The Quarterly Publication Of The Ohio Osteopathic Association Fall 2009
President Christopher J. Loyke, DO President-Elect Schield M. Wikas, DO
First Vice President Albert M. Salomon, DO Second Vice President John F. Ramey, DO Treasurer Robert L. Hunter, DO
Immediate Past President Barbara A. Bennett, DO Past President William F. Emlich Jr., DO At-Large Member Sean D. Stiltner, DO OU-COM Dean John A. Brose, DO
OOHA Representative Kathleen A. Rice, RPh, MBA Executive Director Jon F. Wills
District One • Toledo Craig Warren-Marzola, DO District Two • Lima Wayne A. Feister, DO
District Three • Dayton Jennifer J. Hauler, DO
District Four • Cincinnati Sean D. Stiltner, DO District Five • Sandusky Gilbert S. Bucholz, DO District Six • Columbus Geraldine N. Urse, DO
District Seven • Cleveland Brian A. Kessler, DO
District Eight • Akron/Canton Paul T. Scheatzle, DO District Nine • Marietta William A. Cline, DO
District Ten • Youngstown Vacant District Twelve • Warren John C. Baker, DO Ohio DME President Gregory P. Bloxdorf, DO
The Quarterly Publication of the Ohio Osteopathic Association Fall 2009 • Volume 79 • Number 2 • USPS 068-760
Director of Accounting and Membership Joanne H. Barnhart
Director of Communications Cheryl Markino Director of Leadership Development Laura Whitt
Administrative Assistant Carol C. Tatman
Buckeye Osteopathic Physician Magazine
Buckeye Osteopathic Physician (08983070) is published quarterly for members of the Ohio Osteopathic Association. Editorial, advertising, publication and circulation offices are located at 53 West Third Avenue, Columbus, Ohio 43201. Telephone 614-299-2107; Fax 614-294-0457; www.ooanet.org. Subscription price for non-members is $25 per year. Periodicals postage paid at Columbus, Ohio. Postmaster: Send address changes to Buckeye Osteopathic Physician, PO Box 8130, Columbus, Ohio 43201. Editor Cheryl Markino
Design Director Randy Lynn Witherspoon
Advertisers in This Issue
American Physicians Assurance Corporation First Professionals Insurance Company Novo Nordisk Professional Solutions Insurance Company
President’s Message . . . . . . . . . . . . . . .2 Executive Director’s Report . . . . . . . .3 OOA News . . . . . . . . . . . . . . . . . . . . . . .5 Ohio DOs in the News . . . . . . . . . . . . .7 State Health News . . . . . . . . . . . . . . . .8
Broad & High . . . . . . . . . . . . . . . . . . .10 College News . . . . . . . . . . . . . . . . . . . .12 Hospital Zone . . . . . . . . . . . . . . . . . . .14 AOA & Around the Country . . . . . .16 Washington Watch . . . . . . . . . . . . . . .18 AOOA Bulletin . . . . . . . . . . . . . . . . . .20
On the Cover
The State Road covered bridge in Ashtabula County was built in 1983. The 152 ft. one-lane bridge spans the Conneaut Creek. PHOTO CREDIT: R. WITHERSPOON
Resident Representative Lili A. Lustig, DO
OU-COM Student Council President Lauren M. Fuller, OMS II
Buckeye Osteopathic Physician • Page 3
A Fresh Perspective by Christopher J. Loyke, DO September 19, 2009, 11:55 pm:
Danny’s resting quietly now. Looking out the window of room 476 of Metro General
Hospital I can see the Flats in the distance and watch as Life Flight brings another
patient to the county hospital. Danny is
about two hours post-op from an ORIF of a fracture-dislocation of his left knee. He lies in bed immobilized with a Miami-J collar, dirt and leaves still ground into his thick blond hair…
I wrote those words into a journal at my son’s bedside as I watched him rest post-operatively. He should have been at his high school’s homecoming dance that evening, but for an unfortunate turn of events that would seriously injure him and take the life of his friend. The events of September 19 qualify as a parent’s worst nightmare. I know things could be worse; Danny was still alive and basically intact, but another family is left to mourn the loss of their child. Life can change in an instant and so can one’s perspective. In this case of “change” I would call on people to remember what is important: family, friends, and taking care of each other. On that day Danny was plucked from a field by Life Flight and flown to the county hospital, Metro General, which is considered the “poor” hospital. He was efficiently and professionally cared for by specialists who were on duty even though it was Saturday night. Nobody asked me for my insurance card (sorry Michael Moore) instead they asked me if I needed anything, or had any questions. Within two hours of hitting the trauma bay my son was being operated on by an orthopedic specialist who had his knee back together before midnight.
Page 4 • Buckeye Osteopathic Physician
Keep in mind that throughout our stay nobody was asking for insurance, credit card or other billing information. Nobody knew I was a physician. At that time all three trauma bays were in full motion with other victims. In fact, it wasn’t until after we were discharged that we were contacted for any insurance information and given our billing responsibilities. I have never been on this side of the health care delivery system before and it was an eye-opener for me. Again, perspective changes. Do we need to overhaul our health care system? Not from where I sit. When a serious issue arises with a loved one, trust me when I tell you that your only interest is getting them the best care possible. We currently live in a country where we already have this system in place virtually everywhere. Remember my son was not cared for at the Cleveland Clinic, he was cared for at Metro General Hospital, the county hospital, in one of the poorest cities in the country and his care was outstanding. This hospital provided exactly the care he needed at a critical time where there is little room for error and they, like many other institutions throughout the country, do this 24/7. Now some would have you believe that our country’s health care system ranks 37th in the world (World Health Organization ranking, 2000). I find it interesting to note that Colombia ranks 22nd. Now I really have a hard tome believing that had this accident occurred in Colombia that the outcome for Danny would have been as good. This would all be laughable if those in Washington weren’t actually considering fundamental changes to the one thing that makes this country great – taking care of those who can’t take of themselves. Afterall, isn’t that what a health care system is supposed to do? Isn’t that what a country is supposed to do?
Our system is expensive with many inefficiencies and I think there is a need to improve how the dollars are spent. The system is not perfect and there is room for improvement, but is there anyone out there that doesn’t believe that you get what you pay for? I simply don’t understand how even the most liberal democrat acknowledges that corporate executives need to continue to get million-dollar bonuses because we need the best and the brightest running our nation’s companies and unless we give them top pay, we’re not going to get top people, but they don’t extend this logic into the health care debate as they talk about cutting reimbursement to physicians, nurses, hospitals, etc. I have seen firsthand how our health care system works during the most difficult moment of my life. I’m happy to say I don’t live in Colombia of France or any other country that has a system of providing health care that is ranked better than ours. I’m grateful to be here, in this country, and I’m grateful to have such dedicated health care providers that were readily available when I needed them.
Loyke, a family physician from Cleveland, is OOA president for 2009-2010.
Helping You to Achieve Meaningful Use of Health Information Technology
Researchers have been extolling the benefits of health information technology for more than twenty years, but until recently, the resources haven’t been available to jumpstart the evolution from a paper-based record system to one that is technologically advanced. The US health care industry is the world’s largest, most inefficient information system. It is years behind other industries – like banking, retail and manufacturing – in implementing new technology for cost-saving and efficiency. Most medical records are still stored on paper, leading to poor coordination of care, no method of routinely measuring quality, and no way for consumers to obtain information needed to make informed decisions. The United States trails countries like Sweden, Denmark and the Netherlands in using electronic medical record (EMR) systems; only 15–20 percent of US physicians’ offices and 20–25 percent of hospitals are using them. Barriers to adoption include high costs, lack of certification and standardization, concerns about privacy, and uncertainty over who pays for EMR systems and who profits from them. Experts estimate that effective use of medical records could eventually save more than $81 billion by improving efficiency, enabling disease prevention and management of chronic disease while promoting safety and population health. The health care system, whether we old-timers like it or not, is entering an era of exciting opportunities, but successful HIT implementation will require a willingness to change and huge investments. The HITECH Act On February 17, 2009, President Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act, as part of the stimulus package, also known as the American Recovery and Reinvestment Act (ARRA). The main goal of the HITECH Act is to encourage the adoption of electronic health records (EHRs) through incentive payments to physicians.
According to the Act, physicians are eligible to receive up to $44,000 in total incentives per physician from Medicare for “meaningful use” of a certified EHR starting in 2011. Physicians reimbursed by Medicaid can receive up to approximately $65,000 starting in 2011 based on state-defined guidelines. In March, the federal government announced the first in a series of HITECH priority grant programs to lay the groundwork for widespread electronic health records implementation. In announcing the program, Dr. David Blumenthal, national coordinator for Health Information Technology, said “These programs will offer valuable help to health care providers in the selection and incorporation of EHRs into clinical practice, and for States and their designates to assure that statewide information exchange is developed with an eye toward nationwide connectivity across the health care system.
Ohio Lays Groundwork for Change The state’s 2010-11 biennial budget allocates $8 million in non-General Revenue Funds to the Department of Insurance to support efforts in health information technology. To compete for the HITECH dollars, Gov. Ted Strickland designated a new public-private non-profit organization, called the Ohio Health Information Partnership (OHIP), to lead the implementation of health information technology throughout Ohio. The Department of Insurance is working together with OHIP to oversee the use of this money and the application for federal resources. I am extremely proud that the Governor asked the Ohio Osteopathic Association to be one of a five- member management team forming OHIP. Other partners include the Ohio Hospital Association, Ohio State Medical Association, BioOhio, and Ohio Department of Insurance. Since August, the management team has been working diligently with a cadre of talented state employees to form an
by Jon F. Wills
administrative structure, apply for grants, and develop requests for proposals and other policies to move Ohio’s HIT efforts forward.
OHIP Health Information Exchange OHIP obtained the backing of most statewide health care and physician associations, more than twenty hospital systems and Ohio’s university system, to apply for Ohio’s share of the State Health Information Exchange Cooperative Agreement Program stimulus package. In applying for this grant, OHIP plans to create a sustainable, secure, statewide health information exchange (HIE), offering interoperability between regional and national health information networks to provide access to clinical data and improved, measurable health outcomes for Ohioans. The project will permit easier access to patient information for authorized users; more complete and extensive patient histories; a reduction in the amount of redundant tests ordered; a reduction in the amount of adverse drug interactions; an overall decrease in the cost of health care across the state; increased levels of rural adoption of EMRs; the creation of a population health data bank utilizing prevalent, de-identified health information; a reduction in Medicare disability determination times; and the creation of new ancillary services as a result of the robust network of information and stakeholders.
Wills is executive director of the OOA.
Buckeye Osteopathic Physician • Page 5
OHIP Regional Extension Center Overview The Ohio Health Information Partnership also received approval through the Office of the National Coordinator (ONC) to submit a second grant application to serve as the statewide regional extension center (REC) for Ohio. Objectives are: • To integrate and synchronize adoption activities with the statewide health information exchange; • To coordinate a statewide strategy that ensures statewide adoption, especially in rural and underserved areas; and • To ensure a consistent level of quality for health information technology support services offered statewide in support of both electronic health record adoption and subsequent use. OHIP is proposing to create regional partnerships with existing entities to provide Ohio’s health care community with the resources necessary to adopt EHRs and achieve meaningful use. These regional partners may include, but are not limited to, hospitals systems, physician groups, quality improvement organizations, universities and community colleges, professional associations, consultants and operational HIEs. To ensure consistent quality, the REC application outlines three levels of achievement: REC program outcomes, provider-specific milestones and meaningful use criteria. At the program level, the Health Information Technology Regional Center (HITRC) has established the required outcomes that each regional partner must accomplish such as increasing the number of priority primary care providers that are actively using EHRs. On the provider level, the HITRC has articulated the three milestones that every provider must meet such as adopting EHRs, going live with his/her EHR, and meeting the meaningful use requirements of an EHR. Finally, the US Department of Health and Human Services has developed meaningful use criteria that will be required to meet the third milestone established by HITRC. Service Delivery Overview Under OHIP’s proposed regional partnership model, some services will be provided directly by OHIP while Page 6 • Buckeye Osteopathic Physician
other services will be provided through regional partners or delivered through a coordinated effort of both OHIP and the regional partner. Education and Outreach Services. OHIP will be responsible for developing core course materials and online resources to be used by our regional partners consistent with information provided through the HITRC. Regional partners will be responsible for disseminating materials to providers in their regions, providing individual and group training sessions, providing supplemental materials related to the specific needs of their region and making individual provider visits when necessary. National Learning Consortium. OHIP will be responsible for representing Ohio in HITRC events. It will also convey Ohio’s needs and position in federally led efforts. OHIP will collect and disseminate information to regional partners via the education and outreach services as well as through regular communication methods. Vendor Selection & Group Purchasing. OHIP will work with its board members, regional partners and others to structure group-purchasing opportunities. The goal is to identify discounted EHR opportunities through bulk purchasing or existing HIE networks. Implementation and Project Management. Regional partners will be responsible for supplying direct technical assistance and project management services to individual providers working to achieve meaningful use through the implementation of an EHR. Services should include individualized and onsite coaching, troubleshooting, consultation, organizational readiness, IT infrastructure assessments and remediation, software configuration, system optimization and training for all staff. Practice and Workflow Redesign. Regional partners will be responsible for providing direct, hands-on assistance to the providers who would like to achieve EHR meaningful use. These services include redesigning and documenting related clinical and administrative processes and assisting in tailoring functions and policies for clinicians and support staff so that clinical and administrative efficiency can be achieved. Additionally, regional partners will need to ensure each practice is
meeting HHS-defined criteria for meaningful use by payment year, such as: • implementing electronic administrative transactions • utilizing electronic prescribing • participating in electronic laboratory ordering and receipt of results • sharing key clinical data across practice settings • providing patient access to his/her health information • public health reporting • the adoption of policies and practices that protect the privacy and security of personal health information. Functional Interoperability and HIE. OHIP will identify detailed technical and participation requirements for connecting to the statewide HIE. In addition, OHIP will work with any exchange functioning within Ohio to help maintain consistent standards for providers needing to access the statewide exchange through any HIE. The regional partners will assist individual providers through the technical process of connecting to a local HIE or directly to the statewide HIE. Privacy and Security Best Practices. OHIP will publish best practices and share national standards relating to security and privacy. Regional partners will be responsible for ensuring individual providers are aware of and implement these practices and standards. Local Workforce Support. OHIP will help coordinate and establish training for workforce support services at a statewide level in conjunction with the higher education system and other statewide training providers. These services will be available through our regional partners. Regional partners will be responsible for utilizing the statewide services established by OHIP. Additionally, regional partners should work with local organizations to supplement and customize the statewide services. OHIP expects to learn by mid January if its grant applications are funded. With state matching funds, the Partnership’s funding could be as high as $48 million over three years. Yes, these are exciting and challenging times for health care. We look forward to working with you to provide you with the resources needed to achieve meaningful use of HIT.
OOA News Convention and Legislative Reception Set for April
The osteopathic profession is teaming up next year to host the Ohio Osteopathic Symposium, a unified Convention and CME conference sponsored by the Ohio Osteopathic Association and Ohio University College of Osteopathic Medicine with participation from the Ohio State Society of the American College of Osteopathic Family Physicians and Ohio Osteopathic Hospital Association. This all-new event will be held April 29-May 2, 2010, at the Columbus Hilton at Easton. This meeting combines and replaces the OOA Annual Convention, usually held in June, and the OU-COM CME Conference & All Class Reunion, usually held in September. A Legislative Reception is being held in conjunction with the conference. All OOA members and all 132 members of the Ohio General Assembly will be invited to the Statehouse Atrium on April 28, 5:00-7:00 pm.
The OOA Board of Trustees met in Athens, November 14-15, 2009. The weekend kicked off with a leadership development seminar with officers of various Ohio University College of Osteopathic Medicine (OU-COM) student organizations. After the program, all first and second year students joined the Board for a study break reception. During the OOA Board business meeting the following morning, trustees took the following actions: • Approved 14 new members, and placed those who have not paid 2009-10 dues on the inactive list. • Reviewed the current status of state budget issues and pending legislation, voting to continue to oppose HB 206 (APN Schedule II Prescribing) unless further amended; continue to oppose HB 267 (Ohio Prescription Program) requiring all physicians to buy tamper-proof prescription pads through the Ohio Board of Pharmacy; support HB 185 (Unilateral Contract Changes),
which has passed the House and is pending in the Senate; and oppose the APNs’ attempt to include nurseled medical home projects in HB 198 (Medical Home). • Reviewed the status of the 2009 Ohio Osteopathic Political Action Committee challenge and voted to endorse the candidacy of Terry Johnson, DO, who is running for the Republican nominee for State Representative in the 89th House District. If elected, he would be the first DO to ever serve in the Ohio General Assembly. • Approved the OOA’s participation in a third amicus appearance before the Ohio Supreme Court in reference to Rule 15(D). Although it was apparent in the case that the medical record clearly showed that one physician defendant participated in the decedent’s care, he was not added to the suit until after the twoyear statute of limitations occurred. The OOA, OSMA, and OHA will argue there was ample time to name him within the time period. The associations are particularly concerned because the plaintiff-appellee specifically states in the merit brief the OHA, OSMA, OOA and Ohio
Insurance Institute did not file an amicus brief and their silence refutes the physician defendant’s argument that the case creates “dangerous precedent in malpractice cases.” • Discussed an invitation to send ten OOA members to an educational event, April 15, designed to educate about the Ohio National Guard and the need for physicians to participate as TRICARE providers to treat military families in their districts. The program will include an opportunity to participate in an in-flight air-refueling mission. • Voted to hold OOA elections during the new meeting, in April-May 2010, but to have current OOA President Christopher J. Loyke, DO, represent the profession at the June 2010 commencement activities at OU-COM. • Were briefed on the OOA’s participation in the Healthcare Coverage and Quality Council, Ohio Medical Home Task Force, Availability Web Port pilot project, Ohio Health Information Partnership, and plans for the Medicaid Managed Care carve out. PHOTO CREDIT: L. WHITT
OOA Board members and student leaders from OU-COM attended a True Colors leadership seminar, November 14, at Ohio University in Athens. The OOA sponsored the day-long training session.
Buckeye Osteopathic Physician • Page 7
Ohio Associations Team Up to Preserve Tort Reform
The OOA, Ohio State Medical Association, and Ohio Hospital Association have been monitoring malpractice cases in Ohio’s court system to prevent the erosion of tort reform measures enacted in SB 281 and SB 80. For several years the three associations have made amicus appearances in four Ohio Supreme Court cases, and briefs are currently being prepared in two more. The OOA is taking the lead in Geesaman v. St. Rita’s, which involves the Third District Court of Appeals interpretation of the “Loss of Chance Doctrine.” In Ohio, LCD provides that even if a patient had less than a 50-50 chance of a full recovery at the time of a physician’s negligent act, it is a compensable injury if that negligence deprived the patient of any chance of recovery. The doctrine is usually part of the original malpractice case. In Geesaman v. St. Rita’s the issue before the Court is whether the “loss of chance” or “lost opportunity” doctrine should be expanded beyond its current limited application and, instead, applied to virtually all medical malpractice cases in Ohio. The associations believe it should not and that such an expansion would be a drastic departure from current Ohio negligence law and would wreak havoc on Ohio’s health care industry. The associations are also pointing out that a majority of states have rejected the LCD, even though the Ohio Supreme Court has adopted it as a very narrow exception to traditional “more probable than not causation.” A second case, Jaques v. Manton, challenges whether a jury should be barred from hearing collateral source information about the difference in billed charges and the actual contractual amount paid to the provider. The three associations believe that withholding this information results in overpayments to defendants.
Governor Taps OOA for HIT Non-Profit
Gov. Ted Strickland has asked the Ohio Osteopathic Association, Ohio Hospital Association, Ohio State Medical Association, BioOhio and the Page 8 • Buckeye Osteopathic Physician
Ohio Department of Insurance to form a public-private non-profit foundation to apply for Health Information Technology (HIT) stimulus grants from the federal government to implement an Ohio Health Information Exchange and Statewide Regional Extension Center. The state’s 2010-11 biennial budget allocates $8 million in non-GRF funds to the Ohio Department of Insurance (ODI) to support efforts in health information technology. ODI will work together with the proposed non-profit to oversee the use of this money and the application for federal resources. The five initial members are currently developing a governance structure and budgets, and applying for non-profit tax exempt status. A project team has already applied for two federal grants. OHIP will support the adoption and use of electronic medical records by Ohio’s health care providers. The partnership is charged with implementing and overseeing a statewide health information exchange that will improve access to data and patient information by authorized health care providers while ensuring patient privacy. The partnership will also collaborate with industry experts to provide educational, technical, and procurement services to health care providers who need to implement electronic medical records. The Federal government announced more than $1.2 billion in American Recovery and Reinvestment Act (ARRA) grants for health IT efforts in August. OHIP is currently a subsidiary of BioOhio and has its own independent board. BioOhio is a non-profit that has worked for more than 20 years to build and accelerate bioscience research, industry and education in Ohio.
OOPAC Issues Newsletter
The Ohio Osteopathic Political Action Committee (OOPAC) issued a four-page newsletter in November 2009 which includes a list of contributors, legislative update, recent advocacy efforts, as well as an appeal for contributions. “Political action is a fact of life, whether we like it or not,” said OOPAC Co-Chair Robert S. Juhasz, DO. “State elections have become costly, and without collective resources and a united
voice at the Statehouse, our profession would be overlooked in the decisionmaking process.” Juhasz explained during the past year, the OOA has worked diligently to involve more DOs in the advocacy process. “We have been visible at fundraisers, legislative hearings and in health care reform initiatives, and are helping to shape state health care initiatives,” he said. “As our role increases, we need support from OOA members more than ever.” Co-Chair Robert L. Hunter, DO, noted the osteopathic profession has long been a key player in developing Ohio’s health care policy. He said the leaders of the profession who were responsible for creating the state’s osteopathic hospital system played an active role in state politics. “Because the growth and success of our institutions depended on being actively engaged in the community and watchful in the state legislature, the DOs who founded our hospitals knew the importance of engaging in the political process and helping to support our friends in government by contributing time and money to campaigns,” Hunter said. “We can no longer depend on our hospital leadership to pull the wagon. As individual DOs, we need to open our wallets and contribute generously each year to the Ohio Osteopathic Political Action Committee.” To make a contribution to OOPAC, go to www.ooanet.org or simply call the OOA Central Office at 800-234-4848. The newsletter also included information about Terry Johnson, DO, a family physician who is running for state representative. If elected, he would be the first DO to serve in the Ohio General Assembly.
Congratulations to the Osteopathic Heritage Foundations as they mark 10 years of grantmaking in the osteopathic tradition of caring. Since 1999, the Foundations have approved $110 million designed to improve the health, quality of live and capacity of vulnerable individuals, families and communities in central and southeastern Ohio and to advance osteopathic medicine, medical education and biomedical research nationally.
Ohio DOs in the News Deaths in the Family
OOA Life Member Robert L. Bentz, DO, of Lorain, died September 14, 2009, following a brief illness. He was 90 years old. He graduated from Philadelphia College of Osteopathic Medicine. After his internship and residency, he settled in Lorain where he began his practice and served his patients for 40 years. Bentz made house calls and would tell his patients, “Turn on your porch light and I’ll be right there.” Active in his community, he was president of the Firelands Area Council Boy Scouts of America and received many honors from the organization. He also served as Lorain County deputy coroner. Bentz served as a major in the Ohio National Guard Defense Corp and served four years in the US Army Air Corp before entering medical school. Among his survivors are his wife of 65 years, Martha Strosnider Bentz. Contributions may be made in his memory to the New Building Fund of Lorain Lighthouse United Methodist Church, 400 W. 6th Street, Lorain 44052.
Anthony R. Uonelli, DO, of Perry, died October 30, 2009, after suffering a heart attack. He was 80 years old. The family physician earned his DO degree from Kansas City College of Osteopathic Medicine. He was a federal aviation medical examiner for 49 years and served on the medical staff at Richmond Heights Hospital and Mentor Emergicare Clinic. He conducted free physicals for area athletes. A corporal in the US Army, he served during the Korean conflict. Uonelli was a pilot, an avid motorcyclist, and had an affinity for mechanics. Survivors include his wife of 43 years, Elaine J. Uonelli. Memorial contributions may be made to Lake County Humane Society, International Women’s Air & Space Museum, American Heart Association, United States Aviation Museum or Smile Train.
A memorial tribute was held by BalletMet Columbus in honor of Ann Birrer, the wife of Alan S. Birrer, DO. Ann Birrer, who died June 2009, was a strong advocate for the arts and served on the BalletMet Board for 31 years. William J. Burke, DO, director at the OU- COM/Doctors Hospital Family Practice Residency Program, received the Merck/Schering-Plough Residency Program of the Year and Physician of the Year awards for demonstrating excellence in care as a result of their participation in the AOA’s Clinical Assessment Program (CAP). The award was presented, November 1, 2009, at the American Osteopathic Foundation awards ceremony in New Orleans. In October, Burke was recognized at the Ohio University Alumni Awards Gala with the Distinguished Service Award. The honor is given to an alumnus/na each year for outstanding contributions to the university and community. David Drozek, DO, was named Surgery Mentor of the Year by the national Student Osteopathic Surgical Association (SOSA). He is an assistant professor of specialty medicine at Ohio University College of Osteopathic Medicine. Gregory Grant, DO, was named medical director of Fisher-Titus Home Health Center in Sandusky. Paige S. Gutheil Henderson, DO, was named 2009 OU-COM Graduate of the Year (for recent graduates). The honor was presented at the CME Conference & All Class Reunion, held September 2009 at the Columbus Hilton at Easton. Robert L. Hunter, DO, of Beavercreek, is participating in the 16th Health Policy Fellowship class. The program is designed for osteopathic physicians who are preparing for leadership roles in the profession and positions of influence in health policy, and for individuals with a professional connection to the osteopathic profession. Hunter is sponsored by the Ohio Osteopathic Foundation, Grandview Hospital/Foundation, and Care Source Management Group.
Christopher T. Marazon, DO, joined the medical staff at Holzer Medical Center in Gallipolis. Connie J. McCarroll, DO, of Dayton, received a Pfizer “Fit for Life” nutrition award for her work as medical director and founder of the Diabetes and Obesity Wellness Opportunities Program. She received the award, November 1, 2009, during the American Osteopathic Foundation awards ceremony at the AOA’s 114th Annual Osteopathic Medical Conference and Exposition (OMED). Jan E. Saunders, DO, medical director of Dayton Sports Medicine Institute, received a Pfizer “Fit for Life” physical fitness award, November 1, 2009, at the American Osteopathic Foundation awards ceremony in New Orleans. Jeffrey A. Stanley, DO, of Cleveland, was elected as a trustee of The Ohio University Foundation. Established in 1945, the Foundation is responsible for raising, investing and disbursing funds in support of Ohio University’s educational mission. Keith Watson, DO, associate dean and associate professor of surgery at Ohio University College of Osteopathic Medicine, received the 2009 Distinguished Osteopathic Surgeon award from the American College of Osteopathic Surgeons. OOA Board Trustee Geri Urse, DO, of Columbus, participated as the profession’s representative in Say ‘Yes’ to Health Reform, an online campaign showcasing physicians, health care providers, patients, and others voicing support for health reform that prioritizes prevention and wellness. See www.sayyestohealthreform.com for details about the effort. In May, Sharon Witmer, the wife of Gregory P. Bloxdorf, DO, and sister of Larry Witmer, DO, was crowned Mrs. Ohio United States. More recently, she competed at the national event in Las Vegas where she received the Mrs. Photogenic award.
Buckeye Osteopathic Physician • Page 9
State Health News Hindering Health: Insurance Practices Prevent Proper Care by Carl Shapiro, DO
Instead of acting as facilitators to better health, health-insurance representatives oftentimes act as gatekeepers, inhibiting the ability of medical professionals to deliver the care necessary to keep Americans healthy. A tremendous waste of time and effort is spent daily consulting with health-insurance companies about policies while consumer health is put at risk. As a practicing osteopathic physician, my personal frustrations with this phenomenon are far too many to count. Several insurance policies exist that inhibit timely, quality health care. Diagnostic procedures, therapeutics and even some medications require prior authorization from insurance companies before a patient can begin treatment. When my office calls a company for authorization for a certain test or drug, my staff never spends less than 40 to 45 minutes on hold before getting to speak to an insurance representative. There is something inherently wrong with the multiple barriers insurers have created to obstruct patient care and to intrude on the doctor-patient relationship. For example, prescription switching or prescription substitution is becoming commonplace by insurance companies. While less expensive generics or alternate medications seem reasonable, many new drugs have better efficacy, tolerance profiles and simpler dosing regimens making compliance more certain. The work of dealing with insurance company substitutions is inherently counterproductive because compliance is a key factor in disease management and subsequent complications that are often so expensive. Medically managing cardiac disease may seem costly but really is a bargain compared to the cost of an angioplasty, coronary bypass graft, or intensive care unit stay. One can see how these flawed processes are not only time consuming, Page 10 • Buckeye Osteopathic Physician
but counter-productive to controlling costs. Patients endure sub-optimal treatment, while they and their physicians squander valuable energy and resources on administrative matters having little to do with real medical management and patient education. How can medical professionals address patient care in a timely, effective manner in the face of such interference from insurance companies? Managed-Medicaid patients are prime examples of this obstruction. Individuals using this form of Medicaid to financially support their health care expenses feel the brunt of a flawed structure because their access to preferred treatments is hampered more by stringent restrictions than individuals with private insurance. These patients often have multiple medical problems, and timely treatment and continuity are frustrated. The longer an episode of care takes, the more potential there is for dropping the ball clinically or for the likelihood of being forced to repeat tests in order to complete a diagnosis. As a matter of public policy, this is self-defeating for a state-run program designed to deliver indigent care. Similarly, insurance companies should not be credentialing physicians. The only purpose that credentialing accomplishes is to give insurance companies more control and most credentialing occurs because of perceived need by the insurance company with respect to their provider panels, not documented ability and training of physicians in the community. Restricting access to quality care occurs every day throughout the state, and most often this affects our most vulnerable citizens. Though certain insurance practices seem more affordable for patients and insurance companies, cost savings signify nothing if access is frustrated. The reality is that in the United States insurance company profits have steadily risen over the last 10 years while patient access has become more limited by increased copays or third-party regulation. Health care legislation and regulation need to be authorized by the peo-
ple who understand their intricacies most – medical professionals. The ideal health plan is based on ease of access, administration and medical oversight – not insurance oversight. Patient health should be the primary concern, not the bottom lines of insurer’s pocketbooks. Self-serving insurance companies should not obstruct proper health care.
New Multi-Payer Web Portal Unveiled
The Ohio Osteopathic Association, as a part of a statewide initiative between AHIP, the Blue Cross and Blue Shield Association, and eight leading health plans in Ohio, is encouraging OOA members to explore Availity, a multi-payer web portal solution for researching a patient’s eligibility and benefits coverage; managing referrals to specialists; clearing authorizations for treatment; and submitting and reviewing the disposition of claims. “Physicians have been urging the insurance industry for many years to eliminate duplication and simplify transactions for physicians and patients,” said OOA President Christopher J. Loyke, DO. “Since it’s time-consuming and frustrating for physician offices to deal individually with multiple payers who offer a wide variety of plans with different coverage benefits, this online portal will allow offices to work more efficiently.” The Availity health information network and web portal will help physicians achieve administrative savings by simplifying the exchange of information between providers and payers. The Ohio portal initiative is a oneof-a-kind collaborative effort between health plans, medical providers and professional associations to deliver immediate efficiencies and cost savings across the continuum of care. “We are pleased that America’s Health Insurance Plans and the Blue Cross Blue Shield Association are working together to improve patient service and help reduce administrative costs for physicians,” Loyke said. “We hope this project will prove successful and
eventually involve all health care plans in Ohio.” Consistent usage and early adoption of the Availity portal as a savings tool will give Ohio a greater voice in defining best practices in health care administrative processes. Health plans participating in the multi-payer portal include: Aetna, Anthem Blue Cross and Blue Shield, CIGNA, Humana, Medical Mutual of Ohio, UnitedHealthcare, Kaiser Permanente, and WellCare Health Plans, Inc. For more information and to register for the portal, go to www.availity.com.
State Partners with Retailers to Provide Antivirals
The Ohio Department of Health (ODH) has partnered with four large retail pharmacy chains, Giant Eagle, Kroger, Meijer, and Walgreens, to ensure sufficient antiviral medications are available to Ohioans this flu season. ODH will send medication from the state stockpile to these chains as needed to address any shortages in the commercial marketplace. The chains will in turn send medications to stores where supplies are low. Nearly 1.5 million courses of treatment are available; additional courses are available from federal sources, if necessary. “I’m pleased these retailers have agreed to join us in our effort to help Ohioans as the H1N1 virus continues to cause widespread illness,” said ODH Director Alvin Jackson, MD. The four retailers have stores in 70 of Ohio’s 88 counties. In counties where these retailers do not have a presence, the state will continue to work with local health departments to provide antivirals through independent pharmacies. For more information on H1N1 flu, go to www.flu.ohio.gov or call the ODH H1N1 line at 1-866-800-1404.
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Broad & High Legislators Face Difficult Budget Decisions
The current legislative session has been dominated by Ohio’s budget crisis and the nation’s pressing economic issues, leaving most other legislation stalled in committees as a result. Faced with growing state revenue shortfalls and obstacles imposed by the courts, Gov. Ted Strickland dropped plans in late September to raise revenues through the installation and taxing of video lottery terminals (VLT) at race tracks. As an alternative, he proposed delaying the last phase of a fiveyear income tax cut to eliminate a projected $850 million budget gap. The new proposal became necessary when the Ohio Supreme Court ruled that the VLT proposal requires a public referendum. The decision effectively delayed implementation and put the state budget out of balance, making further legislative action necessary. The House, which is controlled by Democrats, responded quickly by introducing HB 318, sponsored by Rep. Vernon Sykes (D-Akron). The bill delays the 4.2 percent income tax reduction, originally scheduled to occur this year, and imposes a 5 percent pay cut for all members of the General Assembly, similar to ones taken by other state employees over the past year. After one week of hearings and a three-hour floor debate, the House approved HB 318 with a 55-44 vote. The Ohio Senate has began hearings on HB 318, but even if senators approve the tax cut delay, another obstacle is still looming: litigation concerning Ohio’s former Tobacco Use Prevention Foundation. The legislature took $230 million from the Foundation’s endowment to balance the budget, prompting the Foundation to file a lawsuit to prevent the seizure of funds. In August, a Franklin County court ruled that Strickland and the legislature acted illegally when they sought to take back the funds. A permanent injunction on the diversion of the funds was issued. The state has appealed the decision.
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Physician Groups Voice Opposition to APN Bill
The OOA submitted written testimony in opposition to HB 206, sponsored by Rep. Barbara Boyd (D-Cleveland). The bill would allow advance practice nurses (APNs) to write for Schedule II drug prescriptions in all settings except retail clinics. The OOA and other physician associations offered an amendment that would limit the authority to seven categories of facilities: hospitals; nursing homes; county homes or county nursing homes; hospice care programs; community mental health facilities; ambulatory surgical facilities; and freestanding birthing centers. Rep. John Patrick Carney (D-Columbus) attempted to introduce the amendment in committee, but it was blocked on procedural grounds. The bill subsequently passed out of committee with only three legislators, including Carney, voting against the measure. The OOA continues to oppose the bill and will send a letter to state representatives once the bill is scheduled for a floor vote.
Medical Home Legislation in the Works
Many health care reformers believe the medical home model is the key to transforming the American health care system. State Rep. Peggy B. Lehner (RKettering) agrees. The Ohio Osteopathic Association is actively involved in interested party meetings on HB 198, which is sponsored by Lehner. The legislation creates a Medical Home Education Demonstration Program that includes 15 practices affiliated with OU-COM and 15 practices each affiliated with NEOUCOM, Wright State and Toledo. The project would be overseen by an Advisory Committee consisting of six members appointed by the Ohio Academy of Family Physicians, two members appointed by the OOA, two appointed by the Ohio Chapter of the American Academy of Pediatrics, and three representatives from state agencies.
A substitute version of the bill is now in its fifth draft. Advance practice nurses have stalled progress on the bill by advocating for the inclusion of “nurse-directed medical homes.” OU-COM Associate Dean for GME Keith Watson, DO, met with Lehner and co-sponsor Peter Ujvagi (D-Toledo), November 12, to discuss issues related to accreditation and CMS funding.
OOA Opposes Rx Pad Legislation
As part of the Ohio Provider Coalition, the OOA sent letters to all members of the Ohio House of Representatives Health Committee to strongly oppose HB 267, sponsored by Rep. Clayton Luckie (D-Dayton). The bill creates the Ohio Official Prescription Program and requires all prescribers to purchase tamper-proof prescription pads with individual identification numbers through the Ohio Board of Pharmacy. All prescribers would be required to pay an annual $250 maintenance fee to obtain the pads. The annual maintenance fee would be adjusted by rule based on actual usage.
New Proposal Addresses Children’s Health
The OOA has endorsed state legislation to combat childhood obesity by requiring students to exercise 30 minutes a day and mandating that schools adopt nutrition standards, implement body fat testing, and increase physical education requirements. Primary co-sponsor Sen. Kevin Coughlin (R-Cuyahoga Falls), chairman of the Senate Health, Human Services & Aging Committee considering SB 210, said the bill draws on a variety of ideas “and puts together a plan that we think is workable in the state of Ohio.” In the Ohio House of Representatives, Rep. John Carney (D-Columbus) is the primary sponsor.
College News OU-COM Dean Highlights Triumphs, Outlines Future by Richard Heck
Despite uncertainty over future state funding, Ohio University College of Osteopathic Medicine Dean Jack Brose, DO, outlined a list of 15 areas of focus for the next year for the Athens medical school during his annual State of the College address in October 2009. After highlighting both the achievements and financial issues faced by the college during the past year, Brose concluded with a list of priorities that will drive the college’s continued success. “It’s been a fantastic year, an exciting year, and a trying year. It’s never been boring,” Brose said. Higher quality and larger numbers of applicants and new students; expansion of the CORE; completion of the Academic & Research Center (ARC); solid research funding and achievements; and continued health care outreach to the Southeastern Ohio community all are positive highlights of OUCOM’s efforts, Brose said. Last year’s 3,444 applicants—a 7.7 percent increase—netted a record number of 120 first-year students this year, the highest in the college’s history, Brose said. Applications for next year are up by 12 percent, double the amount since 2003. The CORE, Brose said, continues to remain vibrant and growing with the addition of three osteopathic colleges: Midwestern University of Arizona, AT Still University of Arizona, and Pikeville College School of Osteopathic Medicine. The creation of a new CORE site in Cincinnati means expansion to the one area of the state where OUCOM has not had a presence. In keeping with the college’s mission, and despite funding cutbacks by the state including elimination of funding for the OU-COM mobile vans for fiscal year 2010, community outreach and health care remain strong. Page 14 • Buckeye Osteopathic Physician
During the past year, 348 patients were treated at the college’s free clinics and the vans traveled more than 11,000 miles. OU-COM’s AmeriCorps group, COMCorps, provided more than 26,000 hours of service. Through the college’s Community Health Programs unit, 6,455 immunizations were given, 408 prenatal program clients were seen, and 327 breast and cervical cancer screenings were provided. As for budgetary issues, Brose noted that in fiscal year 2009 the college saw an 8.8 percent, or $435,000, reduction in state clinical teaching subsidies and a 13.9 percent, or $216,000, reduction in other state funding. In addition, the college’s royalty/endowment investments lost nearly $2 million. Brose warned that further cutbacks are likely, as the state’s next budget relies on one-time federal stimulus funds. “We will be watching the situation carefully, but we have a good ability to adapt to adversity,” he said. Despite the budgetary uncertainty, the upcoming year provides several opportunities as well as challenges. Expanding electronic medical records and technology in the curriculum is “the direction we need to go to be cutting edge,” he said. Brose also said the college must continue promoting diversity among students as well as staff. Fifteen areas of focus for the next year were outlined: 1. Developing more scholarships. 2. Renewing the emphasis on training students for family practice. 3. Building a new clinic and clinical research center. 4. Promoting translational research. 5. Developing community based participatory research. 6. Preparing for additional state budget cuts. 7. Focusing the CORE strategic planning process to position the consortium for continued growth. 8. Advantaging students for the COMLEX exams, especially students at risk. 9. Establishing special relationships with undergraduate programs. 10.Exploring new types of programs
and partnerships with other universities. 11. Focusing on CORE competencies. 12. Developing an underserved populations curriculum. 13.Expanding medical informatics and health exchange. 14.Accelerating computerized testing development. 15.Emphasizing OU-COM’s pride in and support of the university, while communicating the importance of the college’s budget integrity.
Construction Nears Completion on New Research Center by Richard Heck
The new Academic & Research Center (ARC) at Ohio University is nearly complete. Final touches are underway including the installation of carpet, furniture and wall tiles. The State of Ohio has given the building its final approval for occupancy. OU-COM researchers are slated to begin moving into their new ARC offices and labs in December, and personnel from various university departments will tour the building, learn the systems and gain familiarity with the operation of the facility. Outside, passersby can now stroll around the access driveway and turnaround areas to admire stone accents on brickwork and other exterior details. The concrete patio on the building’s north side sports bollards and light poles. Larger trees have been planted, with additional landscaping and seeding to continue through December. “The various contractors have cooperated well,” said Lynnette Bush Clouse, project manager. “It’s been rewarding to see this building evolve over the last 21 months.” The ARC, designed by the architecture firm Burgess & Niple, features 100,000 square feet of state-of-the-art integrated research space, designed to facilitate development of new diagnostics, therapeutics and treatment paradigms, specifically in the areas of diabetes and cancer. The space will enhance collaboration among individu-
PHOTO COURTESY OU-COM
als from the College of Osteopathic Medicine, Russ College of Engineering and Technology, and others. The grand opening ceremony is set for May 8, 2010.
Research Day: From Sunscreen Dangers to Diabetes Care by Nick Piotrowicz
It’s a hot, sunny day with no clouds in sight. But before you race outside, don’t forget to lather on the sun block—right? According to Lisa Martorano, OMS I, award-winning presenter at the eighth annual Ohio University College of Osteopathic Medicine (OU-COM) Research Day held September 18, some sunscreens may actually harm human skin cells. The study, which won the $200 prize in the category of basic science research, examined the effects of zinc oxide-based sunscreens. She worked with Yang Li, Ph.D., associate professor of biomedical sciences, on the project. “Zinc oxide is routinely used in commercial sunscreens because it’s transparent on the skin; however, it can scatter light—but it also absorbs it,” Martorano said. “If it absorbs light, it has potential for cellular aging and cellular damage.” Martorano also noted that such sunscreens release free zinc—a compound harmful to skin cells—into the skin. “When we added UV light, (free zinc levels) nearly doubled,” Martorano said. She is quick to add that most sunscreens are safe to human skin, but it doesn’t hurt to check labels for zinc oxide. Martorano’s project was one of 19 research posters completed by Ohio University students at Research Day. A panel of judges rated the posters based on professionalism, clarity of presentation, ability to answer questions, and readability and visual impact of the posters. Projects were in one of three groups: two for basic science research and one for clinical research. In addition to Martorano’s poster, two other OUCOM student projects won awards. Tara Edwards, OMS II, won the other basic science award for her project on the Coxsackie virus of the pancreas and
The Academic & Research Center (ARC) at Ohio University is nearly complete. The new building is designed to enhance collaboration among individuals from the College of Osteopathic Medicine, Russ College of Engineering and Technology, and others.
its relation to diabetes, and Kim Phan, OMS II, won the clinical research award for her study on continuing glucose monitoring of rural ICU patients. Edwards worked with Jay H. Shubrook, DO, associate professor of Family Medicine, and Phan worked with Kelly McCall, PhD, assistant professor of Specialty Medicine. “I was looking for professional presentations, and I was also looking for how excited they were about what they learned,” said Joe Bianco, PhD, a judge on the panel and a research scientist in OU-COM’s Department of Geriatric Medicine. “Whether the content has significant findings or not, it’s the enthusiasm and doing the research that counts.” In its eight years, Research Day has become a benchmark of OU-COM, Bianco says. “I think the energy and enthusiasm and the resources put forth show that you can really integrate clinical and research.” According to Jessica Wingett, Research Day coordinator and accounting specialist in OU-COM’s Office of Research and Grants, Research Day participants often do go on to present and win research awards at national medical conferences. In other research news, OU-COM faculty members have been awarded $991,049 in the form of six research grants, five of which were awarded by federal health and science agencies.
Several of the grants were funded through the American Recovery and Reinvestment Act (ARRA). Researchers at OU-COM have submitted more grant proposals this year than in prior years; the school has 45 additional proposals under consideration for funding.
New Osteopathic Medical School Set for Mississippi
The William Carey University College of Osteopathic Medicine (WCU-COM), located in Hattiesburg, Mississippi, received provisional accreditation from the Commission on Osteopathic College Accreditation, and will open its doors to students in 2010. Led by founding Dean Michael Murphy, DO, WCU-COM is Mississippi’s second medical school, and the first medical school in the region focusing on osteopathic medicine. The college is now accepting applications through AACOMAS, AACOM’s centralized application service for the nation’s colleges of osteopathic medicine.
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Hospital Zone South Pointe Wound Center Celebrates First Birthday
South Pointe Hospital, a Cleveland Clinic hospital, recently celebrated the one-year anniversary of its state-of-theart Wound Healing Center. The comprehensive center provides chronic wound management in an outpatient setting and features two hyperbaric chambers and boasts the eastside health system’s only transcutaneous oxygen monitoring equipment. Since opening, the center has achieved a 97.2 percent heal rate for all discharged patients. The center has treated 317 patients and currently has 108 active patients. Candidates for treatment include those suffering from diabetic or pressure ulcers, infections, compromised skin grafts and flaps, and wounds that have not healed within 30 days. The center’s hyperbaric oxygen chambers can also be used to treat patients suffering from ailments such as cyanide poisoning, gangrene, carbon monoxide poisoning, brown recluse spider bites and the “bends,” or decompression sickness.
Youngstown Area Health Centers Launch Green Initiative
Humility of Mary Health Partners (HMHP) is working to lessen its impact on the environment with the introduction of a Sharps Management System at all three of its acute care hospitals, including St. Joseph Health Centers By using Bio Systems reusable containers that keep plastic out of landfills, HMHP is increasing its commitment to the environment and reducing its carbon footprint. Each month approximately 5,000 pounds of sharp objects such as needles, syringes, scalpels and blades are used throughout HMHP’s acute care hospitals. Disposable sharps containers end up in landfills. Each reusable container saves the equivalent of 600 disposable containers from going to landfills. Since 1986, US hospitals using the Stericycle Sharps Page 16 • Buckeye Osteopathic Physician
Management System Bio Services reusable containers have kept more than 73 million disposable containers out of landfills. A study by the University of Chicago Hospitals published in JAMA found the American health care sector accounts for 8 percent of the US carbon footprint. The analysis found that hospitals are the largest contributor of carbon emissions in the health care field.
Physician Diversity Program Teams OhioHealth with OU-COM Students
A partnership between OhioHealth and the Ohio University College of Osteopathic Medicine (OU-COM) provides culturally diverse medical students early and sustained exposure to professional practices within the OhioHealth system, including Doctors Hospital. The Physician Diversity Scholars Program matches first-year Hispanic and African-American students with OhioHealth physicians in a series of mentoring activities intended to serve as a gateway to careers with OhioHealth. “This is a forward-thinking initiative that offers unusual educational opportunities for entry-level medical school students and helps OhioHealth better meet the needs of our multicultural community with a more diversified medical staff,” said Bruce Vanderhoff, MD, Chief Medical Officer, OhioHealth. “Our goal is to establish a connection with first-year students from the diverse pool at OU-COM and encourage them to do their residencies with us.” The four-year program requires at least three shadowing, community service or professional organization events per semester during the first two years of medical school, followed by a more customized relationship, as led by the mentors, during their third- and fourthyear clinical rotations, when students must select at least three OhioHealth rotations. OhioHealth pays each of its Scholars a $500 stipend each academic year to
cover expenses. After graduation, each Scholar is offered a loan repayment of $10,000 a year for each year they participate in an OhioHealth residency. Kristin Peoples, a first-year OUCOM student, already has attended two professional conferences and Columbus Osteopathic Association meetings with her mentor, Geraldine Urse, DO. “The loan repayment is a major benefit, but more important to me was the opportunity to gain real-world experience and build a long-term relationship with Dr. Urse, who can help guide me through my career,” said Peoples, 24, a student from Westerville. Of the 15 first-year students eligible for the program, 13 applied and eight were accepted, based on essays they wrote about their career aspirations and commitment to community service. “The response has been overwhelming,” said Colette McLemore, assistant director of Multicultural Programs at OU-COM. “I've never seen a program like this, and students jumped at the chance to participate. These mentors can introduce them to Columbus, give them a feel for what it’s like to be a physician and show them how they can best serve their patients and the community.” Of the nearly one million nonfederal physicians in the United States, two percent are African-American and three percent are Hispanic, according to the Kaiser Family Foundation. Ohio has 755 African-American and 413 Hispanic physicians. Of the 16,139 medical school graduates in 2007, slightly more than 1,000 each were African-American or Hispanic. With 26 percent of its entering students from minority backgrounds, OUCOM exceeds the national average. “One of the reasons OhioHealth came to us was our outstanding minority recruitment,” said John Schriner, OUCOM director of Admissions. “It’s one of the things we pride ourselves on.”
AOA & Around the Country Wickless Addresses Health Care Reform Debate
During the past 11 months, the American Osteopathic Association and the nation have engaged in the ongoing debate regarding reform of the nation’s health care system. This historic debate has invoked strong reactions from physicians nationwide. The AOA received thousands of inquiries from members on the current debate, legislation under consideration, and the AOA policy-making process, priorities for health care reform, and position on several key issues. In addition the Department of Government Relations in Washington, DC, responded to more than 20,000 inquiries both pro and con reform, since January. To keep physicians informed, the profession has hosted five town hall meetings, two in-person and three virtual, and made communication with Congress and the Administration public via www.DO-Online.org. In a letter to the entire osteopathic family, AOA President Larry A. Wickless, DO, detailed the AOA’s concerns regarding health system reform and discussed efforts to work with lawmakers to create legislation that will ensure access to affordable health coverage for all Americans and fundamentally reform the nation’s health care delivery system. In his six-page letter, Wickless outlined the profession’s five priorities for reform: 1. Ensure Access to Affordable Health Coverage for all Americans 2. Fundamentally Reform the Delivery System – Beginning with Long-Term Reforms of Physician Payment Methodologies 3. Grow the Physician Workforce to Meet Demand and Promote Primary Care and General Surgery 5. Promote Individual Investment in Health Through Prevention, Wellness, and Public Health 5. Create an Equitable Health Care Financing Infrastructure that Promotes Quality and Reduces the Impact of Current Tort Laws Page 18 • Buckeye Osteopathic Physician
Profession Conducts Successful Advocacy Outreach
The traditional August congressional recess period provided the AOA many opportunities to reach-out to lawmakers. This year’s advocacy activities emphasized in-district meetings with key Members of Congress to strengthen the osteopathic relationship with their offices and reinforce AOA’s priorities related to health care reform. In early May, the AOA Congressional Relations team began discussing potential targets for August recess, in-district meetings. The final list of lawmakers included 12 Senators and 40 Representatives from nine states. From this list of 52 Members of Congress, the AOA successfully arranged meetings with more than 40. More than half of the meetings were attended by the Member themselves; the others were attended by key health care staff members. Ohio physicians participated in the advocacy effort, meeting with several members of Congress during the summer recess. Among them: Boyd W. Bowden, DO, Charles G. VonderEmbse, DO, and Executive Director Jon F. Wills met with US Rep. Pat Tiberi in Columbus; Robert L. Hunter, DO, met with Rep. Steve Austria as part of his healthcare advisory panel; Jack Brose, DO, dean of Ohio University College of Osteopathic Medicine, participated in a small roundtable discussion with Rep. Charlie Wilson in Marietta; Richard Snow, DO, and Peter A. Bell, DO, met with staff from Rep. Mary Jo Kilroy’s Columbus office; Robert S. Juhasz, DO, Stuart B. Chesky, DO, Brian A. Kessler, DO, and Cleveland Academy Executive Director Stacy Pot met in Cleveland with Beth Thame, state deputy director for Sen. Sherrod Brown; Victor D. Angel, DO, Carl M. Shapiro, DO, and J. Gregory Frappier, DO, met in Cincinnati with Rep. Steve Driehaus; and Sharon Van Nostran, DO, met with Rep. John Boccieri in Canton. During all of these meetings, physicians noted that those participating in
the Medicare program face a 21 percent cut in their Medicare payments on January 1, 2010, and that the health care reform debate presents an opportunity to make substantial and long-term reforms to the Medicare physician payment formula. They stressed the importance of moving away from the current episodic-based payment system and towards payment models that promote the patient-physician relationship through payment methodologies such as the medical home. Feedback from participants and congressional offices has been positive.
AOA Commends CMS Proposed Fee Schedule
The American Osteopathic Association commended the Centers for Medicare & Medicaid Services (CMS) for taking action to transform the delivery of health care by recognizing the important role primary care physicians have in improving the overall quality of patient care. In a written letter to CMS regarding the 2010 Medicare Physician Fee Schedule proposed rule, the AOA said it believes increasing reimbursements for primary care services will help reverse the growing shortage of primary care physicians. Historically, Medicare has made disproportionately low payments to primary care physicians largely because its payment formula is based on a reimbursement system that rewards procedural volume and fails to foster the comprehensive, coordinated management of patients that is the hallmark of primary care and effective health systems. However, without Congressional intervention physicians still face a 21.5 percent reduction in their 2010 Medicare physician payment update with a conversion factor of $28.3208 -- a decrease from the 2009 CF of $36.0666. The AOA also raised concerns about the severity of the reimbursement cuts that specialties now face, particularly in these difficult economic times.
Online Collection Reveals Unpublished AT Still Documents
For the first time ever, hundreds of original manuscripts and documents written by the father of osteopathic medicine, Andrew Taylor Still, MD, DO, can be viewed online. Thanks to a grant from the Institute of Museum and Library Services funded by the Library Services and Technology Act, the Still National Osteopathic Museum has transcribed more than 650 pages from the Andrew Taylor Still Papers for the online collection. The bulk of the papers consist of Still’s essays, letters, book drafts and other writings. Also present are letters to him, military records and other personal documents. Nearly 200 items (over 650 pages) were transcribed for the online collection. These were chosen with the goal of making rare, difficult-to-read documents both accessible and searchable.
In addition, most of the selected items have not been widely published or circulated. The core of the collection was donated in 1990 by Elizabeth Laughlin, widow of Still’s grandson. It is not known who compiled the material originally; it was handed down from Still’s daughter, Blanche Laughlin. Other items were given by individual donors over a number of years. View the collection on the Missouri Digital Heritage website at www.sos.mo.gov/mdh.
In addition to benefiting the environment by saving an estimated 236,000 pounds of paper and 5,600 pounds of ink during the next fiscal year, The DO’s online transition will provide several new perks for readers, including more frequent news, interactive features, slide shows and more. Visit www.DO-Online.org to learn more about the changes in store for readers as The DO bids farewell to print and hello to cyberspace.
The DO Goes Online
DOs and osteopathic medical students can now look to their computers instead of their mailboxes for The DO magazine’s latest coverage of the osteopathic medical profession. Following nearly five decades in print, The DO has been reborn as a strictly online publication, aligning with the “Leading Change” efforts of AOA President Larry A. Wickless, DO.
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Washington Watch Benjamin Named New Surgeon General
In October, the US Senate unanimously confirmed Regina Benjamin, MD, of Alabama, as surgeon general. Benjamin is founder and CEO of the Bayou La Batre Rural Health Clinic. She is the immediate past-chair of the Federation of State Medical Boards, and previously served as associate dean for Rural Health at the University of South Alabama College of Medicine. In 2002, she became president of the Medical Association of the State of Alabama, making her the first African American woman to be president of a state medical society in the United States. In addition, she was elected to the American Medical Association Board of Trustees in 1995, making her the first physician under age 40 and the first African-American woman to be elected. Benjamin holds a BS in Chemistry from Xavier University, New Orleans. She was in the 2nd class at Morehouse School of Medicine and received her medical degree from the University of Alabama, Birmingham, as well as an MBA from Tulane University. She completed her residency in family medicine at the Medical Center of Central Georgia. The recipient of numerous awards and honors, including the Nelson Mandela Award for Health and Human Rights, she was previously named by Time Magazine as one of the “Nation’s 50 Future Leaders Age 40 and Under.” She has been a longtime supporter of and has worked collaboratively with the osteopathic medical profession.
NIH Offers Student Loan Repayment Program
The National Institutes of Health (NIH) Loan Repayment Program (LRP) repays up to $35,000 per year of educational loan debt for individuals who commit to conducting two years of qualified biomedical or behavioral research at a nonprofit or government institution. The extramural LRPs include Clinical Research, Pediatric Research, Health Disparities Research,
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Contraception and Infertility Research, and Clinical Research for Individuals from Disadvantaged Backgrounds. The 2010 application cycle opened September 1 and closes December 1, 2010. To qualify, applicants must generally possess a doctoral-level degree, devote at least 20 hours per week to qualifying research funded by a domestic nonprofit organization or federal, state, or local government entity, have qualifying educational loan debt equal to or exceeding 20 percent of their institutional base salary, and be a US citizen, national, or permanent resident. On average, nearly 40 percent of all new LRP applications are funded and the awards are renewable. For more information or to apply, go online to www.lrp.nih.gov.
HHS Strengthens HIPAA Enforcement
The US Department of Health and Human Services (HHS) issued an interim final rule to strengthen its enforcement of the rules promulgated under the Health Insurance Portability and Accountability Act (HIPAA). The Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009, modified the HHS Secretary’s authority to impose civil money penalties for violations occurring after February 18, 2009. These HITECH Act revisions significantly increase the penalty amounts the Secretary may impose for violations of the HIPAA rules and encourage prompt corrective action. Prior to the HITECH Act, the Secretary could not impose a penalty of more than $100 for each violation or $25,000 for all identical violations of the same provision. A covered health care provider, health plan or clearinghouse could also bar the Secretary’s imposition of a civil money penalty by demonstrating that it did not know that it violated the HIPAA rules. Section 13410(d) of the HITECH Act strengthened the civil money penalty scheme by establishing tiered ranges of increas-
ing minimum penalty amounts, with a maximum penalty of $1.5 million for all violations of an identical provision. A covered entity can no longer bar the imposition of a civil money penalty for an unknown violation unless it corrects the violation within 30 days of discovery.
CMS Releases Billing Guidance for H1N1 and Seasonal Vaccines
The Centers for Medicare & Medicaid Services (CMS) released as Special Edition MLN Matters article on Billing for the Administration of the Influenza A (H1N1) Vaccine. Specifically, the article notes that Medicare will pay for seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal so that physician practices can make the necessary preparations for the upcoming flu season. Though Medicare typically pays for one vaccination per year, if more than one vaccination per year is medically necessary (i.e., the number of doses of a vaccine and/or type of influenza vaccine), then Medicare will pay for those additional vaccinations. Medicare claims processing contractors have been notified to expect and prepare for earlier-than-usual seasonal flu claims and there should not be a problem in getting those claims paid. Furthermore, in the event that it is necessary for Medicare beneficiaries to receive both a seasonal flu vaccination and an influenza A (H1N1) vaccination, then Medicare will pay for both. Physicians should note if they receive either vaccine free of charge, then Medicare will only cover reimbursement for the vaccine’s administration (not for the vaccine itself). Read the full article online at www.cms.hhs.gov/MLNMattersArticle s/downloads/SE0920.pdf.
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AOOA Bulletin AOOA Yellow Ribbon Suicide Prevention Program
This has been an incredible year for the YRSPP. Through the project, AOOA members continues to stress prevention and provide information about how to get help. Becky Marx has been actively involved. Her activities include four presentations, reaching 52 students at Liberty High School. In addition, she met with the Trumbull and Mahoning County Suicide Prevention coalitions. Mary Schreck has had another busy year. She is still a member of Athens County Suicide Prevention Coalition (ACSPC) and Hocking County Suicide Prevention Coalition (HCSPC). ACSPC again made it possible to pass out 6,300 YR cards and information to high school students from 13 counties. Mary’s presentations: • Ohio University 6 presentations, 154 students • Athens High School 12 presentations, 218 students • Mount Vernon High School 11 presentations, 260 students • Logan High School 14 presentations, 273 students 1 presentation, 68 teachers • Alexander High School 6 presentations, 133 students • Trimble High School 4 presentation, 61 students • Hocking College 2 presentations, 77 students • Marietta College 1 presentation, 25 students • OU-COM 1 presentation, 98 medical students In addition, Schreck had YRSPP information and cards available at four health fairs/seminars and was able to reach about 800 adults and students. She was also a guest on two radio programs: one in Lancaster and the other with NAMI (National Alliance for the Mentally Ill) of Athens. Together, Schreck and Marx have distributed 11,000 YRSPP cards this year. Additionally, What Is a DO? pamphlets were distributed to students. Page 22 • Buckeye Osteopathic Physician
Public Education Effort Stresses Child Safety
Each year the Advocates publish Smart Kids, Safe Kids, an activity and coloring book promoting safety. This 20-page booklet helps young children learn how to make good choices, teaching them to “Be Aware...Not Afraid.” The book is designed for parents and children to work together. There’s also a short section about osteopathic medicine and a list of donors who make the publication possible. More than 1,000 booklets were distributed: Ohio Osteopathic Association (500); Hubbard Township Police (150); Parks and Recreation Department of Dublin (180); Medina Health Department (200); John Vargo, DO (50); Cortland Family Medical Center (100); and Amy Paulson (50). In addition, the AOOA Sixth District took 300 of last year’s books to distribute at Doctor’s Hospital in Columbus. For 2008-2009, donations to support the project were received from: Ohio Osteopathic Association; AOOA Sixth District Academy; Dr. and Mrs. E. Lee Foster; Dr. and Mrs. John Vargo; Dr. and Mrs. Daniel Raub; and the AOOA. For information and ordering details for next year’s Safety Activity Book, see the information below.
Thank you to our contributors. Your generosity allows the AOOA to continue programs and services and in turn promote osteopathic medicine. The contributions listed below were received during fiscal year ended May 31, 2009. Contributions to the Advocates projects are welcome at any time. For information, contact AOOA Treasurer Dee Angel at 513-984-3971. Public Education (Safety Activity Books) Ohio Osteopathic Association Sandi Foster Linda Raub Cortland Family Medical Center Dr. John Vargo Advocates for the 6th District Academy
Scholarship Endowment Fund Advocates for the 1st District Academy Advocates for the 8th District Academy Advocates for the 10th District Academy Yellow Ribbon Program Anita Steinbergh, DO Advocates for the 6th District Academy Advocates for the 9th District Academy Linda Raub
General Fund Advocates for the 3rd District Academy
Buckeye Osteopathic Physician Ohio Osteopathic Association 53 West Third Avenue Columbus, Ohio 43201-0130 www.ooanet.org ADDRESS SERVICE REQUESTED
Periodicals Postage Paid At Columbus, Ohio