasing in all areas of the world. Using points consistent with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), this study discovered obesity rates in Peru of 17.8 percent (WHO) and 17.5 (CDC) and overweight rates of 31.7 percent (WHO) and 29.4 percent (CDC).
6 Honorable Mention m
Community Acquired Methicilin-Resistant Staphylococcus Aureus Abdominal Abscess in 67-Year-Old Female – Molly Maniscalco, DO, Resident, Mount Clemens Regional Medical Center
Summary: Methicilin-Resistant Staphylococcus Aureus (MRSA) abscesses in the abdominopelvic region are rare in literature. In researching a present case of a 67-year-old female with a MRSA positive abscess, the source was deducted to be likely endovascular. Clinical course and surgical interventions were also presented. Contributors: Tara Nelson, MS-IV, Meri Koski, MS-IV and Anthony Ognjan, DO.
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7 Honorable Mention m
Devic’s Disease: A Case Report of Longitudinally Extensive Transverse Myelitis Presenting as Right Lower Extremity Weakness – Jaskiran Jhajj, DO, Garden City Hospital
Because of the patient’s rare disease and unusual presentation, Jaskiran Jhajj, DO, knew it was important to present at the research competition. “We learned so much from this case and wanted to share it with others,” he said. Summary: Devic’s disease or neuromyelitis optica (NMO) is a rare autoimmune inflammatory disease of the spinal cord and optic nerves. This research examined a longitudinally extensive transverse myelitis with NMO-IgG seropositivity in a 60-year-old female. Despite initial aggressive treatment with IV steroids, the patient failed to respond and her prognosis remains poor. Contributor: Erin
Dedicated to academic excellence in the osteopathic profession, the 2011 Scientific Research Exhibit Compe tition was generously sponsored by several members of the Statewide Campus System: Botsford Hospital, Mount Clemens Regional Medical Center, St. John Health, The Doctors Company, St. Joseph Mercy Hospital Oakland, Henry Ford Macomb and Metro Health System. m Andrea Messinger is communications specialist for Michigan Osteopathic Association. She can be reached at email@example.com.
8 Honorable Mention m Research Mechanism of Injury in a High Ankle Sprain: A Cadaveric Study – Joel M. Post, DO, PGY3 Orthopedic Surgery Resident, Ingham Regional Medical Center
As a PGY3 orthopaedic resident with Ingham Regional Medical Center, Joel Post, DO, had the opportunity to collaborate with researchers at Michigan State University’s orthopedic biomechanics laboratory. He said he submitted his poster to the MOA scientific research contest “because we felt our findings would increase understanding of the mechanism of high ankle sprains.” “We were thrilled to receive an Honorable Mention and hope to submit another poster next year, he added.” Summary: The anterior inferior tibiofibular ligament (ATiFL) is a key structure of the ankle syndesmosis and is often injured in a high ankle sprain. To date, no biomechanical cadaveric study has reported a high incidence of isolated ATiFL tears. A recent simula tion study shows that during external foot rotation eversion plays a critical role in developing strain in the ATiFL. It was hypothesized external rotation of the highly everted foot would generate a high ankle sprain by direct injury to the ATiFL. The six highly everted ankles resulted in isolated injury to the ATiFL. The findings provide a basis for understanding, preventing and treating high ankle sprains in the future. Contributors: Feng Wei, PhD, Jerrod Braman, PhD, Eric Meyer, PhD, John Powell, PhD and Roger Haut, PhD.
TRIAD, Summer 2011 19
Whole Child, Whole Family, Whole New World
avid and Beth Grimshaw used the MOA Core Grant to pilot an affordable, threehour workshop for young families on making healthy lifestyle choices as a household unit. Sparked by a demand from within the community and their personal understanding of osteopathic principals, the workshop empowered family members to align day-to-day practices with their ideal family life. In fall 2010, Dr. David Grimshaw, DO and Lifestyle Educator Beth Grimshaw partnered with Dana Yeomans, PT and Jan Nestell, PT on the first workshop, offering two breakout tracks—one for parents and one for children—and a combined parent-child session. “What the family unit looks like is not crucial but to have all members present and engaged in this process is,” Beth Grimshaw noted. The intergenerational learning aspects of the workshop are most
by Andrea Messinger impactful according to Dr. Grimshaw because as parents watch their children connect with new ideas, children take the information to heart given mom and dad are learning it too.
During the event, family members internalize ways to unify around the intention of healthy living. Together they identify and begin discussing ways to practice improved habits for better nutrition, rest, physical activity and schedules. Each family went home with an extensive resource packet so they could revisit opportunities to manage peacefully and holistically later on. “The grant gave us the opportunity to do some extensive planning and not have to make it so expensive that families couldn’t afford to participate,” Beth Grimshaw said. With the first workshop a success, the Grimshaw’s and their partners are ready to take the show on the road. “We’ve all done our prep time and now we’d like to market it out to parent-teacher organizations, schools and other civic groups,” Beth Grimshaw said.
The workshop title, Whole Child, Whole Family, Whole New World, was inspired by a patient’s comment regarding today’s family planning —“It’s just a whole new world isn’t it”— and a book that influenced the Grimshaw’s as new parents, Whole Child/Whole Parent by Polly Berrien Berends.
20 TRIAD, Summer 2011
The Connection to Osteopathic Medicine c The body (family)—is a unit. The workshop educates
To bring Whole Child, Whole Family, Whole New World to your organization or for details about the project, contact Beth Grimshaw at ph: 517. 281.6149 or firstname.lastname@example.org. m Andrea Messinger is communi cations specialist for Michigan Osteopathic Association. She can be reached at amessinger @mi-osteopathic.org.
on fundamental lifestyle choices involving sleep, diet and movement. “When the environment or family is in sync and together have committed to making lifestyle changes that improve health, the probability for sustained change increases,” said Dr Grimshaw. Breakout sessions for children include Yoga, Tai Chi animals, school stresses and stretches and food fun. Adults focus on bedtime and sleep, vitamins and supplements, the extra sensitive child and sports and extracurricular activities. Parents and children come together at the end of the event to explore family communication and the family dinner. c Structure and function are reciprocally interrelated.
How young families plan and go about their days has a direct impact on the function of family life and ultimately the health of each member of the family. Workshop leaders offer their time and expertise to help parents and kids realign their schedules and family life structure with the improved healthier, more sustainable function that comes when the whole organism (family) is working as one. c The role of the physician is to facilitate healing.
In this case, the physician is the teacher and healing is learning. Just as in spiritual or health practice, the more family members engage in whole-family behaviors, the more self-reflective and self-aware they become. During the work shop, physicians and health care providers share knowledge and facilitate self-exploration, providing direction for the families on the journey to healthier living. “Bringing families together empowers them as individuals, says Beth Grimshaw. “It helps them realize there are other travelers on this way that yearn for a healthier, less stress filled way of being family.” c The body (family) has an inherent capacity to heal
itself. Instead of offering a cookie-cutter way to operate as a unit, the workshop focused on inspiring family members to develop unique ways to make important lifestyle changes. “There’s not really a right way to do family and not even an optimum way because it’s so particular to who you are, your culture, background and what’s going on right now in your life,” said Beth Grimshaw. “We focus on giving parents and children the tools to take their family, customs and ideals they hold most high and lay them on top so they can figure out how to make their family work the best it can given their circumstances.” Through presentations, experiential learning and time for reflection and questions, family members learn to spot opportunities for changes in their everyday family life that will facilitate healing individually, as a family unit and as part of the larger community.
TRIAD, Summer 2011 21
Inside the Physician Payments Sunshine Act by Daniel J. Schulte
tarting January 1, 2012, the Physician Payments Sunshine Act will require, under certain circumstances, drug and medical device manufacturers to publically report gifts, transfers and other payments they make to physicians and teaching hospitals and; ownership and investment interests of physicians and teaching hospitals. Ultimately, this information will
be organized in a database accessible by the public.
The Sunshine Act is part of the Patient Protection and Affordable Care Act (PPACA) of 2009 and was created to allow government officials and the public to examine financial relationships between physicians and teaching hospitals and the pharmaceutical and medical device industries. It was also designed to alleviate concerns of actual or perceived influence that pharmaceutical and medical device manufacturers have on physicians and teaching hospitals.
Reporting Requirements under the Sunshine Act as of January 1, 2012 Payments and Transfers of Value to Physicians or Teaching Hospitals: Any manufacturer of any drug, device, bio logical or medical supply covered under Medicare, Medicaid or Children’s Health Insurance Program (CHIP) that provides a payment or other transfer of value to a physician or teaching hospital must submit the following information to the Department of Health and Human Services (DHS): c Name of the physician or teaching hospital receiving the payment or other transfer of value. c Address and national provider identifier of the physician or teaching hospital receiving the payment or other transfer of value. c Amount of payment or other transfer of value. c Description of the form of the payment or other transfer of value (i.e.: cash, stock, in-kind goods, services, etc.). c Description of the nature of payment or other transfer of value (i.e.: gifts, food, consulting fees, research, travel, entertainment, etc.). c Whether or not the payment or other transfer of value is related to marketing, education or research specific to a certain drug, device or medical supply. 22 TRIAD, Summer 2011
Ownership or Investment Interests of Physicians: With regard to a physician’s ownership or investment interest in a manufacturer of any drug, device, biological or medical supply covered under Medicare, Medicaid or CHIP, the manufacturer must submit the following information to the DHS: c The dollar amount invested by each physician holding such ownership or investment interest in the manufacturer. c The value and terms of each such ownership or investment interest. c Any payment or other transfer of value provided to a physician holding an ownership or investment interest including all of the above referenced categories of information. c Any other information requested by the DHS secretary. Availability of Reported Information to the Public: As noted above, manufacturers must commence recording payments, transfers of value and ownership interests beginning January 1, 2012. This recorded information is to be reported to the DHS by March 31, 2013. Subsequent information is to be recorded and reported on an annual basis. The DHS will make this information available to the general public in a searchable online database no later than September 30, 2013. The database will then be updated June 30 of each subsequent year. When up and running, this online database will be searchable by the name of the physician, the value of the transfers or the type of drug or device for which any payments or transfers relate.
Exemptions from Reporting Requirement: The Physician Payments Sunshine Act contains exemptions that will exclude certain kinds of payments or transfers from the reporting requirements. Such excluded payments or transfers include: c Product samples intended for patient use and not to be sold (though the transfer of such samples are regulated by other PPACA sections which contain similar reporting requirements). c Educational materials intended for patient use that benefit patients. c Items or services provided under contractual warranty. c Transfers to physicians when the physician is a patient, not acting in his/her professional capacity. c Discounts and rebates. c In-kind items used for the provision of charity care. c Dividends or distributions from investments in publically traded securities and mutual funds. c Transfers of value which are less than $10 unless the aggregate amount of all transfers to a physician or teaching hospital during a calendar year exceeds $100. Delayed Reporting: Manufacturers are allowed to delay reporting payments or other transfers of value related to clinical trials or product development until the product has been approved by the U.S. Food and Drug Administration or the passage of four years, whichever is earlier. The purpose of this provision is
to mitigate any harm that might be caused by the forced disclosure of commercial research or clinical trials and to encourage continued participation by physicians and hospitals in such research and clinical trials. Penalties for Failure to Report: A manufacturer’s failure to report payments, transfers of value or the existence of a physician’s ownership interest can result in a civil penalty being imposed on the manufacturer of at least $1,000 for each payment, transfer of value or ownership interest not reported. The maximum penalty that may be imposed is $150,000. If the manufacturer knowingly fails to report a transfer of value or ownership interest, the minimum civil penalty will increase to $10,000 for each payment, transfer of value or ownership interest not reported and the maximum penalty increased to $1,000,000. Preemption of State Laws: The Physician Payment Sunshine Act preempts any state law requiring the recording/reporting of this same information. Michigan has no such law but if it did, the Physician Payment Sunshine Act would have to be followed instead. States, however, remain free to enforce laws requiring the collection of other types of data as well as those that require collection for public health purposes or as part of legal proceedings. m Daniel J. Schulte is an attorney with Kerr, Russell and Weber, PLC. He can be reached at email@example.com.
TRIAD, Summer 2011 23
MOA’s 112 th Annual
OA’s 112th Annual Postgraduate Convention
& Scientific Seminar, May 11-14, 2011, witnessed outstanding attendance and enthusiastic reviews. The event offered a variety of Continuing Medical Education programs, networking forums and opportunities for members to exchange ideas with each other and their
DOs Craig Bethune, Michael Frappier, Jan Gromada and Melvin Linden receive the 30-Years-of-Service Award for continuous commitment to participating in MOA’s House of Delegates assembly.
MOA leaders. m
Stephen Swetech, DO, receives the Unique Physician Award for his outstanding efforts representing the field.
Karen J. Nichols, DO, president of the American Osteopathic Association, speaks to the importance of working together to reach common goals. 24 TRIAD, Summer 2011
MOA business members and medical company representatives showcase health care’s newest products and services in the MOA exhibit hall.
More than 200 students from Michigan State University’s College of Osteopathic Medicine attend MSU Student Campus Day while others participate in MOA’s Intern, Resident and New Physician Program.
& Scientific Seminar May 2011 Newly elected MOA President Kurt Anderson, DO, kicks off his term with an evening of fun and jazz at the President’s Reception.
Outgoing MOA president George Sawabini, DO, offers a year-inreview, commenting on how especially proud he is to have served his colleagues in this capacity. Sawabini is also named a Life Professional Award recipient for his dedication to MOA and the osteopathic physician profession.
Brian Keyes, DO, takes first place in MOA’s Scientific Research Exhibit competition, a spirited tradition drawing 51 entries from physicians, residents and students around the state.
MOA House of Delegates members hear from committee chairs, cheer on award recipients and vote in a new board of trustees.
The Distinguished Service Award goes to Craig Magnatta, DO, FACOFP, for personifying MOA’s mission of serving osteopathic physicians and improving health care. TRIAD, Summer 2011 25
D.O.s Making a Difference Researcher Tests Drug’s Impact on Neurological Disease “This clinical trial is poised to teach the medical community
invaluable lessons concerning this disease. IIH has been treated the same way with no quality evidence for decades. I would love to inform the next IIH patient why they are being prescribed a specific treatment and the chance of success and risk associated with that treatment.
– Eric Eggenberger, DO
by Jason Cody
diopathic intracranial hypertension, known as IIH or pseudo-tumor cerebri, is a neurological disease resulting in increased pressure around the brain, specifically in the absence of a tumor. Symptoms include severe headaches, nausea and double vision, and if left untreated, IIH can lead to vision loss and blindness. Eric Eggenberger, DO, professor and associate chairperson in MSU’s Department of Neurology and Ophthalmology and a member of MSU’s Health Team, is leading a clinical trial to test the ability of a commonly used diuretic known as acetazolamide in reducing or reversing vision loss in patients with IIH. Diuretics are drugs that increase the rate of urination. “While weight loss is always recommended for women suffering from IIH, many other treatments are used to battle the disease by decreasing pressure around the brain,” he said. “The problem is, none of these strategies have been verified by clinical trials, and there is no compelling evidence on which treatments work best and why.”
26 TRIAD, Summer 2011
In addition, he said, more evidence is needed on the potential side effects of drugs such as acetazolamide. Though IIH is rather rare, affecting only 22 out of every 100,000 Americans, its incidence rate is rising in parallel with the obesity epidemic sweeping the nation. The cause of the endocrine-based disease is not known, but it usually affects women of child-bearing age who are overweight or obese. It is rare in post-menopausal women and men of all ages. The clinical trial run by Eggenberger at MSU has three main goals: establish evidence-based treatment strategies to restore and protect vision, follow patients for up to four years to observe long-term treatment outcomes and help determine the cause of IIH. “This clinical trial is poised to teach the medical community invaluable lessons concerning this disease,” Eggenberger said. “IIH has been treated the same way with no quality evidence for decades. I would love to inform the next IIH patient why they are being prescribed a specific treatment and the chance of success and risk associated with that treatment.”
All patients in the trial will receive Web- and phonebased diet information to help subjects lose weight. The study also will randomly assign patients to one of two groups: those receiving acetazolamide and those receiving a placebo. Patients will be monitored for six months to test the impact of the drug. Subjects also will undergo genetic screening, specifically looking at vitamin A and genes that may be risk factors for IIH. That analysis could help researchers with the frustrating task of pinpointing what causes the disease, Eggenberger said.
8 Dr. Eggenberger on medical research: n Research is a way to interact with minds of like interest and provides education and enrichment (and fun!) to those involved. n Research allows us to bring a greater understanding of conditions to the bedside of patients and potentially changes the type of therapies we use, sometimes even redefining the standard of care for a particular disease.
The National Institutes of Health-sponsored study includes about 50 test sites nationwide. For more information on the trial and potential recruitment, call (517) 353-8122. m
Jason Cody is media communications manager for Michigan State University, University Relations. He can be reached at firstname.lastname@example.org.
Symposium for Primary Care Medicine Friday & Saturday November 4-5, 2011 Sheraton Detroit Novi Hotel Novi, Michigan For Physicians Physician Assistants and Nurses: 17.0 Category 1-A AOA CME Credits 17.0 AMA PRA Category 1 Credit(s)™ Specialty Credits Issued: Internal Medicine Family Medicine Featuring Hands-On Joint Injection Workshop
n Research allows us the opportunity to help distant patients outside our clinic – patients we may never meet – by helping come up with novel effective and safe therapies. n Research and education are often inseparable, and among the most enjoyable parts of being a physician.
For Information & Registration
Please call: or visit: http://www.botsford.org/physicians/ TRIAD, Summer 2011 27
MOA Announces 2011-12 Board of Trustees
Kurt C. Anderson, DO President
ith great applause and much excitement, MOA delegates approved officers for the 2011-12 MOA board of trustees at the association’s 2011 House of Delegates, May 11 in Dearborn. Kurt Anderson, DO, and Edward Canfield, DO, transitioned into new leadership roles as president and president-elect respectively, while the board welcomed three new members: Bruce Wolf, DO, (trustee), Sonbol Shahid-Salles, DO (intern-resident trustee) and Jesse Park, Michigan State University College of Osteopathic Medicine medical student (student doctor trustee). “This will be a very exciting year for Michigan’s osteopathic physicians to move the profession forward
George T. Sawabini, DO FACOFP, D.Ph Immediate Past President, Professional Affairs Dept.
Michael D. Weiss, DO Secretary/Treasurer
Lawrence L. Prokop, DO Donna R. Moyer, DO Trustee, Membership Dept. Trustee, Judiciary/Ethics Co-Chair Department 28 TRIAD, Summer 2011
Edward J. Canfield, DO President-Elect, Internal Affairs Dept.
through advocacy and education,” Anderson said. “In my new role as MOA president, I will focus on maintaining the energy and momentum of the previous board and taking our strategic goals to a new level.” Responsible for overseeing MOA’s internal workings and driving its legislative agenda, members appointed to new posts join Immediate Past President George Sawabini, DO, Executive Director/CEO Kris Nicholoff and the remaining board members: Lawrence Abramson, DO, MPH; Donna Moyer, DO, Robert Piccinini, DO, dFACN; Lawrence Prokop, DO; John Sealey, DO; Myral Robbins, DO, FAAFP, FACOFP and; Michael Weiss, DO, FACOOG. m
Myral R. Robbins, DO FAAFP, FACOFP Trustee, Membership Dept. Co-Chair
Robert G.G. Piccinini, DO, dFACN Trustee, Public Affairs Dept. Co-Chair
Lawrence J. Abramson, DO, MPH Trustee, Insurance Dept. Co-Chair
John W. Sealey, DO Trustee, Continuing Education Department Co-Chair
Bruce A. Wolf, DO Trustee, Continuing Education Dept. Co-Chair
Sonbol A. Shahid-Salles, DO, MPH Intern-Resident Trustee, Insurance Dept. Co-Chair
Jesse A. Park MSUCOM Student Student Doctor Trustee, Public Affairs Dept. Co-Chair
Kris Nicholoff Executive Director/CEO
dean’s column by William Strampel, DO
Success is the stamp of truth. I will say all men who fail to place their feet on the dome of facts do so by not sieving all truth and throwing the faulty to one side. – Andrew Taylor Still
William Strampel, DO, is dean of Michigan State University College of Osteopathic Medicine. He can be reached at Pat.Grauer@hc.msu.edu.
n 1977, Myron S. Magen, MSUCOM’s first dean, rallied the profession to address “the osteopathic short-leg syndrome” – research – in the Louisa Burns Memorial Lecture. His was a clarion call to a profession that had focused itself for nearly a century on good patient care and education. Magen urged all osteopathic physicians to contribute to the scientific body of knowledge so essential to medicine, and to encourage such studies on care that was uniquely osteopathic. Today, three-and-a-half decades later, we in the osteopathic profession in Michigan have done much. At MSUCOM, our scientists have greatly expanded knowledge about the causes of cancer, the etiology of cerebral malaria, treatments for Pompe disease, mechanisms underlying Parkinson’s disease, the pathophysiology of atherosclerosis, the basic biomechanics of human movement and much, more. The credibility of our efforts is reflected in our college retaining its position as the top osteopathic recipient of research funding from the National Institutes of Health. We have also been at the center for educating for research. Our DO-PhD program, the first in the world, has continued to grow in both numbers and stature, and many of its alumni have developed outstanding careers as physician-scientists. But we need to do more. Albert Einstein is reputed to have hung a sign in his office at Princeton University which read: “Not everything that can be counted counts and not everything that counts can be counted.” This is part of the conundrum when we look at research on osteopathic manipulative medicine (OMM). A lot of it can be counted – through electromyography or measurements of range of motion or assessing forces applied or other means. But I would maintain OMM is such an iterative process, requiring a delicate interplay between physician and patient that much more sophisticated technology will have to be developed to capture the dynamics. Even then, we will probably still be left with the “not everything that counts can be counted,” for every physician and every patient will have individual differences, including the emotional and physiological reactions to simply being touched. It may be that new modes or research will be necessary to truly explain such complex events – new ways of knowing and testing and minimizing uncertainties. Osteopathic physicians should be at the forefront of discovering these truths – standing with their feet on the dome of fact and sieving the true from the faulty. As usual, old Will Rogers said it best: “You’ve got to go out on a limb sometimes because that’s where the fruit is.” m TRIAD, Summer 2011 29
New Delta Dental Plan Designs Give MOA Members Something to Smile About!
ichigan Osteopathic Association (MOA) is pleased to announce two new Delta Dental plan options available January 1, 2011. These new plan designs still provide quality benefits at affordable rates but with additional covered services and increased yearly benefit maximums.
Good oral health is essential to good overall health. Having a quality dental benefits plan makes it easy for you to help maintain your oral health and in turn, your general well ness. And because Delta Dental specializes in dental benefits, they can provide the best programs available to keep you, your family and your employees healthy. PLAN A LOW OPTION Delta Dental PPO (Point-of-Service) (Group #7317-1000)
PLAN B HIGH OPTION Delta Dental PPO (Point-of-Service) (Group #7317-2000)
Delta Dental PPO, Premier Delta Dental PPO Delta Dental Premier or Nonparticipating or Nonparticipating
CLASS I Diagnostic Service & Preventive Services
CLASS II Oral Surgery Includes extractions and other surgical dental procedures employed by dentisits 50% 75%
Includes Oral exam, cleanings, floride treatments and space maintainers
Emergency Palliative Treatments Used to temporarily relieve pain Radiographs X-rays, as required and in conjunction with the diagnosis of a specific condition requiring treatments
Sealants (to age 9 on first molars; to age 14 on second molars) Dental sealants to prevent decay of permanent molars
including pre-operative and post operative care
Minor Restorative Services
CLASS III Major Restorative Services 50% 60%
Includes amalgams (silver fillings) and resin restorations, relines, and repairs to prosthetic appliances
Periodontics Procedures employed by dentists to treat diseases of the gums and supporting structures of the teeth
Procedures employed by dentists to treat teeth with diseased or damaged nerves (for example, root canals)
Includes cast restorations (crowns), but only when the teeth can’t be restored with another filling material
CLASS IV Orthodontics Treatment and procedures required for the correction of malposed teeth (to age 19) NA 60%
BENEFIT MAXIMUMS Class I, Class II & Class III, maximum dollar amount the plan pays during a calendar year per person $800 $1,200
Class IV orthodontic care, the plan pays a lifetime maximum for each eligible person of:
Includes procedures for the construction of bridges, partial dentures, and complete dentures, endosteal implants
Not only does Delta Dental’s large network save you money on your out-of-pocket expenses, their network includes more than 93 percent of Michigan dentists and three out of four dentists nationwide. This makes it easy for you to visit a participating dentist anywhere. By visiting a participating dentist, you will save 20 to 30 percent compared to the amount you would pay if you were not enrolled with Delta Dental. In addition to Delta Dentals world-class customer service department, you also have access to the secure, online Consumer Toolkit®, which provides the tools necessary for you to be an informed, responsible dental benefit user. Through the toolkit you are able to monitor your claim activity and keep current with dental wellness information. 30 TRIAD, Summer 2011
PLAN A PLAN B LOW OPTION HIGH OPTION Group #7317-1000 Group #7317-2000
Monthly Rates shown are effective January 1, 2011
The Delta Dental program is a voluntary program. Both plan designs are available EXCLUSIVELY to MOA members and their staff. There is no waiting period for benefits once your enrollment is effective. For more information, contact Julie Watson of Association Benefits at 248-359-6489 or 1-800-782-0712 x167. m
practice manager’s column by Rob Sawalski
Rob Sawalski is ICD-10 Program Communications for Blue Cross Blue Shield of Michigan. He can be reached at email@example.com.
ICD-10: Will You Be Ready?
iagnosis coding for physician offices is going to change. That’s a fact. The success of the change and how it will impact public health reporting for the next several years is up to those in the health care industry. This change comes from a government mandate that all health care entities must use the ICD-10 code set in place of the ICD-9 code set beginning October 1, 2013. That includes diagnosis reporting on claims from physician offices. It’s important to note this change affects diagnosis and inpatient procedure coding but does not impact CPT or HCPCS codes. How Big of a Change is the Transition to ICD-10? Once you begin to dissect the nuances of the ICD-10 code set, it’s clear this transition is more than a standard code update. It represents a fundamental shift in the way the ICD codes are structured and reported. For example, the current ICD-9 code set of around 17,000 codes will increase to more than 150,000 ICD-10 codes. In addition to the number of codes, the way the codes are structured, including the number of characters and positioning of letters and numbers, will change. The code set also has several new features to help provide accurate reporting of conditions and diseases: • Laterality • Combination codes for symptoms and associated conditions • Inclusion of clinical concepts not in ICD-9-CM (such as under-dosing, blood type, blood alcohol level) • Expansion of codes in categories like diabetes, injuries, substance abuse, postoperative complications Essentially, the ICD-10 transition means the way you understand and use the codes today will cease to exist as of the compliance date. Why Make the Change? There are several reasons the government cites for making the transition. Among them are: • The current ICD-9 code set has been in use since the 1970s and is not prepared to accommodate new codes as new diagnoses and procedures are created.
• ICD-10 provides the higher level of detail needed to accurately report all conditions and associated procedures (ICD-10-PCS). • In some cases, ICD-9 terminology is outdated. Medicine is constantly changing and undergoing its own transformation – we need to ensure reporting tools keep pace. 2013 is Closer Than You Think With so many competing priorities, there is a tempta tion to worry about ICD-10 ”tomorrow.” However, given the size and scope of the transition, if you haven’t started to look at the details now is the time to begin. Here are some tips to get you started: • Make sure you and your office are familiar with the new code set and the changes. • Identify where ICD-9 codes currently exist and under stand how the shift from ICD-9 to ICD-10 will affect daily business processes. • Look at documentation standards within the office and see what will need to be done in light of the ICD-10 code set. • Know that your coders will most likely have to attend ICD-10 training, so plan ahead. • Check with vendors, payers and other trading partners to determine if they know about the ICD-10 transition and have started to prepare their businesses. Blue Cross Blue Shield of Michigan Preparedness BCBSM has been working on the transition since 2009. In the summer of 2010, we began talking to our partners (physicians, physician organizations, hospitals, state entities, vendors and other payers) to discuss ICD-10 and what it means to all our stakeholders. As part of our implementation plan, we also started to make our systems ICD-10 compliant and planned for future business process changes and testing opportunities. For more information about the ICD-10 transition in general, go to cms.gov/icd10. For BCBSM-specific information, visit bcbsm.com/icd10. m TRIAD, Summer 2011 31
The Doctors Company Offers Litigation Education Retreats in Michigan by Bill Fleming, Regional Vice President, The Doctors Company/American Physicians
he Doctors Company’s mission is to relentlessly defend, protect and reward physicians. No other insurer is more tenacious or aggressive when it comes to defending your practice, your reputation and your livelihood. The Doctors Company convenes Litigation Education Retreats for our members involved in lawsuits. With our recent acquisition of American Physicians, we have new members in Michigan who will benefit from this opportunity. If a claim is made, our expert defense team supports doctors every step of the way. As a refresher, in Michigan claims begin as a Notice of Intent. The Doctors Company believes in providing the strongest defense possible for each of our member’s cases. From the start we are relentless. We don’t give up. When a member faces a baseless claim, we are untiring in their defense. Should the Notice of Intent turn into a lawsuit, members are then invited to an upcoming meeting. The Litigation Education Retreat is a full day training session for our members and their spouses currently involved in a lawsuit. The purpose is to assist members in becoming the best witness they can be in both the deposition and trial settings. The morning begins with a discussion led by a psychiatrist addressing stress on physicians, their families and their medical practice, caused by the litigation process. The discussion includes some helpful tools that can be used to reduce or alleviate the stress. Next, one of our local leading defense attorneys works with the members to illustrate the process of medical liability litigation. This usually results in exten sive question and answer sessions allowing physicians to explore any of their litigation-related questions. The day continues with perhaps the most interesting segment, led by a jury consultant. This legal specialist
32 TRIAD, Summer 2011
works with physicians to demonstrate how juries react to different types of physical presentation, demeanor and information shared by witnesses. In addition, legal specialists and member claims experts work with members to conduct mock depositions. These depositions allow members to practice and demonstrate what has been learned throughout the day. Again, these tools are provided to help the members to avoid some of the common pitfalls of litigation, help them understand the legal process, their role, and how to work with their counsel to put forth an uncompromising defense to the allegations made against them. The Doctors Company completed 14 Litigation Education Retreats in seven states during 2010 and received overwhelmingly positive responses from the attendees regarding the value they placed on these sessions. Here is some of the feedback we obtained from the evaluations completed after each meeting:
“In 18 years, this is the first such meeting any carrier has invited me to. Good job! ” “You always learn the most from actual cases/mock deposition. This was excellent. Thank you.” “I appreciate that The Doctors Company offered this opportunity to help me prepare and hopefully win my upcoming case. Very good group of speakers.” The first Michigan meeting was held on June 18. In addition to the training outlined, members can earn 6.5 CME credits. m
The Doctors Company/American Physicians is exclusively endorsed by MOA as the medical professional liability insurer of choice for their members. For more information, visit: www.thedoctors.com.
intern-resident perspective by Gregory Harris, DO
A Message from MOA’s Intern-Resident Committee: In addition to becoming medical experts, Michigan residents are trained in manage ment skills, health advocacy, research methodology and professionalism. We look to them to become future leaders in our profession, advocates for their patients, and some become state, national and world leaders in health research. The MOA’s Intern and Resident Committee is a freestanding group of interns and residents who participate in MOA activities and functions. If you are interested in serving on this committee or would like more information, please contact MOA’s Shelly Madden at firstname.lastname@example.org. – Sonbol Shahid-Salles, DO, MPH
esearch aims to contribute unique knowledge to the field of medicine. Clinical research opportunities attract physicians-in-training to medicine and research is a core mission of many residency programs. Curiosity, critical thinking and humanitarianism define the medical profession and are the driving forces behind research. The necessity to perform research seems a simple and integral part of our profession, but why perform research during residency? Previous work demonstrates a structured research curriculum can substantially enhance scholarly success for physicians-in-training and their mentors.1 Hayward and Taweel surveyed alumni of internal medicine residency programs with a research requirement. The results show most alumni felt their research projects were a valuable learning experience. In fact, no other residency program component was rated higher than the research project.1 A similar survey of family medicine residents revealed a greater appreciation for evidence-based medicine among those who had themselves received research training.2 The survey showed that the top three reasons residents worked on research projects were intellectual curiosity (73 percent), career development (60 percent), and to fulfill a mandatory research requirement (32 percent). There are many obstacles to performing research while in residency. The largest barrier is time. Many programs try to assist residents by offering a four-week elective block devoted to research. Although a dedicated research block is helpful, a resident research project usually requires a much greater commitment of time, interest and resources, averaging 12 to 24 months to complete. Josette et al. surveyed residents’ opinions on completing a successful scholarly project and several themes emerged: 1. Start early. 2. Set aside adequate time. 3. Adhere to a timeline. 4. Work with a strong mentor. 5. Choose a research topic that genuinely interests you. 6. Keep the project simple yet innovative. They also found what residents thought their programs could do to effectively facilitate research: 1. Provide adequate amount of protected time. 2. Enhance or establish a research curriculum. 3. Provide encouragement.3 I believe by following these simple steps with the support of the residency program, valuable research can be completed during residency. Performing clinical research is an integral part of the medical residency experience. Such research during residency is valuable and may influence a resident’s ultimate career path by continuing to contribute unique knowledge to the medical field. m
Gregory Harris, DO, is an internal medicine resident with Genesys Regional Medical Center. He can be reached at drgregoryharrisdo @gmail.com.
1 Hayward RA. Taweel F. Data and the internal medicine house officer (alumni’s views of the educational value of
a residency program’s research requirement). J Gen Intern Med. 1993; 8:140–142 2 Smith M. Research in residency (do research curricula impact post-residency practice?). Fam Med. 2005; 37:322–327 3 Josette R. Completing a Scholarly Project during Residency Training. Perspectives of Residents Who Have Been
Successful. Journal of general internal medicine 2005; 20(4):366-9.
TRIAD, Summer 2011 33
Grant Call for Entries
• A pply by S eptember 5 •
Recognizing Commitment to Primary Care and Prevention About Core Grants MOA will award up to three Core Grant recipients each $1,000 in funding to support outstanding primary care and prevention initiatives. These programs — whether an educational event series, research project or patient-centric campaign — illustrate outstanding commitment to the principal tenets of osteopathic medicine. Winners will also be featured in MOA print and Web publications. Core Grants were established by MOA’s Michigan Council of Osteopathic Promotion (MCOP) in 2007. Grant recipients are selected based on their project’s level of need, feasibility, impact and how well it embodies the osteopathic values of preventive health. Eligibility: MOA members and osteopathic students hosting health clinics, fairs, programs or other special projects that embody the osteopathic values of preventive medicine are eligible to apply for an MOA Core Grant. Health clinics/fairs or other projects must occur after the grant application deadline in September 2011.
34 TRIAD, Summer 2011
Application Process: Submit the following materials by September 5, 2011 online or to email@example.com. 1. Application form (at mi-osteopathic.org/awards). 2. Project abstract (100 words or less). 3. Detailed project description (approximately 1,000 words) including: a. How the project embodies the osteopathic values of preventive health care. b. Project goals including purpose, audience, methods and objectives. c. An explanation of why funding assistance from the MOA is needed, how it would help in the implementation of the program and how funds will be used.
Selection Process: Three award winners will be chosen by a panel comprised of wmembers of the MOA MCOP and notified by November 2011. Recipients will be selected based on: 1. Need. 2. Project feasibility (project planning and organization). 3. How well the project embodies the osteopathic values of preventive health care. m
msucom student perspective by Michael Joseph Burla, OMS I
s a student at Michigan State University College of Osteopathic Medicine (MSUCOM), I am surrounded by opportunities to get involved with research. The Student Osteopathic Medical Association (SOMA) has a specific position designed to help its members become involved in research. I am currently the director of research for my SOMA chapter and in this position I have connected my fellow medical students, as well as myself, with faculty members conducting research. MSUCOM has several faculty members involved with research and the opportunities for students to have mentors are numerous.
In addition to domestic research, MSUCOM is leading the way in international research among osteopathic schools. I will be conducting research in Peru this August on a medical mission that has been ongoing for years. Last year, the Peru trip noted an interest in the obesity levels with the children of villages visited.The abstract was published in the Journal of the American Osteopathic Association and the research team’s poster won the People’s Choice Award at MOA’s 2011 Scientific Research Competition. This year’s research will be a continuation of what was done last year to help understand why there is an obesity issue in these regions and what we can do to help. Also, we will be donating medication and treating patients with osteopathic medicine. We aim to help the people of Peru with the osteopathic philosophy in mind and to publish the continuing research. While this trip is very expensive, being a student at MSUCOM has given me access to grants.To fund a portion of my trip, I was awarded the Rossnick Humanitarian Grant and our research is being funding by a grant from the SOMA Research Fellowship Program.
Michael Joseph Burla is a first-year student at Michigan State University College of Osteopathic Medicine and director of research for Student Osteopathic Medical Association-Michigan. He can be reached at firstname.lastname@example.org.
Besides the opportunities MSUCOM has provided, I benefitted from the abundance of clinical research being conducted at Michigan hospitals. Michigan has three major research universities in Michigan State University, University of Michigan, and Wayne State University (WSU), aside from other clinical research being done at independent hospitals. I am at the Detroit Medical Center campus at MSUCOM which puts me in close proximity to Detroit Receiving Hospital, where I have been involved in clinical research projects for the last several years in the emergency department. The research projects are through WSU and they have been a great way to get hands on experience with patients. The projects revolve around hypertension, preclinical cardiac dysfunction, the various confounders for these conditions, and how we can better treat these patients.The most recent project in which I will be involved examines the relationship between vitamin D deficiency and hypertension. I plan on being involved with research throughout my entire medical career; because of the experiences that come with attending MSUCOM and participating in a Michigan residency program, I am well positioned to reach this goal. m TRIAD, Summer 2011 35
Michigan Osteopathic Political Action Committee (MOPAC) 2011 Contributors as of April 27, 2011 The group that’s wildly passionate about supporting legislative activities to promote Michigan’s osteopathic physicians needs your support. Learn more about MOPAC at mi-osteopathic.org.
Michigan Osteopathic Political Action Committee
Governor’s Club ($500-up) Lawrence Abramson, DO Andrew Adair, DO Kurt Anderson, DO William G. Anderson, DO Zac Baker Henry Beckmeyer, DO Donna Benford, DO Craig Bethune, DO Kevin Beyer, DO John Bodell, DO Patrick Botz, DO Paul Brown, Jr, DO Edward Canfield, DO Carolyn Dennis Lori Dillard, DO Karl Emerick, DO Daniel Gibson Joseph Gorz Harold Friedman, DO Brenda Fortunate, DO Ryan Hart, DO Anthony Heidt Khawaja H. Ikram, DO David Jankowski, DO Sophia Johnson Al Juocys, DO John Kazmierski, DO Francis Komara, DO Chad Kovala, DO Ann Kuenker, DO Paul LaCasse, DO Raquel Lepera-DeMaght, DO Edward A. Loniewski, DO Jon Mackey Craig Magnatta, DO Thomas McCurdy, DO William McDevitt, DO Kevin McKinney Max McKinney, DO Joseph McNerney, DO Carol Monson, DO John H. Morrison, Jr, DO Donna Moyer, DO Kris Nicholoff Anthony Ognjan, DO Eugene Oliveri, DO Patrick Pavwoski Gladstone Payton, DO Emily Penn, DO William Penn, DO Carl Matthew Pesta, DO Robert Piccinini, DO Lawrence Prokop, DO Steven Proper
36 TRIAD, Winter 2011
Kenneth Richter, DO Jennifer Rise, DO Audrey Sanders George Sawabini, DO Shane Sergent Sonbol Shahid-Salles, DO Sarah Shook Mark Sikorski, DO Robert Snyder, DO Ryan Spencer Ronald Steury, DO Jeffrey Stevens, DO William Strampel, DO Stephen Swetech, DO Cynthia Trosin, DO Mary Jo Voelpel, DO Kimberly Watson, DO Ann Weaver, DO Larry Wickless, DO Gary Willyerd, DO Bruce Wolf, DO
Senator’s Club ($250-$499) Andrew Adair, DO Jacob Adams Mandip Atwal, DO Brian Beck, DO Patrick Botz, DO Frank Clark, DO Davis Dalton, DO Jeffrey Deweerd, DO William Dunker, DO John Floreno, DO Arthur Frazier, MD Craig Glines, DO Jan Goldberger, DO Mary Goldman, DO Joanne Grzeszak, DO Paul Haduck, DO Adam Hunt, DO Robert Joyce, DO Tara Kisnonsky Carole Kremer, DO Timothy Logan, DO David Makowski, DO Gregory Marcoe, DO Gary Marsiglia, D.O. Craig Meisner Timothy Piontkowski, DO Kathleen Rollinger, DO Katie Rosen Richard Schiappacassee, MD Christopher Shamass Allison Simms Monique Turner
Lawrence Ulmer, DO Douglas Vanator, DO Alyssa Vermeulen Bonita Wang, DO Michael Weiss, DO Barbara Zajdel, DO
Representative’s Club ($100-$249) Linda Adams Charles Alderdice, DO Anastasia Arab, DO William Athens, Sr, DO Archie Attarian, DO Rebecca Bajoka Ann Auburn, DO Michelle Becher, DO Albert Belfie, DO Maurice Belkin, DO Andrew Berry, DO Edna Bick, DO Bernard Billman, DO Randy Bork, DO Matthew Bombard Barry Braver, DO Robert Brengel, DO Kristopher Brenner, DO Gerald Brickner, DO Michael Burla Dorothy Carnegie, DO Christine Chelladurai Frank Clark, DO Laura Clark Brad Clegg, DO Tim Conlon, DO David Cooley, DO Jeffrey DeMoss, DO Brian W. Doughty, D.O. Brandon Fetterolf Joyce Foster-Hartsfield, DO Stephanie Fox Waldo Frankenstein, DO Pat Freeman, DO David Furmanski, DO Anna Gladstone, DO Jonathan Goldsmith, DO Andrew Gordon Glenn Gradis, DO Vincent Granowicz, DO Lawrence Greenberg, DO Dwayne Griffin, DO Thomas Hadad, DO Gregory Harris, DO Brenda Harshman-Plonski, DO Ronald Heitmann, DO Reuben Henderson, DO
Larry Hendricks, DO Isaac J. Hinton Lawrence Holen, DO Susan Horling, DO Howard Hurt, DO Timothy Ismond, DO Michael Jacobson Max Kaiser Katie Kaput David Karr Norman Keller, DO Jeffrey Kiel, DO Kurtis Kieleszewski Matthew Kittle Ron Koehler, DO Joseph Kozlowski, DO Christin Lawrence Edward K Lee, DO Jack Lennox, DO Bruce Lirones, DO Sara Liter-Kuester, DO Paul Liu, DO Carrie Lotenero, DO Patrick McClellan, DO Dana Mandel, DO Norris March, IV, DO Lee Marshall, DO Jacklyn McParlane, DO Floyd Meachum, DO Amy Mertens Andrew Messenger, DO Saroj Misra, DO James Mitton, DO Charles Mok, DO Roger Monsour, DO William Morrone, DO Michael Moutsatson, DO James O’Connor, DO Jesse Park Brandon Peltier, DO Don Pham Michael Popoff, DO Rachel Punke Reza Rahmani, DO Shaun Ramsey Gail Riegle, PhD Katie Rosen Jagneswar Saha, DO Marc Salo Jaroslaw Sawka, DO
Jennifer Schell, DO Ernest Schillinger, DO Charles W Schisler, DO Ann Schreiber Arno Schury, DO Jo Scovel, DO Medina Shaltry, DO Alice Shanaver, DO Janice Shimoda, DO Michael Simms, DO Lynn Squanda Murphy, DO Henry Szelag, DO Donald Spaeth, DO Kyle Thomas Keith Tom, DO Victor Ubom, DO Randi VanOcker John Vargas, DO Sarah Vyskocil, DO Catherine Ward, DO Ronald Weller, DO Greg Wilkerson Kathy Waldron, DO Lewin Wyatt, Jr, DO Jasper Yung Caroline Zohoury, DO
Other Generous Contributors Donald Arlinsky, DO Jerry Bell, DO David Best, DO Barry Bronstein, DO Zoila Denno, DO Kenneth Kobes, DO Ned Krohn, DO Sol Lizerbram, DO Sylvia Mustonen, DO Mark Notman, PhD Arlene Smith, DO Carl Territo Malcolm Williamson, DO
Find MOPAC on Facebook facebook.com/my.mopac
last word by Joseph K. Prinsen, OMS VI
Michigan’s Osteopathic Students Poised to Impact Medicine through Research
Joseph K. Prinsen is national research director for Student Osteopathic Medical Association, a member of the American Osteopathic Association Bureau of Osteopathic Clinical Education and Research, and a sixth-year DO and PhD candidate at Michigan State University. He can be reached at email@example.com.
he Student Osteopathic Medical Association (SOMA) awarded Michigan State University College of Osteopathic Medicine (MSUCOM) the Golden Femur award for the second consecutive year during the American Osteopathic Association’s (AOA) DO Day on the Hill. This award is given annually to the most remarkable SOMA chapter in the country. A key component of this award is the institutional availability and accessibility of research and scholarly opportunities, one of many areas where MSUCOM stands out. The AOA Commission on Osteopathic College Accreditation’s recent addition of standard seven, which addresses research and scholarly activities, is evidence of the commitment to research activities within the osteopathic profession. Well before this standard was mandated, MSUCOM was ahead of the curve, making significant investments in research advancement initiatives. As a result, Michigan is producing DO physicians who are well versed in research methodology and prepared to impact clinical and basic science in the future. I am one of 27 students in the DO-PhD program at MSUCOM who have a long time fascination with research. MSUCOM has maintained active national recruitment of students who are dedicated to research into one of several PhD programs. Currently there are students involved in a broad array of scholarly endeavors including bench research, epidemiology, ethics and anthropology.This forethought on the part of the dean of MSUCOM fills a critical shortage of osteopathic physicians who are highly qualified to both teach and conduct research in basic sciences and medical humanities. In particular they are able to translate and synthesize evidence from the field of basic science and apply that knowledge to answering practical clinical questions. For more than 20 years, this investment has been one way MSUCOM has used research to address the need for innovation within Michigan. Through collaboration with AOA, my division of SOMA recently began a Student Research Fellowship. This competitive award is given to osteopathic students who, through their application, show research promise. I am happy to report three of the five national recipients of this award attend Michigan State University. They are: • Youssef Kousa, DO-PhD Student – MSUCOM • Shane Sergent, OMSIII – MSUCOM • Ivan Alger, OMS II – MSUCOM MSUCOM has been well represented during the national osteopathic research exhibitions. Each August there is a deadline for two abstract competitions. Selected candidates for the National SOMA Research Poster Presentation and the Bureau on International Osteopathic Medical Education and Affairs are invited to present posters or a talk during the Fall AOA Osteopathic Medical Exposition, this year held in Orlando, FL. Since the beginning of my involvement three years ago, Michigan has had a wonderful and regular research presence during this meeting. The future of medicine relies on scientific developments conducted by physicians skilled in research. For that reason, it is important for osteopathic students to be at the forefront of such scientific progress. Michigan has clearly identified student research as a priority. Michigan is poised to continue as a leader in producing high quality osteopathic physician researchers well into the future. I am happy about this commitment by MSUCOM and the support of the Michigan osteopathic community and look forward to a bright future. Further information about the programs I mentioned can be found at StudentDO.com. m TRIAD, Summer 2011 37
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