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The Journal of the Oklahoma Osteopathic Association

OKLAHOMA D.O.

May/June 2013 May/June 2014

Volume 79, No. 1

Oklahoma D.O. | May / June 2014

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2014 - 2015 OOA PRESIDENT

Oklahoma D.O.

MICHAEL K. COOPER, DO


WE KNOW OKLAHOMA HEALTHCARE

Oklahoma D.O. PAGE 2

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Oklahoma D.O. | May / June 2014


The Journal of the Oklahoma Osteopathic Association

OKLAHOMA

May/June 2012 May/June 2013 May/June 2014

D.O.

Volume 79, No. 1

January 2012

OOA Officers: Michael K. Cooper, DO, FACOFP, President (Northeastern District) C. Michael Ogle, DO, President-Elect (Northwest District) Gabriel M. Pitman, DO, Vice President (South Central District) Bret S. Langerman, DO, Past President (South Central District) OOA Trustees: Kenneth E. Calabrese, DO, FACOI (Tulsa District) Dale Derby, DO (Tulsa District) Melissa A. Gastorf, DO, FACOFP (Southeastern District) Timothy J. Moser, DO, FACOFP (South Central District) Richard W. Schafer, DO, FACOFP (Tulsa District) Christopher A. Shearer, DO, FACOI (Northwest District) Kayse M. Shrum, DO, FACOP (Tulsa District) Ronald S. Stevens, DO (Eastern District) OOA Central Office Staff: Lynette C. McLain, Executive Director Lany Milner, Director of Operations and Education Matt Harney, MBA, Director of Advocacy and Legislation Marie Kadavy, Director of Communications and Membership Jessica Hansen, Special Projects Coordinator Lisa Creson, Administrative Assistant

The Oklahoma D.O. is published monthly from the Oklahoma Osteopathic Association Central Office: 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335. Lany Milner, Graphic Designer and Associate Editor Copy deadline is the 10th of the month preceding publication. Advertising copy deadline is the 15th of the month preceding publication.

“Inaugural Address” provided by Michael K. Cooper, DO, FACOFP, 2014-2015 President

7

2014-2015 OOA Board of Trustees & Special Guests

8

2014 OOA Doctor of the Year-Dennis J. Carter, DO, FACOFP

9

2014 Outstanding & Distinguished Service Award-Kayse M. Shrum, DO, FACOP

10

Award of Appreciation & Rookie Recipients

12

2014 Life Members/OEFOM Scholarship Recipients/ROGME

13

114th OOA Convention Exhibitors

14-15

OOA/OEFOM Golf Tournament

16-21

Convention Photo Gallery

22-23 2014-2015 OOA Departments, Bureaus, Committees & Councils 24

Bureau News

26

AOA ACGME Resolution

30

“Meet the OSU Regional Coordinators: Catch Their Passion!” Provided by: Vicky Pace, M.Ed., Director of Rural Medical Education, OSU Center for Rural Health

34

Legislative Report provided by Matt Harney, MBA

38

“OSU and Mercy Finalize Agreement to Manage OSU Medical Center” provided by OSU Medical Center

40

What DO’s Need To Know

42

May Birthdays

44

June Birthdays

46

“Sorting Out Seasonal Allergies” provided by the American Osteopathic Association

48

“Preventing Sudden Cardiac Death Utilizing Wearable External Cardiac Defibrillator: The OSUMC Experience”

51 Classifieds

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The OOA Website is located at www.okosteo.org

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Oklahoma D.O.

For more information: 405.528.4848 or 800.522.8379 Fax: 405.528.6102 E-mail: ooa@okosteo.org

Lynette C. McLain, Editor Lany Milner, Associate Editor


Inaugural Address by Michael K. Cooper, DO Presented during the Greats Banquet

The reason osteopathic medicine has survived for 140+ years is adaptability, the ability to react positively to changes in our environment. This adaptability has been fostered by and made stronger by our osteopathic culture. We should never lose our osteopathic difference.

"I would like to thank you members of our association, the Oklahoma Osteopathic Association, for placing your trust in me and giving me the opportunity to serve as president. This is an awesome responsibility which I do not take lightly. I would like to start out by asking a simple question. Are we who we say we are? Sure, we have the initials DO behind our names. But are we really doctors of osteopathic medicine? We have graduated from osteopathic medical schools. But does that make us osteopathic physicians? Osteopathic medicine was started out of the need to provide better care for patients. Osteopathic physicians understand that holding the hand of a frightened patient is just as important as performing her potentially life-saving procedure. The osteopathic physician is trained to be a complete physician—taking care of a patient's body, mind and spirit. Sure, osteopathic medicine includes manual therapy also known as OMT, a skill which every osteopathic physician in every specialty should be doing in accordance with their specialty. OMT is not the only skill which we should master. But, it is a skill unique to those trained in osteopathic medicine. A skill that can treat the patient's body, mind and spirit. It helps to foster the patient's healing and his sense of wellbeing. As Dr. Still reminded us, anyone can find disease, but an osteopathic physician must find health. As osteopathic physicians, we understand that treating the spirit of a patient is just as important as treating the mind and body. The patients of osteopathic physicians may not understand this. But they know that we make differences for them. That is why many of our patients will bypass multiple medical facilities to reach our offices. They know that they can get treatment for their physical needs in many places. Their osteopathic physician will address not only their physical needs, but also their mental and spiritual needs as well. Despite the less than stellar reputation that doctors have received as a whole, every osteopathic physician has more than a handful of patients who think that their doctor is the best doctor in the world.

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Again, I ask you—Are we who we say we are?

Oklahoma D.O. | May / June 2014


Osteopathic medicine has survived for over 140 years—but not without its challenges. Dr. Still’s difficulties in starting the first osteopathic medical school have been well chronicled. But evidently, he was successful. The Flexner report of 1910 was critical of medical education. Many medical schools, both allopathic and osteopathic were closed. This left only five osteopathic medical schools. But look how many we have now. In World War II, osteopathic physicians were not drafted as physicians. So we stayed home to build practices and reputations as quality physicians. It was not until 1962 that osteopathic physicians could enlist as physicians in the military. Many osteopathic physicians have gone on to distinguish themselves in service to their country, even rising as high as the rank of assistant surgeon general of one of several service branches. We were once barred from practicing in hospitals. There are many physicians still around to remind us of this history. I personally know one physician in Claremore, Okla., that had to get into a fist fight for hospital privileges. So, since we could not practice in established hospitals, we built our own hospitals. Hospitals so successful that allopathic physicians soon wanted to be on staff. But now since osteopathic physicians are more widely accepted, our solely osteopathic hospitals have gone the way of the dinosaur. However, the emergence of the OPTI continues to ensure the system of osteopathic medical education. And thus, helps us to maintain osteopathic medical education integrity.

Osteopathic culture. Even before medical school, I was introduced to the osteopathic culture. I have had many osteopathic mentors along the way. Even as an allopathic family medicine resident in Enid, Okla., the osteopathic physicians of the Northwest District treated me and my wife like family. To this day I still look up to these physicians who taught me about osteopathic culture. It has been my osteopathic mentors during my education that taught me not only about medicine, but also about how to live each day as an example of what an osteopathic physician should be. I am not the first allopathically trained physician to become president of the Oklahoma Osteopathic Association. And I hope I'm not the last. Because if I am, we will have failed in attempts to expand our osteopathic culture. The allopathically trained osteopathic physicians serving on this board are not merely products just of our training, a strategy or formula; but rather a product of osteopathic culture. This goes to prove what management consultant and educator Peter Drucker meant when he said 'Culture eats strategy for breakfast every day.' Culture is an outgrowth of leadership. Osteopathic physicians need to be demonstrating osteopathic ideals in order to mentor new osteopathic physicians. It doesn't matter how much we plan or strategize, culture will trump any plan or strategy. No matter how brilliant the strategy, it will not survive and be realized if it is not supported by culture. It is osteopathic culture that has allowed our profession to come through previous setback attempts—not only just surviving, but becoming stronger. It is the osteopathic culture that will see us through this new opportunity in postgraduate training. Also, remember that graduating from an osteopathic residency does not ensure that the graduate will be an osteopathic physician unless that resident is already sewn within the fabric of osteopathic culture. Osteopathic culture also drives the differences that we make in the lives of our patients. This difference should never be intangible or hard to describe. It should be a daily way of life for all of us. If osteopathic culture is ever forgotten, I fear that the osteopathic difference will be lost. It is osteopathic culture that makes us most adaptable to external changes within medicine. Osteopathic culture helps us to fill practices with patients. An osteopathic physician can receive no greater compliment or reward than receiving a patient's trust. This trust is magnified many times over when the patient also trusts us

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Oklahoma D.O. | May / June 2014

I stand before you tonight as an osteopathic physician who completed an allopathic residency in family medicine. I didn't even apply to an allopathic medical school. I met my first osteopathic physician, Wendy Heller, DO, while I was in college. It was from that time that I wanted to be an osteopathic physician. After I completed my residency, I took both allopathic and osteopathic specialty boards. But I will continue tomorrow to maintain only my osteopathic certification. Why?

Oklahoma D.O.

Now, we have a new situation that at first glance appears to be a threat to our profession—the combining of allopathic and osteopathic postgraduate medical education. Whether you agree or disagree with the change, changes in postgraduate education are coming in some form. We should not look at this as the beginning of the end, but rather we should look at this as an opportunity to further our profession in terms of visibility and influence. Because we have been so successful, we now have more graduates from our osteopathic medical schools than we have postgraduate training positions. It is estimated this year, 2014, we will have 5,150 osteopathic medical school graduates to fill 2,988 available osteopathic graduate medical education openings. And this gap appears to be getting larger every year. A significant number of osteopathic medical graduates have been trained in allopathic residencies. This is not a bad thing. Our graduates enter residency programs to learn skills and procedures. All physicians, both DO and MD, perform the same procedures in the same manner. I'm sure that a cholecystectomy is performed the same way by both allopathic and osteopathic physicians. The difference comes in treating the whole patient, both before and after the procedure. We cannot throw our osteopathic graduates under the bus. We must ensure that they receive the best medical training possible in the specialty of their choice. They must have access to fellowships that are not available as osteopathic training programs. Our students generally do not choose a residency program based on whether it is an allopathic or osteopathic program. They choose programs that will provide the desired course of training. They choose programs which will allow their spouses to continue to work and their kids to remain in school. They choose programs where they have a social support network to help care for their families.

Medical schools graduate doctors. Residency programs train doctors. But only a physician can train a physician. The apprenticeship practices involved in medical training has never changed and it should never be changed. If a graduate from an osteopathic medical school is not well enmeshed within the fabric of the osteopathic profession by the time he/she finish their DO degree or at least a residency program, then chances are, they never will be.


with the things that they hold most dear—the health of their children. Alison Levine is not exactly a household name outside mountain climbing circles. She was one of the first women to complete the grand slam of mountain climbing by climbing the highest peak on every continent. If you know anything about mountain climbing, you know it is very dependent upon the weather conditions. It is the weather that helps to determine whether a climber will be able to reach the summit. Very little ever prevents Alison from reaching her goal because she is very adaptable. When faced with a difficult challenge, a challenge made much more complicated by external conditions, she is able to change her actions in order to meet the challenge successfully. As she says, 'you can't change your environment, but you can change the way you react to it.'

I would like to introduce some of the people with us tonight that are very important to me. 1. My parents, Kent and Sherry Cooper 2. My in-laws, Tom and Juanita Spillers 3. My brother, David Cooper, a naval veteran of 20 years 4. I would also like to thank Kris Steele for being a part of this evening. 5. My medical assistants, Twilla Summers and Jennifer Cherry; and Dr. Tara Claussen, one of my partners. 6. And, the most important person in the world to me. She is the major reason I am able to stand here today. The woman who has helped me more than anyone can imagine, my wife, Diane Cooper. Thank you and good night." *I would like to thank AOA president Norman Vinn for the inspiration and supplying the historic details.

The reason osteopathic medicine has survived for 140+ years is adaptability, the ability to react positively to changes in our environment. This adaptability has been fostered by and made stronger by our osteopathic culture. We should never lose our osteopathic difference. I would like to leave you with one last quote by Peter Drucker. 'The best way to predict the future is to create it.'

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Please help maintain our osteopathic culture. Get involved with our association—participate in district meetings, volunteer to work on a committee. The more that we are involved in our association, the stronger we can become. But most important of all, mentor a student or resident to become an osteopathic physician. You just might be training your future personal physician. And remember, if we truly believe in the osteopathic culture, if we continue to live as examples of good osteopathic physicians, osteopathic medicine will not merely continue to survive, it will thrive.

Oklahoma D.O. | May / June 2014


2014-2015 OOA Board of Trustees & Special Guests Back row (L-R): Lynette C. McLain, executive director; Richard W. Schafer, DO, FACOFP, newly elected trustee; Ronald S. Stevens, DO, trustee; Layne E. Subera, DO, FACOFP; Gabriel M. Pitman, DO, newly elected OOA vice president; Kenneth E. Calabrese, DO, FACOI, trustee; Christopher A. Shearer, DO, trustee; Dale Derby, DO, trustee; Timothy J. Moser, DO, trustee; Front row (L-R): Ronnie B. Martin, DO, FACOFP dist.; Kayse M. Shrum, DO, FACOP, trustee, dean of OSU-COM; Duane G. Koehler, DO, FACOFP, governor of the American College of Osteopathic Family Physicians (ACOFP); C. Michael Ogle, DO, newly elected president-elect; Michael K. Cooper, DO, FACOFP, newly elected OOA president; Robert S. Juhasz, DO, presidentelect of the AOA; Bret S. Langerman, DO, OOA past president; Ray E. Stowers, DO, FACOFP dist., past president of the AOA; Melissa A. Gastorf, DO, FACOFP, trustee.

Oklahoma Osteopathic Association Inducts Michael K. Cooper, DO, FACOFP as the 2014-2015 President

Dr. Cooper is a graduate of Oklahoma State University College of Osteopathic Medicine and currently practices in Claremore.

Oklahoma D.O. | May / June 2014

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Special guests highlighting the 114th Annual Convention were Robert S. Juhasz, DO, president-elect of the American Osteopathic Association; Duane G. Koehler, DO, FACOFP, governor of the American College of Osteopathic Family Physicians; and Ray E. Stowers, DO, FACOFP, immediate past president of the American Osteopathic Association. Participation in the four-day program provided osteopathic physicians with continuing medical education requirements for Oklahoma license renewal and certification.

Oklahoma D.O.

The Oklahoma Osteopathic Association (OOA) inducted Michael K. Cooper, DO, FACOFP, board-certified family practice and osteopathic manipulative medicine physician from Claremore, Okla., as the 2014-2015 president during the OOA’s 114th Annual Convention. This year’s convention, with the theme “DOCumentary Family Film Festival,” was held April 24-27, 2014 at the Norman Embassy Suites in Norman, Okla. The induction ceremonies were Saturday evening, April 26, during the “Greats Banquet.” Master of ceremonies for the evening was Ronnie B. Martin, DO, FACOFP dist.


114th Annual Convention special presentations & awards DENNIS J. CARTER, DO, FACOFP

2014 OOA Doctor of the Year The Oklahoma Osteopathic Association (OOA) presented Dennis J. Carter, DO, FACOFP, from Poteau, Okla., with the “2014 OOA Doctor of the Year.” This award is given to the osteopathic physician who has shown exemplary leadership qualities in the profession, demonstrates high moral characteristics, and is highly respected among their colleagues and peers. While he was still in school, he worked as an orderly at the local hospital. The experience and training he would receive would have a profound effect on his life. He believed a career in medicine would allow him to see everything— what the nurses did, what the doctors did—the whole picture. Because of this philosophy he gained a great respect for nurses, who dedicated more time with the patient than the actual physician. It was also while working at the hospital that he met his mentor who would mold him into the physician he is today. It was the teaching and philosophy of this mentor that led him down the osteopathic path. He was later accepted into the Oklahoma College of Osteopathic Medicine and Surgery, today known as OSU College of Osteopathic Medicine. He credits his acceptance to his mentor’s recommendation letter.

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He completed his internship at Hillcrest Hospital in Oklahoma City and then moved closer to his hometown where he began working in the same hospital where he was born. Side-by-side, he trained with his mentor Dr. R.G. “Bucky” Gillson. It was during this time, that Dr. Gillson bestowed not only the teachings of osteopathic medicine but also the philosophies of being a professional in this great profession. Dr. Gillson was a strong believer in giving back to the profession, a philosophy that still resonates in Dr. Carter’s life. Through Dr. Gillson’s encouragement, Dr. Carter gave back to his profession by donating financially, as well as giving of his time. His passion for his profession led him to become president of this great association, as well as serve and represent Oklahoma on both the state and national level. He also followed in his mentor’s footsteps by becoming a mentor himself. He began training osteopathic medical students by allowing them to rotate with him—one of those students is the 2014-2015 OOA President Michael K. Cooper, DO. Dr. Carter believes in supporting and mentoring the future of the osteopathic profession. His passion for taking care of the sick has opened the door for future medical students to pursue a career in family medicine or geriatrics. He gives back to his community through educating students in his hometown about osteopathic medicine. He doesn’t have many hobbies, but he does enjoy fly fishing, quail and pheasant hunting, and spending time with family. He is a deacon and choir member at the First Baptist Church in Poteau and also contributes his time at the Christian Free Clinic in Poteau. Oklahoma D.O. | May / June 2014


KAYSE M. SHRUM, DO, FACOP

2014 OUTSTANDING & DISTINGUISHED SERVICE AWARD The Oklahoma Osteopathic Association presented Kayse M. Shrum, DO, president of the Oklahoma State University Center for Health Sciences, with the “Outstanding & Distinguished Service Award.” This award is given to an osteopathic physician who is an outstanding asset to patients, physicians, hospitals, medical students and professional organizations. Dr. Shrum was recognized for her strong rural advocacy efforts in Oklahoma and her dedication to preserving the principles and philosophies of osteopathic medicine at the OSU College of Osteopathic Medicine. Dr. Shrum grew up in rural Oklahoma and to this day the doctor’s personal mission is to provide medicine to those in need—including patients in rural communities and underserved areas. With a passion for science, she was encouraged to consider a career in medicine by an undergraduate professor. She went on to earn a Doctor of Osteopathic Medicine degree from the Oklahoma State University College of Osteopathic Medicine and began a career in private practice, being named Rookie Physician of the Year in 2001. Later, she became a full-time educator and administrator and was named chair of OSU Center for Health Sciences Department of Pediatrics in 2005 and the Saint Francis Health System’s Endowed Chair of Pediatrics in 2009. She was promoted to interim vice president of academic affairs in 2009 and, in 2011, was named the George Kaiser Family Foundation Endowed Chair of Medical Excellence & Service. Dr. Shrum became provost of the OSU Center for Health Sciences and dean of OSU College of Osteopathic Medicine in January 2011. Last year, she was named president of Oklahoma State University Center for Health Sciences, and is the youngest and first female president and dean of a medical school in the state of Oklahoma, as well as the first OSU CHS graduate to become dean of the college.

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Dr. Shrum resides in her hometown of Coweta, Okla., with her husband of 22 years, Darren, and is also doctor mom to Colton, Joseph, Kyndall, Kilientn and Karsyn.

Oklahoma D.O.

She has dedicated her career to preserving the principles and philosophies of osteopathic medicine and is a committed advocate for rural Oklahoma medicine. She serves as chair-elect of the American Osteopathic Board of Pediatrics and as a trustee of the Oklahoma Osteopathic Association. She received the Tulsa Mayor’s Commission on the Status of Women Pinnacle Award in Health in 2012 and was awarded recognition as one of Oklahoma Magazine’s 40 Under 40 Class of 2012. An outstanding athlete, this doctor was recently inducted into the Connors Athletic Hall of Fame as a fast-pitch softball player.


CONVENTION AWARD RECIPIENTS During the Alumni Luncheon on Saturday, April 26 the “Awards of Appreciation” were presented on behalf of the Association.

Preston L. Doerflinger

Representative Jerry McPeak

Jerry Hudson

In grateful appreciation the profession thanks you for your outstanding advocacy efforts in preserving our osteopathic training programs through your vigorous support for funding for the OSU Medical Center.

You are being recognized as a great member of the Oklahoma House of Representatives. The Oklahoma Osteopathic Association appreciates your loyalty of the rural health programs from the OSU College of Osteopathic Medicine. Your support of funding for the OSU Medical Center and Center for Health Sciences is always central to its success. Thank you for being OSU Medicine’s champion in the rural caucus.

You are being recognized as a champion of osteopathic education. You are a man the Oklahoma Osteopathic Association considers a genuine friend with moral and ethical character, whose position of influence has benefited the future of the osteopathic training hospital. We applaud your tenacity in holding firm to preserving the osteopathic integrity of the OSU Medical Center.

Tulsa, Okla.

Tulsa, Okla.

Warner, Okla.

Rookie Physicians Oklahoma D.O. PAGE 10

The OOA presented three physicians with the “Rookie of the Year” designation during the Friday Luncheon, April 25. Physicians in their first two years of practice qualify for the “Rookie Physician of the Year Award.”

Chelsey D. Gilbertson, DO Oklahoma City, Okla.

Aaron S. Sizelove, DO Enid, Okla.

Monica M. Woodall, DO Durant, Okla.

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CONVENTION AWARD RECIPIENTS

2014 Life Members

Congratulations to the following physicians who received their life membership to the OOA: Robert E. Baker, DO Broken Arrow, Okla. James D. Ford, DO Durant, Okla. B. Frank Shaw Jr., DO Muskogee, Okla. E. Joseph Sutton II, DO Tulsa, Okla. LeRoy E. Young, DO Oklahoma City, Okla. In picture (l-r) LeRoy E. Young, DO, and B. Frank Shaw Jr., DO, receiving their life memberships from Bret S. Langerman, DO, 2013-2014 OOA President

scholarship OEFOM recipients Congratulations to the following students who received the OEFOM scholarships:

Stephanie S. Harry, OMS II-$3,000 scholarship Amy J. Carter-Wilson, OMS II-$2,000 scholarship Summer M. Hill, OMS II-$1,000 scholarship Matthew W. Smith, OMS II-$1,000 scholarship In picture (l-r) Robert S. Juhasz, DO, AOA President-Elect; Amy J. CarterWilson; Matthew W. Smith; Summer M. Hill; Robin R. Dyer, DO, OEFOM 2013-2014 President

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2014 ROGME

This is the 6th year for the Research in Osteopathic Graduate Medical Education (ROGME) Poster Symposium, sponsored by the OOA as a project of the Bureau on Postgraduate Education. 1st place winner: Tu T. Cao, DO-$1,500

“Preventing Sudden Cardiac Death Utilizing Wearable External Cardiac Defibrillators: The OSUMC Experience”

2nd place winner: Alicia Apple, DO-$1,000

“Comparison of Microbial Populations on Infant Pacifiers verses Their Oral Swab: What Are We Putting in Our Kids Mouths?!”

3rd Place winner: Theron A. Risinger, DO-$500 “Implications of Tornado Impacts on Schools: An Historic Approach”

In picture (l-r) Theron A. Risinger, DO; Tu T. Cao, DO; Melissa A. Gastorf, DO. Oklahoma D.O. | May / June 2014


Convention Exhibitors The 114TH OOA Annual Convention Exhibitor Hall

APRIL 24-25, 2014 The OOA sends many thanks to all of the exhibitors for their time, energy, support, and dedication to the success of the OOA Convention Hall. We ask all Oklahoma physicians to take another look at the many companies listed below and please utilize their services to show your appreciation!

114TH Convention Exhibitors

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Oklahoma D.O.

Rich & Cartmill, Inc. & MedPro Oklahoma Health Care Authority Novo Nordisk Mercy Physician Recruitment PLICO Janssen Pharmaceuticals ProCure Proton Therapy Center OSU-COM Alumni Association Cancer Treatment Centers of America Natera, Inc. The Apothecary Shoppe Healthy Habits Medical Consultants OOC Locum Tenens & Permanent Placement OSU Center for Health Sciences Medical Library Vivus, Inc. Iroko Pharmaceuticals Diagnostic Laboratory of Oklahoma SI-BONE, Inc. A+ Computer Solutions Axis Practice Solutions Management Oklahoma Academy of Physician Assistants Clinical Pathology Laboratories Community Hospitals e-MD, Inc. Cook Children’s Health Care System MC-Imaging Chickasaw Nation Department of Health Integris Physician Recruitment NBC Oklahoma Physician Housecalls Blue Cross Blue Shield Oklahoma Regional Medical Laboratory, Inc. US Army Healthcare Oklahoma Beef Council Revert Systems J.D. McCarty Center Relax the Back AstraZeneca Physician Rx Source Mylan, Inc. Teva Respiratory CHS Oklahoma OSMA Health HealthChoice OFMQ-HIT Lilly USA Wilshire-Pennington Wealth Advisors It Works! Global United Allergy Services myHealth Access Network OSU Medical Center McAlester Regional Health Center Wells Fargo Advisors Physician Manpower Training Commission Sunovion Pharmaceuticals Health Diagnostic Laboratory, Inc. Liberty Mutual Ideal Protein


OOA/OEFOM GOLF CLASSIC Wednesday, April 23, 2014

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The Oklahoma Osteopathic Association (OOA) and the Oklahoma Educational Foundation for Osteopathic Medicine (OEFOM) hosted the “FORE the LOVE of Osteopathic Medicine” Golf Tournament at Oak Tree Country Club in Edmond, Okla. Although the day was a bit windy, the dedicated golfers and supporters of the OOA enjoyed a great day of golf and healthy competition.

Oklahoma D.O. | May / June 2014


thanks to

our sponsoring partners

ACOFP-Oklahoma State Society Classics Printing, Inc. Cory’s Audio Visual Cosmetic Surgery Center-Paul. F. Benien, Jr., DO Dr. and Mrs. Dennis Carter Embassy Suites Norman-Hotel & Conference Center OCOM Imaging Osteopathic Founders Foundation OSU-COM Alumni Association PLICO United Allergy Services

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Oklahoma D.O. | May / June 2014


CONVENTION PHOTO GALLERY Thursday, April 24, 2014

The Oklahoma Osteopathic Association 114th Annual Convention kicked off with the morning sessions dealing with ICD-10 and physician reimbursement. The opening session was delivered by OSU President V. Burns Hargis, JD, and then attendees were led into the exhibit hall with the help of a special guest.

Thursday, April 24, 2014

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The afternoon consisted of the OOA Annual Business Meeting and the ACOFP Business meeting. The oncology track also kicked off on Thursday with help from Lorenzo Cohen, PhD, and Katherine Anderson, ND, FABNO.

Oklahoma D.O. | May / June 2014


Friday, April 25 2014

Physicians from across the state came together to fellowship and enhance their medical knowledge by attending one of the eight-simultaneous specialty tracks that were offered during the convention. During the ONE Leadership Luncheon, the 2014 Rookies of the Year were acknowledged for their outstanding accomplishments within their first two years of practice. Friday night, everyone let loose and kicked up their heels during the Family Fun Carnival Night.

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Oklahoma D.O. | May / June 2014


OOPAC FUNDRAISER

BY

ONE

Oklahoma D.O. PAGE 18

THE OOA LEADERSHIP HELPED RAISE FUNDS FOR OOPAC BY ENDURING 10 MINUTES IN THE DUNK TANK

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SATURDAY PHOTO GALLERY

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Saturday, April 26, 2014

The eight-simultaneous specialty tracks continued throughout Saturday. Several awards were distributed during the Alumni Luncheon. The OEFOM Scholarship recipients were acknowledged, along with the ROGME winners, and the Awards of Appreciation were distributed to friends of the profession. Saturday night the roaring ‘20s came alive during the “Greats Banquet” through the entertainment of 176 Keys-Dueling Pianos.

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Oklahoma D.O. | May / June 2014


Bureau News:

OOA’S 2014- 2015 DEPARTMENTS, BUREAUS, COMMITTEES & COUNCILS

Executive Committee President: Michael K. Cooper, DO President-Elect: C. Michael Ogle, DO Vice President: Gabriel M. Pitman, DO Past President: Bret S. Langerman, DO Department of Professional Affairs Chief: C. Michael Ogle, DO, President-Elect Bureau on Awards 5 Immediate Past Presidents Chair: Duane G. Koehler, DO Vice Chair: Scott S. Cyrus, DO LeRoy E. Young, DO Layne E. Subera, DO Bret S. Langerman, DO Bureau on Membership Chair: Melissa A. Gastorf, DO Vice Chair: Richard W. Schafer, DO Kenneth E. Calabrese, DO Ronald S. Stevens, DO

Oklahoma D.O. PAGE 22

Bureau on Physician Grievance Chair: H. Zane DeLaughter, DO Vice Chair: Ronald S. Stevens, DO Richard W. Schafer, DO Bobby N. Daniel, DO Brian K. Lepley, DO Laurie A. Duckett, DO L. Janelle Whitt, DO Stephen W. Woodson, DO Russell D. Moneypenny, DO Robert J. Gunderson, DO Kenneth R. Watson, DO Physicians Health & Recovery Committee Chair: R. Randy Hunt, DO Vice Chair: Dale Derby, DO Lynette C. McLain, Executive Director Michell A. Cohn, DO Nicholas J. Bentley, DO Bobby N. Daniel, DO James I. Graham, DO Sarah E. Land, DO Laurie A. Duckett , DO L. Janelle Whitt, DO Russell D. Moneypenny, DO Robert J. Gunderson, DO Gabriel M. Pitman, DO Brian K. Lepley, DO Ben J. Martin, DO Dereck A. Peery, DO Steven P. Sanders, DO Thomas D. Schneider, DO Justin S. Sparkes, DO Kenneth E. Calabrese, DO

Bureau on Continuing Medical Education Chair: Melinda R. Allen, DO Vice Chair: Timothy J. Moser, DO George E. Erbacher, DO Nicholas J. Bentley, DO Joseph R. Johnson, DO Scott S. Cyrus, DO Robert J. Gunderson, DO Walter E. Kelley, DO Gabriel M. Pitman, DO Ronald S. Stevens, DO Dale Derby, DO Ryan W. Schafer, DO Jeffrey A. Gastorf, DO Melissa A. Gastorf, DO H. Zane DeLaughter, DO Bureau on Constitution & Bylaws Chair: Kayse M. Shrum, DO Vice Chair: Melissa A. Gastorf, DO Leroy E. Young, DO Gabriel M. Pitman, DO Timothy J. Moser, DO Ronald S. Stevens, DO Bureau on Postgraduate Education Chair: Kristopher K. Hart, DO Vice Chair: Timothy J. Moser, DO Nicholas Bentley, DO Joseph R. Johnson, DO Ronald S. Stevens, DO Robert J. Gunderson, DO V. Ray Cordry, DO Cris D. Schultz, DO Charles C. Glendenning, DO Walter E. Kelley, DO James P. McClay, DO J. M. Fitzgerald, Sr., DO Gabriel M. Pitman, DO Melissa A. Gastorf, DO Thomas D. Schneider, DO Bureau of New Physicians Chair: Christopher A. Shearer, DO Vice Chair: Rebecca D. Lewis, DO Nate D. Stetson, DO Nicholas J. Bentley, DO Jonathan K. Bushman, DO Laurie A. Duckett, DO Robert J. Gunderson, DO Department of Public Affairs Chief: Gabriel M. Pitman, DO, Vice President Bureau on Information Technology Chairman: Timothy J. Moser, DO Vice Chair: Dale Derby, DO Raj K. Motwani, DO

Joseph R. Johnson, DO Robert J. Gunderson, DO Ronald S. Stevens, DO Richard W. Schafer, DO Gabriel M. Pitman, DO Bureau on Legislation Chair: LeRoy E. Young, DO Vice Chair: Gabriel M. Pitman, DO Patrice A. Aston, DO Gary K. Augter, DO Gary C. Bastin, Lobbyist Janice Bratzler, ex officio Jonathan K. Bushman, DO Kenneth E. Calabrese, DO Thomas J. Carlile, DO Michael K. Cooper, DO Scott S. Cyrus, DO Bobby N. Daniel, DO Brent W. Davis, DO Dale Derby, DO Melissa A. Gastorf, DO Greg H. Gray, DO Robert J. Gunderson, DO H. Dwight Hardy, III, DO James E. Harrington, DO David F. Hitzeman, DO David K. Hopkins, DO M. Shane Hull, DO Stephanie J. Husen, DO Joseph R. Johnson, DO Duane G. Koehler, DO Sarah E. Land, DO Bret S. Langerman, DO Gordon P. Laird, DO Bryan K. Ledbetter, DO Thomas B. Leahey, DO Regina M. Lewis, DO Lynette C. McLain, Executive Director Trudy J. Milner, DO Russell D. Moneypenny, DO Timothy J. Moser, DO Terry L. Nickels, DO Sean Nix, DO M. Sean O’Brien, DO C. Michael Ogle, DO Temitayo Oyekan, DO Carl B. Pettigrew, DO Gerald D. Rana, DO Clayton H. Royder, DO Christopher A. Shearer, DO Kayse M. Shrum, DO Mark Snyder, Lobbyist Justin S. Sparkes, DO Saundra S. Spruiell, DO Sheila J. Stanek, DO Ronald S. Stevens, DO Jonathan B. Stone, DO Oklahoma D.O. | May / June 2014


Michael F. Stratton, DO Layne E. Subera, DO Heath A. VanDeLinder, DO Sherri Wise, CPA, ex officio

Staff: Lynette C. McLain, Executive Director Bret S. Langerman, DO Michael K. Cooper, DO Kayse M. Shrum, DO

OOPAC Committee Chair: LeRoy E. Young, DO Vice Chair: Gabriel M. Pitman, DO Treasurer: Lynette C. McLain Thomas J. Carlile, DO Michael K. Cooper, DO David F. Hitzeman, DO Bret S. Langerman, DO Terry L. Nickels, DO

Bureau on Member Services Chair: Bobby N. Daniel, DO Vice Chair: C. Michael Ogle, DO Robert J. Gunderson, DO Korby Pogue, DO Harold Claver, DO Gabriel M. Pitman, DO

Health Policy Task Force Chair: Duane G. Koehler, DO Vice Chair: Trudy J. Milner, DO Kenneth E. Calabrese, DO Melissa A. Gastorf, DO Department of Business Affairs Chief: Bret S. Langerman, DO, Past President Bureau on Finance Chair: C. Michael Ogle, DO Vice Chair: Gabriel M. Pitman, DO

Meet

Past Presidents’ Council Chair: Layne E. Subera, DO Vice Chair: Bret S. Langerman, DO

Bureau on Convention General Convention Chair: C. Michael Ogle, DO Professional Program Chair: Gabriel M. Pitman, DO

Bureau on Public Awareness Chair: Kayse M. Shrum, DO Vice Chair: Dale Derby, DO Robert J. Gunderson, DO Gabriel M. Pitman, DO

the

Robert J. Gunderson, DO Richard W. Schafer, DO Gabriel M. Pitman, DO Duane G. Koehler, DO James P. McClay, DO M. Todd Reilly, DO Justin S. Sparkes, DO Qualls Stevens, DO Jonathan B. Stone, DO Dianna Willis, DO

Bureau on Professional Liability Insurance Chair: C. Michael Ogle, DO Vice Chair: Bret S. Langerman, DO Staff: Lany Milner LeRoy E. Young, DO Robert J. Gunderson, DO Charles C. Glendenning, DO Richard W. Schafer, DO Gabriel M. Pitman, DO

District Presidents’ Council Chair: Melissa A. Gastorf, DO Vice Chair: Thomas H. Conklin Jr., DO (Eastern) Jennifer R. Ferrell, DO (North Central) Melinda R. Allen, DO (Northeastern) R. Kelly McMurry, DO (Panhandle) Timothy J. Moser, DO (South Central) Thomas B. Leahey, DO (Southern) Melissa A. Gastorf, DO (Southeastern) Melvin L. Robison, DO (Southwestern) L. Janelle Whitt, DO (Tulsa) Kenan L. Kirkendall, DO (Western) James E. Harrington, DO (Northwestern)

Bureau on Managed Care & Physician Reimbursement Chair: Ronald S. Stevens, DO Vice Chair: Christopher A. Shearer, DO

teaM

Oklahoma D.O.

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MORE Bureau News:

Bureau on Membership The OOA Board of Trustees welcomes the following new members to the OOA family! Corey R. Babb, DO OB/GYN (Tulsa) Rodger C. Mattson, DO Family Practice (Front Royal, VA)

ACOFP Fellows Inducted Melissa A. Gastorf, DO, FACOFP (Durant) was awarded with the prestigious fellow recognition of the American College of Osteopathic Family Physicians. Dr. Gastorf joined the elite group during the 2014 Conclave of Fellows Awards Ceremony on Saturday, March 15, 2014. Members are named “Fellow of the American College of Osteopathic Family Physicians (FACOFP)� in recognition of individual experience, dedication, and contributions through teaching, authorship, research and professional leadership. It has been presented annually since 1976.

John Ross Miller III, DO Family Practice (Tahlequah) Jarrod J. Mueggenborg, DO Emergency Medicine (Moore) Kerri L. Williams, DO Family Practice (Bartlesville)

Oklahoma D.O. PAGE 24

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Support OOPAC in 2014! DO your part To protect and promote osteopathic medicine in Oklahoma. 2014 OOPAC Investment _____ My personal check made payable to “OOPAC� is enclosed [ ] $100

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Oklahoma D.O. | May / June 2014

PAGE 25

Please mail to: OOPAC, 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335.

Oklahoma D.O.

I declare that this contribution is freely and voluntarily given from my personal property. I have not directly or indirectly been compensated or reimbursed for the contribution. This personal contribution is not deductible as a donation or business expense.


AMERICAN OSTEOPATHIC ASSOCIATION

UNIFIED GRADUATE MEDICAL EDUCATION ACCREDITATION SYSTEM During the 2014 AOA House of Delegates Meeting the following resolution will be presented to the House for approval. The Okahoma Osteopathic Association Board of Trustees has not taken a position on this resolution. For a summary of the May 4, 2014 MOU Summit, see page 28.

SUBJECT: UNIFIED GRADUATE MEDICAL EDUCATION ACCREDITATION SYSTEM SUBMITTED BY: AOA Board of Trustees REFERRED TO: House of Delegates WHEREAS, the American Osteopathic Association (AOA) Board of Trustees and American Association of Colleges of Osteopathic Medicine (AACOM) Board of Deans have voted at their respective Board meetings to approve a Memorandum of Understanding (MOU) with the Accreditation Council for Graduate Medical Education (ACGME) that outlines the process, format and timeline for transition to a single, unified graduate medical education accreditation system; and WHEREAS, the transformation of healthcare is placing demands on all sectors of the healthcare delivery system, including graduate medical education, to operate more efficiently and effectively and demonstrate the quality of their services; and WHEREAS, the opportunity to partner with the ACGME and AACOM in developing a single accreditation system provides the AOA and AACOM with a platform to promote the quality and importance of osteopathic medicine as a key driver of the healthcare delivery system in the United States; and WHEREAS, the decision to enter into the agreement was reached after two years of extensive and ongoing evaluation of the internal and external environments, and examination of the risks and benefits of creating the new system; and WHEREAS, the AOA Board of Trustees is satisfied that, through the MOU and accompanying letter of clarification, the AOA’s core negotiating principles have been appropriately addressed; and

Oklahoma D.O. PAGE 26

WHEREAS, there are currently more than 1,000 postdoctoral training programs accredited by the AOA in the United States, 162 of which are dually accredited by the AOA and ACGME; and WHEREAS, osteopathic graduate medical education (OGME) and ACGME training share six core competencies, which must be integrated into the curriculum (patient care, medical knowledge, practice based learning and improvement, systems based practice, profession alism, and interpersonal skills and communication); and WHEREAS, OGME and AOA-accreditation is distinct from ACGME in that it incorporates an additional competency in osteopathic principles and practice, which is interwoven within the other six competencies; and WHEREAS, the AOA is committed to maintaining and preserving OGME; and WHEREAS, the AOA and ACGME have coordinated meetings of many of the ACGME residency review committees and the AOA Specialty College evaluating committees at which there was an opportunity to compare the current AOA and ACGME accreditation standards and which found that AOA and ACGME standards are similar on most points; and Oklahoma D.O. | May / June 2014


WHEREAS, the MOU provides for member organization status within the ACGME for AOA and AACOM, and the ability for both organizations to nominate members to the ACGME Board of Directors; and WHEREAS, the MOU provides AOA with an ability to nominate voting members of the ACGME residency review committees for all specialties where AOA currently accredits training programs; and WHEREAS, the ACGME advises that the osteopathic profession will have representation on the ACGME Board of Directors’ Monitoring Com mittee, which will have responsibility for overseeing the fair and equal application of accreditation standards by the RRCs; and WHEREAS, the ACGME has indicated its intent to create a senior staff position to be hired from within the osteopathic postdoctoral training community to help oversee the transition to a single unified accreditation system; and WHEREAS, the MOU provides that current AOA-accredited residency programs will have up to five years (beginning on July 1, 2015) and the potential for multiple reviews by ACGME as they prepare to transition to ACGME accreditation; and WHEREAS, during the five-year transition, AOA-accredited residency programs will pay only one application fee even if multiple reviews are necessary; and WHEREAS, the ACGME evaluates programs to determine if they are in “substantial compliance” with accreditation standards and, therefore has flexibility in evaluating programs seeking ACGME accreditation; and WHEREAS, the MOU provides for continuation of OGME by creating osteopathically focused ACGME training programs and an Osteopathic Principles Committee that will have the authority to approve standards for the osteopathic elements of residency training and, in ef- fect, codify osteopathic principles within the ACGME standards; and WHEREAS, the Osteopathic Principles Committee will be able to recommend specific outcomes measures to be used in evaluating progress of residents, such as successful completion of osteopathic board certification examinations; and WHEREAS, the number of graduating osteopathic medical students far exceeds the number of first-year osteopathic graduate medical educa tion positions and the majority of osteopathic medical graduates now complete training in residency programs accredited by the ACGME; and WHEREAS, the ACGME will, beginning in July 2016, limit access to positions in fellowship programs and advanced residency programs to physicians who completed prior clinical training in ACGME accredited programs; and WHEREAS, osteopathic medical students believe that the ability to advance into fellowships and advanced residency programs is a top priority in selecting residency programs and, therefore, have expressed their overwhelming support for the unified system; and WHEREAS, the development of ACGME-accredited osteopathic GME programs will enhance the ability of the AOA and osteopathic state and specialty affiliates to attract members who are currently training in ACGME residency programs; and WHEREAS, the AOA will monitor and evaluate the transition process with respect to: 1) The ability of AOA-trained and certified physicians to serve as program directors in ACGME osteopathic residency programs; 2) The maintenance of smaller, rural and community-based training programs; and 3) Recognition of the importance of osteopathic board certification exams as a valid outcome measure of the quality of residency programs with osteopathic recognition

RESOLVED, that the AOA House of Delegates expresses its support for the AOA’s entry into a single accreditation system that perpetuates unique osteopathic graduate medical education programs. Explanatory Statement: The AOA will continue to monitor the progress of the transition to a single GME accreditation system and the emergence of any unintended consequences of the implementation of the new system.

Oklahoma D.O.

now, therefore be it:

PAGE 27

Oklahoma D.O. | May / June 2014


Summary of May 4, 2014 Progress Update Seminar Dear AOA Leaders: On Sunday, May 4, the AOA hosted a Progress Update Seminar in Chicago to review the Memorandum of Understanding (MOU) on the single GME accreditation system. Over 100 osteopathic state and specialty organization leaders had the opportunity to discuss the MOU with leaders of the AOA, AACOM and ACGME. At the meeting, we demonstrated that the MOU is consistent with information that has already been shared. Several attendees took the opportunity to offer comments and ask questions around four general areas: osteopathic board certification, faculty and program director requirements, hospital costs and student choice. Discussion about the future of osteopathic board certification focused on ensuring that our boards remain valued and viable. Osteopathic board certification will continue to be the best way for DOs to demonstrate their distinctive competencies. As the transition to single accreditation moves forward, making our boards desirable for DO graduates is our challenge to win or lose, and the new system gives us the opportunities to increase demand for AOA certification. Questions about faculty eligibility and requirements for program directors naturally arose. Although the ACGME will not issue blanket recognition of AOA certification for program directors, Residency Review Committees have the authority to approve program directors’ qualifications on a case-by-case basis and/or through changes in their specialty standards. There also is the option to appoint an MD co-director, which is not unlike the current requirements for an AOA-certified program director in ACGME programs that have sought and received dual accreditation. The MOU gives the infrastructure for these changes to move forward. As we progress and develop solutions for key issues, the AOA and AACOM will have a seat at the table and participate actively in the development of those solutions. AOA leaders and representatives will continue to advocate aggressively for program directors as well as students, residents and other key stakeholders. Some concerns were expressed over whether hospitals would face additional costs. Each hospital has unique circumstances and the cost savings or increases will need to be individually determined. Also, ACGME standards are based on “substantial compliance” rather than strict compliance. We are urging hospital partners to gather further information about the application of standards at their particular institution before making any assumptions regarding program costs. Regardless, OGME programs will eventually need a competency-based system, which may incur potential cost increases irrespective of whether the system is accredited by the AOA or ACGME. Students and postdoctoral trainees who attended the meeting expressed their strong support for the new system, believing it absolutely necessary for the next generation of DOs. We have posted on our website comments from ACGME Chair Timothy Goldfarb; ACGME CEO Thomas Nasca, MD; AACOM President and CEO Stephen Shannon, DO; AACOM Chair Kenneth Veit, DO; AOA President-elect Robert Juhasz, DO; and my own introductory remarks. These brief presentations provide insight into each organization’s vision for the new system as well as expectations during the transition. A recent article published in the Annals of Family Medicine provides additional perspective and endorsement from the allopathic community on the need for a single GME accreditation system.

Oklahoma D.O. PAGE 28

With regard to further distribution of the MOU, AOA leaders, 2014 delegates and executive directors who wish to review the MOU may do so by scheduling an appointment at the AOA office. There also will be an opportunity to review the MOU at the House of Delegates meeting in July. Finally, as we are now beginning to build the structure of the new system, we welcome nominations for DOs to serve on various ACGME Residency Review and other committees. To submit names, or schedule a time to view the MOU, please contact the AOA Executive Director’s office. As always, thank you for your passion and engagement in efforts to build the future of the osteopathic profession and to bring our distinct principles and practices to more people. We ask that you continue to share your comments, observations and recommendations so that together we can create an optimal single accreditation system. Sincerely yours, Norman E. Vinn, DO AOA President

Oklahoma D.O. | May / June 2014


BE A MENTOR

The OSU College of Osteopathic Medicine Class of 2018 will be starting their first year in less than three months. OSU-COM recruits and admits 115 outstanding students from all across the United States every year. The class roster will be finalized in the coming weeks and through the OOA, you’ll have the opportunity to mentor a student during this challenging first year of medical school. The OOA will pair you with a student who very likely shares a specialty or region of the state with you. You’ll be asked to serve as a motivator, guide and friend to your mentee. Many of our mentors and mentees have friendships that last well beyond the years spent in medical school. If you’re interested in serving as a mentor, please contact Matt Harney at 405-528-4848 or matt@okosteo.org.

Oklahoma D.O. PAGE 29

Oklahoma D.O. | May / June 2014


Meet the OSU Regional Coordinators:

Catch their Passion!

A

Provided by: Vicky Pace, M.Ed., Director of Rural Medical Education, OSU Center for Rural Health

As an osteopathic physician in Oklahoma, you may know about the OSU Center for Rural Health office in Tulsa and even the State Office of Rural Health in Oklahoma City. You may have already visited our website and blog or followed us on Facebook and Twitter, but are you aware that the OSU Center for Rural Health has four other offices across the state? This article introduces you to the Regional Coordinators that staff the four offices and reviews how they serve OSU medical students, preceptors, and the local community. Catch their passion for recruiting and training osteopathic medical students to increase the number of physicians in rural Oklahoma!

OSU Regional Coordinators assist OSU-CHS in recruiting at the high school level through the Dr. Pete, Operation Orange, and Early Assurance programs. They market the Rural Medical Track (RMT) program through the Summer Rural Externship (SRE) for transitioning 1st to 2nd year medical students and enjoy getting to know the students early. Regional Coordinators love providing support for 3rd and 4th year medical students, assisting before, during, and after rotations with schedules, housing, videoconferencing, orientations, curriculum assignments, contact information, emergencies, and showing them around their community. Working with the preceptors (current and future) is one of the many responsibilities that Regional Coordinators unanimously say is one of their favorite. With all the new programs, the increase in student enrollment, changes to old sites and adding new sites, they are always busy and could be anywhere in their region. When you meet them, visit with them and it will be obvious how much they believe in what they are doing to make

Oklahoma D.O. PAGE 30

a difference in Oklahoma. We at OSU-CHS are fortunate that they work as a team and shine bright orange!

Danelle Shufeldt, M.B.A., OSU Southeast Regional Coordinator (l), with the Rural Health Elective class on a tour of the Talihina rotation site.

Oklahoma D.O. | May / June 2014


“

NW SE

As interest in the Rural Medical Track has grown, so has the need for new [training] sites. Continual preceptor recruitment helps to insure success of the Rural Medical Track program to provide future physicians for rural Oklahoma.

There are many things I love about my job. One of my favorite aspects is interacting with the preceptors, their staff and the students. Each preceptor, site and student is unique. I love to explore, learn the history and culture, and provide unique learning opportunities for the students.

SW

�

PAGE 31

Oklahoma D.O. | May / June 2014

The average age of rural physicians is retirement age. They just keep working because they love what they do and they enjoy supporting their patients. I think this is the type of doctor that OSU was designed to produce. I enjoy getting to know the students and helping them learn to appreciate the locations they are visiting. I enjoy working with the students to help them achieve their goals. OSU-CHS has a mission to train physicians to practice in rural and underserved Oklahoma and I believe this is a worthy goal

Oklahoma D.O.

The Rural Medical Track (RMT) program provides promise for healthcare in rural Oklahoma. The RMT students, many from rural Oklahoma, are passionate about bringing physicians back to rural Oklahoma. After seeing first-hand the impact that rural doctors provide, I am convinced rural preceptors take an active role in our student’s learning and make an immeasurable impact in the lives of students and patients.

NE


NORTHWEST

Robert Sammons, M.A., OSU Northwest Regional Coordinator, joined the OSU Center for Rural Health in April of 2012. Prior to joining OSU, Robert served as an instructor and also worked with the YMCA. Robert is currently working on his Ph.D. in Public Policy and American Politics. Robert lives in Morrison, Okla., and commutes to the regional office in Enid. According to Robert, “As interest in the Rural Medical Track has grown, so has the need for new [training] sites. Continual preceptor recruitment helps to ensure success of the Rural Medical Track program to provide future physicians for rural Oklahoma.” Contact Robert via email at robert.sammons@okstate.edu or (918) 401-0799. Robert Sammons, M.A., OSU Northwest Regional Coordinator (r), lectures to third-year medical students at the OSU Center for Rural Health office in Tulsa

NORTHEAST

Oklahoma D.O. PAGE 32

Xan Bryant, M.B.A., OSU Northeast Regional Coordinator, stands outside the OSU Center for Rural Health Northeast Regional Office in Tahlequah

Alexandra “Xan” Bryant, M.B.A., is the OSU Northeast Regional Coordinator based in Tahlequah since November 2008. Xan always brings a little something to brighten the day, whether she is visiting preceptors or the Tulsa office. She actively participates in Tahlequah community activities. According to Xan, “during the summer months I enjoy meeting the high school students interested in medical careers that participate in the OSU-CHS one day recruiting event called Operation Orange and working with 1st to 2nd year medical students that shadow rural primary care physicians for the Summer Rural Externship program. Oklahoma is an incredibly interesting and diverse state and I think the students are lucky to get to learn about the different parts of the state and what makes each area unique.” She adds, “My main job as liaison between the students, preceptors, communities and OSU ensures that students have a good experience, preceptors feel connected to the school, the school has better access to training sites in rural Oklahoma and communities are aware students are there and provide needed support.” She concludes, “The average age of rural physicians is retirement age. They just keep working because they love what they do, and they enjoy supporting their patients. I think this is the type of doctor that OSU was designed to produce. I enjoy getting to know the students and helping them learn to appreciate the locations they are visiting. I enjoy working with the students to help them achieve their goals. OSUCHS has a mission to train physicians to practice in rural and underserved Oklahoma, and I believe this is a worthy goal.” Contact Xan via email at xan.bryant@okstate.edu or (918) 401-0074.

Oklahoma D.O. | May / June 2014


SOUTHWEST

Nicole Neilson, M.S., OSU Southwest Regional Coordinator, left the Oklahoma State Extension Service to join the OSU Center for Rural Health in March 2013. Nicole lives in Duncan and commutes to the regional office in Lawton. Reflecting on her time at OSU, Nicole mentions, “When I started working for the OSU Center for Rural Health I had little knowledge of what medical students went through to become physicians or the crisis that we are facing in health care with regards to rural medicine. It has been an amazing experience for me to work for the OSU Center for Rural Health assisting students to become the best and brightest physicians. I love working with students and preceptors, learning their stories and the life experiences that brought them to the field of medicine.” She added, “The Rural Medical Track (RMT) program provides promise for healthcare in rural Oklahoma. The RMT students, many from rural Oklahoma, are passionate about bringing physicians back to rural Oklahoma. After seeing first-hand the impact that rural doctors provide, I am convinced rural preceptors take an active role in our students’ learning and make an immeasurable impact in the lives of students and patients.” Contact Nicole via email at nicole.neilson@okstate. edu or (918) 401-0073.

Figure 1. OSU Center for Rural Health regions and office locations, April 2014.

Nicole Neilson, M. A., OSU Southwest Regional Coordinator (r), poses with OSU Center for Health Sciences medical students outside Representative Tom Cole’s office in the Rayburn House Office Building in Washington, D.C.

SOUTHEAST

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Oklahoma D.O. | May / June 2014

Oklahoma D.O.

Danelle Shufeldt, M.B.A., is the OSU Southeast Regional Coordinator based in McAlester. Before joining OSU in September 2012, Danelle worked in medical records and as a certified nurse aid. Danelle was born and raised in southeastern Oklahoma and according to her, “Living in rural Oklahoma, I can tell you that doctors have so many patients that it can take up to two months to get in to see them! That is a long wait if you’re sick. Most of the community relies on the urgent care type settings or the walk-in clinics. It is hard to keep a good doctor in rural Oklahoma and recruiting one to rural Oklahoma is a challenge.” Danelle continued, “There are many things I love about my job. One of my favorite aspects is interacting with the preceptors, their staff and the students. Each preceptor, site and student is unique. I love to explore, learn the history and culture, and provide unique learning opportunities for the students.” Contact Danelle via email at danelle.shufeldt@okstate.edu or (918) 401-0273.


LEGISLATIVE REPORT provided by Matt Harney, MBA PMP Mandate Legislation Advances

SB 1820, a physician mandate bill for the Prescription Monitoring Program (PMP) in Oklahoma, has worked its way through the legislature taking on many different forms along the way. The essence of the bill was initially contained within SB 1821. After passing the Senate, House Public Health Committee Chairman Rep. David Derby refused to hear the bill, effectively killing that particular legislation. However, a shell bill, SB 1820, was still alive and was the recipient of the language contained in SB 1821. Improvements have been made to the bill by striking the clause disallowing the physician to share the PMP check information with their patient. Also, the licensure board will have punitive authority regarding PMP checks. While these modifications are beneficial to health outcomes, the impact of the bill on physicians and their staff is still immense. Coming into this legislative session, the only PMP check requirement is for methadone prescriptions. The most recent annual report by the Commonwealth of Kentucky Justice & Public Safety Cabinet shows Oklahoma as one of only 13 states who witnessed a decrease in non-medical use of painkillers for one of the biggest drug diverters, 18-25 year-olds.

Oklahoma D.O. PAGE 34

As of the printing of this journal, the primary PMP issues being discussed revolve around frequency and which controlled substances shall require a PMP check. The OOA and OSMA are supportive of PMP checks for all new patients, once a year, and if aberrant behavior is evident. The bill has passed both the Senate and the House, but in different forms. A conference committee has been appointed by the Senate President Pro Tempore. A conference committee is a temporary committee appointed by the caucus leader and is tasked with reconciling differences in legislation that has been passed in both chambers. Senate conferees include Sens. Brian Bingman, Corey Brooks, Sean Burrage, Brian Crain, A.J. Griffin, and Al McAffrey. In the House, the bill will return to the original committee of origin, which is the Public Safety Committee. The members of that committee include: Rep. Steve Martin (R) - Chair Rep. Ken Walker (R) - Vice Chair Rep. Ed Cannaday (D) Rep. Mike Christian (R) Rep. Randy Grau (R) Rep. Tommy Hardin (R) Rep. Chuck Hoskin (D) Rep. Fred Jordan (R)

Rep. Steve Kouplen (D) Rep. Leslie Osborn (R) Rep. Pat Ownbey (R) Rep. Pam Peterson (R) Rep. R.C. Pruett (D) Rep. Brian Renegar (D) Rep. Mike Ritze, DO (R) Rep. Steve Vaughan (R) Speaker Jeff Hickman (R)

We ask our physician membership in these districts to contact their legislator and ask them to not sign the conference report. If a majority of committee members fail to sign the report, the bill fails.

Physical Therapist Representative Continues to Push PT Direct Access Bill Through Conference Committees

The bill granting direct access to physical therapists, HB 1020, passed conference committees in the House and Senate. The bill had direct access stricken in the Senate, which initiated the conference committees to reconcile the differences. The OOA and our lobbyists have worked tirelessly to negotiate this bill, ensuring physicians serve as the leader in the team approach to medical care. However, direct access has been thrust on the table by the House author, Rep. Arthur Hulbert, R-Fort Gibson. Rep. Hulbert is a physical therapist. In the past, countless legislators have stepped back from issues that directly impact their professional lives outside of the legislature. This has clearly not been the case with Hulbert, as he has championed this bill on behalf of his industry. As physical therapists are simply not qualified to perform the initial diagnosis that comes with direct access, the OOA urges you to call your legislators and let them know the dangers of this bill. This bill poses a tremendous public health risk.

Please Call Your Legislators and Ask Them to Oppose HB 1020!

This bill will undoubtedly lead to scope of practice overreaches by other physician extenders. The reasons for opposing this bill are many. Please feel free to mention any of the following statements in opposition to this bill: • Allowing PTs to expand their scope of practice, without also increasing their level of education and training require ments, runs counter to the state's obligation of protecting the public. Oklahoma D.O. | May / June 2014


Truth in Advertising: 2008-2010 Survey Results; American Medical Association, available at http://www.ama-assn. org/resources/doc/arc/tiasurvey.pdf 1

Budget Shortfall Impacts Physicians

This budget crunch will have a direct impact on physicians who proOklahoma D.O. | May / June 2014

Several budget savings are being considered, such as decreasing Medicaid services as well as reducing provider rates. Only if the additional $90 million budget is approved will provider rates likely remain constant. If the OHCA receives a standstill budget, provider rates are still likely to be reduced—by about 6% or 7%. If the agency receives a 5% cut like several other agencies, provider rates could be slashed by as much as 14%. Regarding state revenues, an item yielding a great deal of discussion is the gross production tax. Oil companies are currently benefiting from a generous tax cut, set to expire next year. The tax on horizontal drilling is currently only 1%, down from 7%. In early May, executives from Chesapeake Energy, Devon Energy, and Continental Resources announced a proposal that would establish a permanent 2% tax rate on horizontal as well as vertical drilling for the first 4 years on all new wells. By comparison, tax rates on horizontal drilling is above 7% in oil powerhouses Texas and North Dakota. The Oklahoma Tax Commission estimates this gross production tax cut will cost state coffers about $250 million in 2014. The tax giveaway was approved at a time when fracking was a less common technique and more experimental. Now, horizontal drilling makes up about 90% of state production.

House Republicans Re-elect Speaker Hickman

On May 5, House Republican met behind closed doors to elect their caucus leader for the next two years. This caucus election comes only three months after the most recent leadership election following Rep. T.W. Shannon’s exit as Speaker of the House. Rep. Shannon stepped down in early February to focus on his campaign for the United States Senate, an open seat created by Sen. Tom Coburn’s resignation effective January 2015. Rep. Jeff Hickman, R-Fairview, defeated Rep. Jason Murphey, RGuthrie in this intracaucus battle. Vote totals are not available and were not publicized to the Republican caucus. Following the election, Speaker Hickman released a statement touting his conservatism. “It has been an honor to serve as Speaker of the House for the past three months, and I am humbled that my fellow Republican members have chosen me as Speaker-designate for the 55th Legislature,” said Hickman, R-Fairview. “This session, we have passed several conservative measures in the areas of education, tax relief and pension reform. House Republicans have shown their willingness to work hard so that Oklahoma continues to be a conservative example of prosperity to the rest of the nation. I look forward to the upcoming months so we can prepare for a new session with new faces and ideas; but at the same time, my focus is on completing the business ahead of us in the remaining weeks of this session.”

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The legislature is tackling many issues in the closing weeks of session, most notably the state budget shortfall of nearly $200 million. This shortfall is compounded by a growing population that requires additional services. The Board of Equalization certified a $188 million budget shortfall for the next fiscal year and Gov. Mary Fallin has stated that many agencies will receive up to a 5% cut.

vide care to Medicaid patients. The Oklahoma Health Care Authority, which administers the state’s Medicaid program, is requesting an additional $90 million from the state legislature for the next fiscal year. At the monthly OHCA board meeting on May 8, OHCA CEO Nico Gomez spoke about the ongoing complexity of the budget negotiations. “There’s a lot of options and a lot of work still to be done. So there’s still some level of detail that needs to be processed as we go through and ask, ‘Are there unintended consequences to our actions that we aren’t considering?’” said Gomez. About 850,000 Oklahomans are enrolled in the program, most of whom are children.

Oklahoma D.O.

• Inserting a physical therapist before a physician in the team approach to medicine prioritizes convenience before care. • To preserve a patient’s health, he or she should be evaluated by his or her physician before receiving treatment from a physical therapist. This is the only way to ensure that no disease or condition goes unnoticed. • Patients who see a PT before a physician will be going 30 days without a possible diagnosis. • HB 1020 will not cover PTs for Medicaid patients. • HB 1020 is not covered under worker’s compensation. • Multiple PT visits will shift costs to employer-sponsored plans. • Medical costs skyrocket as a result of increased malpractice suits against PTs who are not adequately trained to evaluate the whole patient. • Physical therapy students typically complete only 2 semes- ters' worth of full-time clinical training. Physicians are re- quired to complete 3-7 years of residency training in a clinic or hospital. • Following graduation, PTs are not required to complete post-graduate supervised medical education or training. Physicians in Oklahoma must complete no less than 16 hours of credit annually to maintain licensure. • The bill will harm patient outcomes by expanding the scope of practice for PTs beyond their education and training without appropriate supervision and oversight. • Osteopathic physicians complete four years of osteopathic medical school, which includes two years of didactic study and two years of clinical rotations. Clinical rotations in the third and fourth years are done in community hospitals, major medical centers and doctors’ offices. This is followed by three to seven years of postgraduate medical education, i.e., residencies, where DOs develop advanced knowledge and clinical skills relating to a wide variety of patient cond itions. Physicians have both extensive medical education and comprehensive training that prepares them to under- stand medical treatment of disease, complex case manage- ment and surgery. • In a national patient survey, 90% of respondents said that a physician’s additional years of education and training are vital to optimal patient care, especially in the event of a complication or medical emergency.1 • Allowing direct access to PTs will not expand access to care for health services in rural or underserved areas. PTs in Oklahoma practice in the same areas in the state as pri- mary care physicians, physical medicine and rehabilitation physicians, and orthopaedic surgeons.


House Republicans will vote to reaffirm this decision following the general election in November to include the voices of the newly-elected state legislators.

Senate Republicans re-elect President Pro Tempore Bingman

On April 15, the Senate Republicans re-elected Sen. Brian Bingman of Sapulpa to serve as President Pro Tempore of the Senate. This election makes Bingman the first Republican in state history to serve three terms as President Pro Tempore. In a statement, Sen. Bingman said, “I am incredibly humbled and honored that my fellow Senators have given me the opportunity to continue to serve the state and all Oklahomans in this capacity. I look forward to working with the full membership of the Senate as we continue our efforts to create the jobs we need to fuel Oklahoma’s economy for generations to come.” Bingman went on to list workers’ compensation and lawsuit reform, a push for a reduction in Oklahoma’s income tax rate, and removal of Common Core standards from statutes among his leadership victories. “There is still much more work to do to make Oklahoma the best place to live and work in the nation,” said Bingman. His Democratic counterpart, Sen. Sean Burrage, congratulated Bingman by stating, “I want to offer my sincere congratulations to President Pro Tempore Brian Bingman. It has been a pleasure serving with Sen. Bingman, and it’s also been my privilege to co-author several pieces of legislation with him. He’s a man of intelligence, integrity and humor. I feel fortunate to count Brian as a friend and I wish him the best in his third term as President Pro Tempore,” said Burrage. Bingman will formally be elected Senate President Pro Tempore for the 55th Legislature in January of 2015.

Senate Democrats Oust Leader-Elect Sparks, Elect Sen. Randy Bass

Oklahoma D.O. PAGE 36

The Oklahoma Senate Democrats ousted Sen. John Sparks, only a few weeks after initially electing him to serve as their next caucus leader on Feb. 17. The current Democratic Leader of the Senate is Sen. Sean Burrage of Claremore. Burrage is not term-limited but decided not to seek re-election. In a statement addressing the sudden switch, Sen. Bass said, “the issue of the horizontal drilling tax is an overriding one this session, especially considering the budget constraints we’re facing. We realize there’s a great deal at stake for everyone at the table, and discussions are ongoing. We understand the vital role the energy industry has played in Oklahoma’s past—a role it will continue to play in the future. At the same time, we also understand the serious needs facing our state, particularly in education. As a caucus, we had agreed to let those discussions unfold before staking out a definitive position. When that didn’t happen, there was a decision that we needed to go in a different direction to move the caucus forward. I appreciate the support of my fellow Senate Democrats, and I look forward to the challenges ahead as we work to address the needs of our citizens and the great state of Oklahoma.” Sen. Bass will ascend to Democratic Leader of the Senate when the caucus meets in advance of the 55th Legislature.

Patients First Coalition meets, discusses pressing legislation in the final month of session

The Patients First Coalition met several times in the final weeks of session (April 22, May 6, and May 13) to discuss issues impacting physicians. Two of the most essential pieces of legislation impacting the public health and patient access to care, HB 1020 and SB 1820, have absorbed a great deal of time for the coalition as well as the lobbyists and staff of the respective physician organizations. The OOA, OSMA, and leaders from the physician specialty organizations are collectively working to remove the most excessive components of these bills, or ideally, defeat them entirely. Given the quickly changing nature of the legislation and our need for your active engagement, please stay tuned to the weekly OOA Report and be responsive to any action alerts issued by the OOA. The Patients First Coalition works to ensure quality patient care by ensuring physicians serve as the leader in a team approach to medicine and defends against scope of practice overreaches.

Health Insurance Marketplace Enrollment Surpasses Estimate, Tops 8 million

The six month open enrollment period for the Health Insurance Marketplace ended March 31 with a flurry of activity. While official tallies are still being finalized, estimates show more than 8 million American enrolled for private health insurance through the marketplace on healthcare.gov. The Obama Administration allowed those individuals who had at least begun their online application by March 31 to enroll as long as their application was submitted no later than April 15. 2.2 million, or 28%, of the new enrollees are between the ages of 18 and 34. That number increases to 2.7 million, or 34%, when including ages 0 to 17. In a news release issued by the Health & Human Services (HHS) on May 1, HHS Secretary Kathleen Sebelius reported an additional 4.8 million individuals have enrolled in Medicaid and CHIP (Children’s Health Insurance Program) since Oct. 1, 2013. CHIP provides insurance to children in families who earn too much to qualify for Medicaid but cannot afford to purchase health insurance. Also, young adults who gained coverage through their parent’s health plan total another 3 million. “More than 8 million Americans signed up through the Marketplace, exceeding expectations and demonstrating brisk demand for quality, affordable coverage,” said Sibelius. Of those more than 8 million enrollees: 54% are female, a clear majority (65%) selected a Bronze plan, and 85% selected a plan with financial assistance. Financial assistance was available to all individuals between 138% and 400% of the Federal Poverty Level (FPL). For a family of four, 400% of the FPL is approximately $94,000. For the first time, ethnicity statistics for the federal Marketplace were also released. 31% of enrollees elected to not report their race/ethnicity or chose “other.” Of those who reported: • 63% are white • 17% are African American • 11% are Latino • 8% are Asian • 1.3% are multiracial Oklahoma D.O. | May / June 2014


• 0.3% are American Indian/Alaska Native • 0.1% are Native Hawaiian/Pacific Islander

In Oklahoma, nearly 70,000 individuals enrolled for private insurance though healthcare.gov. A report issued in April 2014 by the Henry J. Kaiser Foundation estimates approximately 145,000 Oklahomans fall into this coverage gap, all of whom make less than $16,000 a year. However, Oklahoma did not establish its own marketplace and did not advertise the marketplace to its citizens. Also, Oklahoma did not expand Medicaid as allowed by the Affordable Care Act (ACA). The ACA mandated this expansion but the Supreme Court repealed this portion of the legislation in June of 2012. Therefore, a gap exists for low-wage earners between current Medicaid eligibility in Oklahoma and where premium subsidies begin (138% of FPL). According to the report, Oklahoma has the highest rate of low-income, non-elderly uninsured individuals in the nation—65%. Perhaps the greatest unreported story of the national health care discussion is the number of individuals who purchased insurance directly through private carriers. The RAND Corp. estimates 7.8 million Americans purchased health insurance between September and mid-March directly from a carrier. The RAND Corp. is a nonprofit institution that helps improve policy and decision-making through research and analysis. Therefore, between those purchasing insurance through the marketplace, gaining coverage through their parent’s plan, enrolling in Medicaid, or purchasing coverage independently, more than 23 million Americans have gained health insurance since the passage of the Affordable Care Act in 2010. Information relating to the impacts of rejecting Medicaid expansion can be found at: http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsuredpoor-adults-in-states-that-do-not-expand-medicaid/

OSU Medical Center Appropriation Update

State agencies are preparing for cuts as the budget picture for the state of Oklahoma continues to darken. Despite the decreasing revenues, Gov. Mary Fallin signed a bill last month reducing rate on the top state income tax bracket. This bill will go into effect in 2015 and reduces the tax on the top bracket from 5.25% to 4.85% over the course of 2 years, provided certain revenue triggers are met. The first reduction is from 5.25% to 5.0% with the second year covering the remainder. According to the Oklahoma Tax Commission, the tax cut will provide an estimated $1,377 in savings for those making more than $1 million a year and will only provide a savings of no more than $19 for those making less than $34,000 a year.

As mentioned earlier in the Legislative Report, another central item Oklahoma D.O. | May / June 2014

Governor Signs Law Banning e-Cigarettes Sales to Minors

On April 28, Gov. Mary Fallin signed a law banning sales of electronic cigarettes and vapor products to minors. SB 1602, authored by Sen. Rob Johnson, R-Kingfisher, passed unanimously in both chambers and finalizes state action in advance of similar legislation expected at the federal level. The bill modifies the Prevention to Youth Access to Tobacco Act and establishes fines for those found in violation. The OOA Board of Trustees supported any legislative vessel which achieved a ban on e-cigarettes sales to minors after being brought forth by the OOA’s Bureau on Legislation. The bill defines vapor product as “noncombustible products that may or may not contain nicotine, that employs a mechanical heating element, battery, electronic circuit, or other mechanism, regardless of shape or size, that can be used to produce a vapor in a solution or other form. Vapor products shall include any vapor cartridge or other container with or without nicotine or other form that is intended to be used with an electronic cigarette, electronic cigar, electronic cigarillo, electronic pipe, or similar product or device and any vapor cartridge or other container of a solution, that may or may not contain nicotine, that is intended to be used with or in an electronic cigarette, electronic cigar, electronic cigarillo or electronic device.” Also, “vapor products do not include any products regulated by the United States Food and Drug Administration under Chapter V of the Food, Drug, and Cosmetic Act.” The bill will go into effect on Nov. 1, 2014

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While the state income tax cut will further complicate future budget negotiations, several funding concerns exist for the upcoming 2015 fiscal year. Chief among them is the Oklahoma Health Care Authority (OHCA). The OHCA is seeking a budget increase of $144 million in a year the state has $188 million less to spend than the previous year.

As budget shortfalls typically affect every agency that receives an appropriation, the shortfall is also of concern for OSU Medical Center officials. OSUMC received $13 million last year and was able to draw down another $5 million in federal matching funds. This year, the OSU Medical Authority (the trust that oversees OSUMC) is slated to receive $12.35 million in Gov. Fallin’s budget for the next fiscal year. For the first time ever, this appropriation is currently built into the base as a recurring annual appropriation.

Oklahoma D.O.

The Tax Foundation, an independent tax policy research organization, ranks Oklahoma as having the 12th lowest state and local tax burden in the country, totaling 8.7%. Local taxation is also minimal, as Oklahoma’s property taxes are ranked 2nd lowest in the nation. The Tax Foundation researches and analyzes tax policy at the federal, state, and local levels and was started in 1937.

relating to the budget is taxation on horizontal drilling. This tax on this production was initially 7%, but has benefited from a tax giveaway the past four years with a nearly non-existent tax of 1%. Budget negotiators and the Governor continue to review proposals in developing the state budget.


OSU and Mercy Finalize Agreement to Manage OSU Medical Center Agreement Will Focus on the Future of the Downtown Tulsa Hospital

M

Provided by: Jamie Calkins, Marketing/Media Coordinator, OSU Medical Center

Oklahoma D.O. PAGE 38

Mercy Health and Oklahoma State University Medical Authority (OSUMA) announced an agreement for Mercy to manage the Oklahoma State University Medical Center in downtown Tulsa.

as the teaching hospital for the Oklahoma State University College of Osteopathic Medicine.

“Mercy shares our commitment to provide primary care physiIn April, OSUMA cians to Oklahoformally selected ma through our Mercy as their manmedical school agement partner. and teaching hosIn the intervenpital. The OSU ing weeks OSU Medical Center is Back row from left to right: Wasim Patel, Financial Analyst Mercy; Kayse M. Shrum, DO, President and Provost of OSU Center for Health Sciences; Diane Rafferty, CEO OSU Medical Center. Front row left to and Mercy worked the nation’s largright: David Tew, COO Mercy Health System of Oklahoma; Di Smalley, Mercy Regional President, State of through the operaest osteopathic Oklahoma; Jerry Hudson, OSU Medical Authority President. Picture take April 2014. tional details to finalteaching hospital ize the management agreement. and this agreement ensures that our cy’s regional president for the state of medical students and residents will have Oklahoma. “The Mercy culture of car“We are very pleased to sign a manan excellent facility and inspiring mening should be an ideal fit in Tulsa. We agement contract with Mercy Health tors and faculty to continue their mediare already exploring ways to customize to manage our medical center. Our cal education,” said Kayse M. Shrum, well-proven systems and processes to steadfastness to find an ideal partner DO, president and provost of OSU make the transition as seamless as posthe past two years has paid off with an Center for Health Sciences. “That pipesible.” agreement which will strengthen and line of primary care doctors is essential expand the mission of our urban hosto Oklahoma’s well-being. This is a vital “OSU couldn’t have chosen a better pital in Tulsa through the commitment first step in building a long-term relaprivate partner to manage the OSU of resources and expertise from Mercy tionship with Mercy.” Medical Center. During negotiations Health,” said Jerry Hudson, OSU the past two years, Mercy has remained Medical Authority president. “The The Tulsa economy depends on the steadfast in its commitment to the fuever changing national health care enOSU Medical Center for more than ture success of the hospital,” said OSU vironment has made it near impossible 900 high-paying jobs with more than President Burns Hargis. “We want to to independently operate our medi$125 million in economic impact inthank Gov. Mary Fallin, the Oklahoma cal center. This contract with Mercy cluding tax collections. State Legislature and the leadership in Health represents a big step in securing Tulsa for standing by us in the effort to a bright future for our medical center The new agreement went into effect ensure Tulsa and Northeastern Oklaand medical school. ” May 1, 2014. DO homa will have a downtown medical center that will thrive and offer an ex“OSU has built a solid foundation of ceptional level of care.” quality medical care and compassionThe OSU Medical Center has a unique ate healing in downtown Tulsa and it dual role to care for the medically unwill be a privilege to build on that sucderserved in the region and to serve cess,” said Di Smalley, FACHE, MerOK

Oklahoma D.O. | May / June 2014


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What DO’s Need To

KNOW

House Energy and Commerce Committee Hearing Examines Telemedicine The House Energy and Commerce, Health Subcommittee in a hearing offered strong bipartisan support for removing roadblocks to the expansion of telemedicine. Only $12 million was billed to Medicare for telemedicine services in 2013. At the hearing, Rep. Joe Barton (R-TX) promised to ask the Centers for Medicare and Medicaid Services (CMS) to immediately lift some billing restrictions, but experts said it would take legislative action to significantly expand federal payments for telehealth, and licensure issues must be addressed. Rand Corporation Policy Analyst, Dr. Ateev Mehrotra, said that telemedicine can lower costs on a per-visit basis, but could increase spending as patients seek additional clinical encounters with the convenience of telehealth. It can help those in rural areas, but those in urban areas may turn to telehealth because of this convenience. Dr. Mehrotra added that the cost of increased access could be tempered through bundled payments. The AOA submitted a Statement for the Record of its telemedicine policy, which was accepted by the subcommittee. CMS Releases More Details on ICD-10 Delay The new implementation date for ICD-10 coding is October 1, 2015, according to the Centers for Medicare and Medicaid Services (CMS), which is a delay of one year. The use of ICD-10 coding was scheduled to start Oct. 1, 2014 but Congress mandated the delay through Protecting Access to Medicare Act of 2014 (Public Law 113-93), following mounting pressure from physician associations, including the AOA. Earlier this year, the AOA sent a letter to HHS Secretary Kathleen Sebelius opposing implementation of ICD-10 due to the anticipated costs and burdens facing physicians. Physicians and other HIPAA-covered entities must continue to use ICD-9 coding through September 30, 2015. Due to the ICD-10 implementation delay, CMS has cancelled claims testing of ICD-10 codes for the remainder of this year. The agency is expected to release an interim final rule regarding the latest changes. No release date of the interim rule has been announced. New Guidance from CMS on Hospice Drug Payments Beginning this month, prescribed medications for hospice patients billed to Medicare Part D could be denied unless certain requirements are fulfilled, according to a memo by the Centers for Medicare and Medicaid Services (CMS) to Part D Plan Sponsors and Medicare Hospice Providers. The purpose of the guidance is to prevent Medicare from paying for the same drugs twice. Sometimes drugs that are covered under the Medicare Hospice benefit have been paid by Medicare Part D drug plans as well. Prescriptions related to palliative and comfort care are already covered under Medicare’s hospice benefit and therefore should not be paid under Part D for patients who elect the hospice benefit. Part D insurers have therefore been instructed not to pay for any prescriptions by hospice patients until prior authorization requirements have been fulfilled to determine that the prescription is for a condition unrelated to the terminal illness.

Oklahoma D.O. PAGE 40

If your practice experiences any difficulties as a result of this policy, please report it Carol Monaco, AOA director of Federal Affairs. Review Your Sunshine Act Information Before CMS Publishes It Starting June 1, physicians and teaching hospitals can register with the Centers for Medicare and Medicaid Services (CMS) to review information about payments or other transfers of value given to them by the drug or device industry prior to public posting of the data under the Physician Payments Sunshine Act. Educational materials about the Sunshine Act are available on the AOA’s web page. Registration in the CMS Enterprise Portal (the gateway to CMS’ Enterprise Management system) is voluntary; however, it is required if physicians or teaching hospitals want to review and dispute any of the data reported about them. Any data that are disputed, if not corrected by industry, will still be made public but will be marked as disputed. Learn more about the review and dispute process. In the coming weeks, CMS will provide additional guidance about how to complete the CMS registration process, and when Phase 2 registration and the review and dispute process will begin for physicians and teaching hospitals. Oklahoma D.O. | May / June 2014


Oklahoma D.O. PAGE 41

Oklahoma D.O. | May / June 2014


y a M

birthdays

1st Gary K. Cunningham II, DO Chad E. Borin, DO Jimmy B. Dang, DO 2nd Violet Saint John, DO Terence E. Grewe, DO Shelly D. Faubion, DO Lisa M. Regal, DO Julie A. Curry, DO Qualls Stevens, DO

Oklahoma D.O. PAGE 42

3rd Michael Wyly, DO Donald N. MacIver, DO Timothy J. Frink, DO Tanya S. MacLaren, DO Nathan G. Reusser, DO Anne Winsjansen, DO 4th Gregory J. McWilliams, DO Trenton L. Mefford, DO Brent W. Hinkle, DO Brandy M. O'Neal-Duke, DO Cerissa K. Key, DO

5th Paul G. Bizzle, DO Wallace J. Champlain Jr., DO Theresa A. Murch, DO Julie M. Morrow, DO James R. Madison, DO Erin N. Hill, DO Michael Todd Cannon, DO Michael L. Gearhart, DO 6th Nancy K. Walter, DO John W. Hester, DO Robert T. Lehew, DO Jordan E. Brown, DO Casey L. Snodgress, DO 7th James C. Cooper Jr., DO Juanita Pappas, DO James A. Wagner, DO Ted W. Kaspar, DO Shane K. Marshall, DO 8th Said S. Sadeghi, DO Marchel W. Clements, DO David R. Ring, DO Martiann A. Bohl-Witchey, DO Benjamine M. Welch, DO

9th Michael L. Beals, DO Roy L. Goddard Jr., DO Elizabeth S. Monnot, DO Patrick M. Cody, DO Melissa A. Gastorf, DO Kelley M. Struble, DO 10th George M. Cole, DO Jack S. Aldridge, DO Kevin M. Riccitelli, DO Harriet H. Shaw, DO Timothy H. Sanford, DO Greta A. Warta, DO 11th Cheryl A. Boyd, DO C. Michael Ogle, DO C. Scott Anthony, DO Douglas W. Brant Jr., DO 12th Darwin B. Childs, DO David D. Moon, DO Beth M. May, DO William A. See III, DO Gregory C. Claiborn, DO 13th Thomas W. Essex, DO Todd C. Beasley, DO Gabriel M. Pitman, DO 14th Dale E. Wheeler, DO Jeffrey D. Endsley, DO Michael W. Herndon, DO Donna R. Hill, DO Brennon K. Cox, DO Robert W. Brinkley, DO Robert C. Burwell, DO Brianne E. Clark, DO Jonathan P. Dunker, DO

Oklahoma D.O. | May / June 2014


15th C. Lon Smith, DO Perry W. Evans Jr., DO Shanna E. Hampton, DO 17th Margaret A. Stripling, DO Jonathan R. Clark, DO Scott E. Evans, DO 18th Ted C. Clark, DO Patricia J. Allison, DO Billy R. Bryan, DO Anthony L. Cruse, DO Kash K. Biddle, DO Noel E. Gattenby, DO Karin E. Shinn, DO Tracy L. Asher, DO John T. Maple, DO Christopher M. Crocker, DO Phillip Scott Williams, DO Justin W. Fairless, DO, NRP Nicole M. Willis, DO 19th Stephanie Kuehling, DO Stephanie E. Summers, DO Dennis S. McFadden, DO

26th J. Dewayne Geren, DO Roberto Gonzalez Jr., DO Regan Nichols, DO Joseph M. Nicholson III, DO Paula A. Deupree, DO Britt D. Morris, DO Samuel S. Maroney, DO Michael P. McLaughlin, DO

22nd Robert J. Wiebe, DO Roy N. Skousen, DO Mark D. Gage, DO Janice M. Tuohy, DO Gail R. Marchant, DO Leslie J. Ollar-Shoemake, DO Royce L. Bargas, DO Lori M. Schimmel, DO

27th Steven J. Finley, DO Lenard B. Phillips Jr., DO James P. McClay, DO Atul A. Walia, DO Mark D. Callery, DO Mindi M. Bull, DO

23rd George M. Turner, DO Joe D. Huddleston, DO Denny R. Parton, DO Mary K. Mills, DO Blake E. Weaver, DO 24th Paul A. Waruszewski, DO Raymond W. Deiter, DO Donald L. Sutmiller, DO Robert W. Worden, DO Leah G. Baxter, DO 25th Joseph R. Schlecht, DO John B. Marlar, DO Gerald G. Reed, DO Bret A. Hubbard, DO

28th James R. Turrentine, DO Larry D. Cherry, DO Richard J. Helton, DO Tina D. Dickerson, DO Michael L. Lawrence, DO Sarah K. Hamill, DO 29th Christy A. Bennett, DO B. Don Schumpert Jr., DO Justin R. Bryant, DO Shannon L. Thomas, DO Laura Fluke, DO 30th Cyrus D. Motazedi, DO R. Jeffrey Cotner, DO Carol N. Azadi, DO 31st Christian M. Ellis, DO

Oklahoma D.O.

20th B. Frank Shaw Jr., DO J. Steve Grigsby, DO Ronald S. Stevens, DO Cary L. Lacefield, DO Parker Kim Truong, DO Le K. Lee, DO Mark H. Thai, DO Ann M. Shaw, DO

21st Gary E. Johnston, DO Paulette P. Bennett, DO Kenneth R. Trinidad, DO Robert J. Gunderson, DO Stacia B. Shipman, DO Ashley N. Muckala, DO Katie L. Washburn, DO Amber M. Williams, DO

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Oklahoma D.O. | May / June 2014


june birthdays 1st Robert D. Baker, DO Gregg J. Eichman, DO E. Joseph Sutton II, DO Yvan N. Thomas, DO

Oklahoma D.O. PAGE 44

2nd Kelly A. Fitzpatrick, DO Tom A. Hamilton, DO Scott E. Hendrickson, DO Dawn J. Hensley, DO Robert D. McCullough II, DO Jason D. Remington, DO Jason L. Riffe, DO L. Janelle Whitt, DO 3rd Jeffrey Gastorf, DO Benjamin A. Kamp, DO Randall L. Kemp, DO Larry G. Mobly, DO Valerie A. Schmidt, DO Mousumi Som, DO 4th Donald W. Hahn, DO Jessica Lewis, DO Chelsea C. McGee, DO John S. Musilla, DO

5th Curtis E. Ball, DO Dennis J. Carter, DO Marie J. Carter, DO David M. Gearhart, DO Jim B. Harjo, DO Jana L. Jordan, DO Eric D. Long, DO Vania O. Revell, DO Michelle E. Webster, DO 6th Donald R. Barney, DO Keri Conner, DO Jeremy L. Jones, DO Susan J. Jones, DO Anne E. Kozlowski, DO Kayla Lakin-Southern, DO Linda Lantrip, DO Brian H. Lewis, DO Gerald M. Martin, DO Matthew R. Misner, DO Thomas R. Pickard, DO 7th Elizabeth K. Harris, DO Christopher A. Lane, DO G. Adam Vascellaro, DO Debra M. Webb, DO

8th Carrie J. Clark, DO Phillip W. Jones, DO Nick T. Reynolds, DO Michael E. Salrin, DO Robert Bradley Vogel, DO Rudolph J. Wolf, DO 9th Marilyn Appiah, DO James Brull, DO Chelsey D. Griffin, DO Danny E. Thomason, DO 10th Donald G. Dunaway, DO Earl G. Garrison Jr., DO Robert W. Hasselman, DO Thomas S. Ivan, DO Dereck A. Peery, DO William J. Pettit, DO Vernon S. Smith, DO Kevin J. Yunt, DO 11th Erin L. Balzer, DO

Oklahoma D.O. | May / June 2014


12th Michele Bucholtz, DO Joel W. Corn, DO Keenan L. Ferguson, DO Ron M. Gann, DO Keith R. Layne, DO Jay M. Williamson, DO

19th Anthony G. Bascone, DO Courtney M. Carter, DO Jeffrey L. Galles, DO Michael D. Hendrix, DO Gregory A. Hill, DO James M. Short, DO Robert S. Warren, DO

13th Keith W. Russell, DO

20th Ronald M. Cable Jr., DO Michael J. Major, DO Jason K. Regan, DO Michael B. Scott, DO

14th E. Dawn Campbell, DO Catherine L. Gaffney, DO Douglas A. Matey III, DO Gary Wells, DO Dennis A. Williams, DO Deena R. Wise, DO 15th Erin K. Allen, DO Craig A. Anderson, DO Lindsey B. Barnes, DO James R. Davis, DO Patrick A. Sharp Jr., DO Lewis D. Shuler, DO 16th Francis C. Eaton, DO H. Chayne Fisher, DO Constance G. Honeycutt, DO Anita D. Patel, DO

Oklahoma D.O. | May / June 2014

23rd Shane J. Ashford, DO Laurie A. Duckett, DO Miranda L. Johnson, DO Matthew R. Okland, DO 24th Robert L. Archer, DO Ladd Atkins, DO Murray D. Crow, DO Carol D. Gambrill, DO Samara H. Peters, DO Ebb W. Reeves, DO Barbara S. Saunders, DO

27th Jonathon D. Kirkland, DO Rick L. Robbins, DO 28th Theresa A. Cooper, DO David S. James, DO 29th Kevin T. Fisher, DO Chariny M. Herring, DO Asha Raju, DO Lori B. Stewart, DO Marvin Williams Jr., DO 30th David L. Bradshaw, DO Trinh Nam Ho, DO Michael J. Irvin, DO Shancy Jacob, DO Michael A. Whinery, DO

PAGE 45

18th Richard E. Castillo, DO Kevin J. Gordon, DO Stephanie L. Hall, DO James E. Harrington, DO Wade G. McClain, DO

22nd Jeffrey L. Gibson, DO Gregory Gray, DO Kenny M. Grider, DO M. Adele King, DO Byron J. Marr, DO Jim G. Melton, DO Ronald N. Oglesby, DO

26th Mark D. Erhardt, DO Barry D. Troutman, DO

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25th Arielle M. Allen, DO Philip M. Beck, DO Christian D. Nielsen, DO Sharon E. Noel, DO Stanley R. Stacy, DO


American Osteopathic Association Health For the Whole Family

“Sorting Out Seasonal Allergies” Sneezing, runny nose, nasal congestion. Symptoms of the common cold or seasonal allergies? Without the intervention of your physician, it might be hard to tell. Here’s what you should know about seasonal allergies – what causes them and how you might avoid them this season. “Allergies are an abnormal reaction by a person’s immune system to a normally harmless substance,” explains Pamela A. Georgeson, DO, an osteopathic allergist from Chesterfield Township, Mich. “People can be allergic to all types of things, including pollens from trees, grasses and weeds, mold spores, pet dander, dust mites, foods and medications.” According to Dr. Georgeson, the term “seasonal allergies” refers only to allergic reactions triggered during certain times of the year, such as spring or fall. They are typically allergic reactions to tree, weed, grass and ragweed pollen. “As the weather gets warmer and plants start to bloom, trees and grasses release pollen into the air,” says Dr. Georgeson. “For people with seasonal allergies, this pollen reacts with antibodies in the body, causing histamine and other chemical substances to be released, which then cause various symptoms.”

Symptoms of seasonal allergies can include:

• • • • • •

Sneezing Runny nose Nasal congestion Itching of the nose Post-nasal drip Itchy, puffy, red, and watery eyes

Oklahoma D.O. PAGE 46

“Not everyone will experience all the symptoms of seasonal allergies.” says Dr. Georgeson.

How do I know if I have seasonal allergies?

According to Dr. Georgeson, the best way to determine whether or not your symptoms are caused by seasonal allergies is to visit your primary care physician. “Your physician may see different signs during a physical exam that point to allergies, such as the appearance of your nasal mucous membranes,” she explains. “The only true way to determine if a person has allergies, however, is to undergo allergy testing. So, your physician may recommend that you visit an allergist for further evaluation to identify what allergies you have.” Oklahoma D.O. | May / June 2014


Preventive medicine is just one aspect of care osteopathic physicians (DOs) provide. DOs are fully licensed to prescribe medicine and practice in all specialty areas, including surgery. DOs are trained to consider the health of the whole person and use their hands to help diagnose and treat their patients.

Avoiding seasonal allergies

Because seasonal allergies are caused by pollen that exists in the air, they can be difficult to avoid, but not impossible. Here are Dr. Georgeson’s six tips for avoiding pollen exposure. 1. Keep doors and windows closed, both in your home and when traveling. Use air conditioning. 2. Do not mow the lawn or go near freshly cut grass.

3. Limit morning outdoor activity, when pollen is usually emitted— between 5-10 a.m.

4. Take a vacation during the height of the pollen season to a more pollen-free area, such as the beach.

5. Do not hang your laundry outside to dry, where it can collect pollen.

6. Remove clothing and shower if you have spent a lot of time outdoors.

How do I treat my seasonal allergies?

“Avoidance is best, but often not practical. Some of the most common treatments for seasonal allergies are over-the-counter antihistamines and decongestants,” says Dr. Georgeson. “Your physician may also prescribe steroid nasal sprays, which work to decrease inflammation.” If environmental/avoidance precautions and medications fail to provide relief, allergy shots are usually administered.

Am I stuck with seasonal allergies forever?

Some allergy sufferers become so accustomed to their symptoms that living with them becomes a way of life and they accept the inconveniences of seasonal sniffling and sneezing. Usually after treatment, they will realize the improvements in their quality of life and productivity. “Your physician can best determine a method of treatment that will suit your lifestyle,” says Dr. Georgeson. “The thing people need to realize is that they do have options when it comes to dealing with allergies.”

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CENTER FOR HEALTH SCIENCES Mousumi Som, DO, FACOI Assistant Professor of Medicine Department of Internal Medicine Preventing Sudden Cardiac Death Utilizing Wearable External Cardiac Defibrillator: The OSUMC Experience Mussaber Ahmad, DO Cardiology Fellow OSU Medical Center Tu Cao, DO Internal Medicine Resident OSU Medical Center D. Matt Wilkett, DO Attending Cardiologist OSU Center for Health Sciences Jeffrey Stroup, PharmD, BCPS Associate Professor OSU Center for Health Sciences

Oklahoma D.O. PAGE 48

Objective: To perform a retrospective analysis of all patients to whom wearable external cardiac defibrillators (WCD, Zoll Lifevest) were prescribed to determine if a significant mortality benefit was conferred to patients and to determine which subset of the population based on risk factors would benefit most from wearable external cardiac defibrillator therapy. Background: Many studies have been performed over the years demonstrating a clear mortality benefit conveyed by ICD implantation in patients with depressed left ventricular function. Large scale trials evaluating the mortality benefit of WCDs are in progress. Most notably, the ongoing WEARIT-II registry will enroll 2000 patients in the United States and 1000 in Europe and Israel. Recently, an analysis of 882 patients enrolled in the United States arm of the registry demonstrated a 1.13% absolute mortality benefit. 1 To date no studies stratify which patients would benefit the most based on

Oklahoma State University Center for Health Sciences College of Osteopathic Medicine 1111 West 17th Street Tulsa, Oklahoma 74107-1998 risk factors or type of cardiomyopathy. Methods: Risk profiles of all patients prescribed external defibrillators at OSUMC from 12/1/2010 to 1/1/2013 were compiled. The patients were subdivided into subsets of ischemic and non-ischemic cardiomyopathy. Additional risk factors including anemia, depressed renal function, diabetes, HTN, dyslipidemia, and current history of smoking were also evaluated. The data was then analyzed to determine overall conferred mortality benefit defined as an appropriate ICD firing. Also, risk factors were analyzed to see if a pattern of higher mortality benefit was evident in any subsets of the population. Results: A total of 50 patients were treated with wearable external cardiac defibrillators. Two patients received appropriate shocks conferring an overall mortality benefit of 4%. Further analysis demonstrated a 3.3% mortality benefit in the ischemic cardiomyopathy group compared to a 5% benefit in the nonischemic cardiomyopathy group. Conclusion: Our experience at OSUMC confirms that in appropriately selected patients implementation of WCD has a significant survival benefit. Our non-ischemic patient population showed the greatest mortality benefit. Large scale prospective studies are needed to better establish a risk stratification algorithm that will confer a more cost effective way to implement this life saving therapy by identifying patients with the greatest mortality benefit from WCD. Background: Sudden cardiac death (SCD) is a known complication of congestive heart failure. Up to 40% of patients die due to arrhythmias, predominately ventricular tachy-

cardia (VT) or ventricular fibrillation (VF). A multitude of trials have demonstrated a mortality benefit with implantable cardiac defibrillator (ICD) placement for primary prevention. 2,3,4 Current guidelines recommend ICD therapy for primary prevention 40 days post myocardial infarction or 90 days post medical optimization in cases of nonischemic cardiomyopathy. During this waiting period patients without an ICD are unprotected and at risk of succumbing to sudden cardiac death. A wearable automatic defibrillator vest (WCD, Zoll Lifevest) may confer a mortality benefit in these patients who are categorized as high risk for SCD. The WCD consists of a fitted jacket that has installed ECG sensing electrodes and shockelectrodes/gel packs that are connected to an alarm and monitor system. The most recent data presented by the WEARIT-II investigators was an analysis of the first 882 U.S. patients in the registry. The data demonstrated that WCD therapy resulted in appropriate defibrillation terminating ventricular tachycardia and/or ventricular fibrillation in 10 patients. The company states that at least one life is saved per day by wearable automatic defibrillator vests. Our goal is to compare OSUMC results with those reported in WEARIT-II. We will also attempt to identify patterns that might allow better risk stratification of patients to create a cost effective algorithm to those patients who would benefit most from WCD therapy. Methods: A retrospective analysis was performed of all patients prescribed WCD at Oklahoma State University Medical Center (OSUMC) from 12/01/2010 to 01/01/2013. In addition to age and gender the presence or absence of the following variables was recorded: history of diabetes, current smoker, hypercholesterolemia, hypertension (HTN), previous coronary angioplasty, previous bypass surgery, history of stroke, history of peripheral vascular disease, and creatinine clearance (CrCl) on admission during which WCD was preOklahoma D.O. | May / June 2014


Oklahoma D.O. | May / June 2014

Table 1. Figure 1.

Diabetes Mellitus (%)

60

50

Current Smoker (%)

43

55

Hypercholesterolemia (%)

83

60

Hypertension (%)

87

80

Anemia (%)

63

25

Creatinine Clearance <60 ml/min (%)

27

15

Triple Vessel Disease (%)

73

0

Prior PCI (%)

13

0

Prior Bypass Surgery (%)

10

0

History of Cerebrovascular Disease (%)

13

0

History of Peripheral Vascular Disease (%)

17

0

Figure 2.

Non-Ischemic Cardiomyopathy (N=20)

CADILLAC Risk Score Risk Factor

Points

Age >65 years

2

Killip class 2/3

3

Baseline left ventricular ejection fraction <40%

4

Anemia

2

Renal insufficiency

3

Triple vessel disease

2

Post-procedural Thrombolysis In Myocardial Infarction flow grade 0-2

2

Low Risk: 0-2, Intermediate risk: 3-5, High risk: â&#x2030;Ľ6

PAGE 49

Ejection fraction (EF) for each group was evaluated as well (figure 2). For the ischemic cardiomyopathy group the EF distribution was as follows: <20% in 43.3% of patients, 20-29% in 43.3% of patients, 30-35% in 10% of patients, and >35% in 3.3% of patients. For the nonischemic cardiomyopathy group the distribution was as follows:

Ischemic Cardiomyopathy (N=30)

Oklahoma D.O.

Thirty patients carried a diagnosis of ischemic cardiomyopathy compared to 20 with nonischemic cardiomyopathy (table 1, figure 1). The ischemic cardiomyopathy group had an average age of 56.5 (range 3379) and was predominately male (90%). 87% of the patients in this arm had HTN and 83% had hypercholesterolemia. 73% had triple vessel disease. 63% patients underwent revascularization, and the remainder were managed medically. Of those that underwent revascularization 8 patients (42%) had coronary artery bypass grafting and 11patients (58%) underwent percutaneous coronary intervention (PCI). The non-ischemic cardiomyopathy group had an average age of 58.5 (range 35-67) with a male predominance (70%). The predominant risk factor was HTN (80%). 60% of patients had hypercholesterolemia. No patients in this group had triple vessel disease, prior PCI or bypass surgery.

Figure 3.

Results: Fifty-four patients were prescribed a WCD at OSUMC from 12/01/2010 to 01/01/2013. 4 patients were excluded from the data analysis. One patient died in the hospital prior to discharge, thus the WCD was cancelled. 2 patients refused to wear the vest. One device was prescribed to a patient with Right Ventricular Outflow Tract Ventricular Tachycardia in the setting of preserved Left Ventricular Ejection Fraction.

scribed. The patients were subdivided into two groups, patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy. Outcomes in terms of appropriate termination by the WCD of rapid ventricular tachycardia or ventricular fibrillations were recorded. The data was then analyzed to calculate the percentage of patients who received a mortality benefit from WCD therapy. Risk profiles of patients with ischemic and nonischemic cardiomyopathy were compared to identify any patterns associated with patients at higher risk for SCD. The primary endpoint was clinical benefit defined as appropriate WCD therapy.


<20% in 45% of patients, 20-29% in 45% of patients, 30-35% in 5% of patients, and >35% in 5% of patients. Two episodes of rapid VT/VF were correctly terminated, one in each group. The patient in the nonischemic cardiomyopathy arm was a 62 y/o white male who had dilated non-ischemic cardiomyopathy (EF of 20%) secondary to alcohol abuse. Additional risk factors included hypertension, diabetes mellitus, and CrCl less than 60ml/min. The patient in the ischemic cardiomyopathy arm was a 47 y/o male with an EF of 15-20%. He had triple vessel coronary artery disease, HTN, hypercholesterolemia, and HIV. He underwent successful coronary artery bypass grafting, and while in the post revascularization waiting period had a VT/VF arrest that was successfully aborted by the WCD. Both of these individuals received an ICD thereafter.

Oklahoma D.O. PAGE 50

A total of fifty patients were treated with wearable external cardiac defibrillators. Two patients received appropriate shocks conferring an overall mortality benefit of 4% with a 3.3% mortality benefit in the ischemic cardiomyopathy group and a 5% benefit in the nonischemic cardiomyopathy group. Discussion: The majority of studies risk stratified patients for sudden cardiac death have been carried out in patients with myocardial infarction. Even in this subgroup sudden cardiac death rates have been shown to be reduced by 45% when ICD implantation occurs within 30 days of infarct. Unfortunately, trials such as the Immediate Risk Stratification Improves Survival (IRIS) trial have failed to prove a significant mortality benefit over a 3 year period for this selected group when comparing early ICD implantation to medical therapy. 5 However, the primary endpoint of overall mortality in patients with chronic stable class II or III heart failure with an ejection fraction of 35% or less is decreased by 23% when an ICD is implanted for primary prevention (SCD-HeFT). In the MADIT trial, a survival benefit became evident 18 months after infarction. Similarly, true mortality benefit of WCD therapy may only become apparent after long term follow up. Presently, various methods to risk stratify patients with ischemic cardiomyopathy can be utilized. The CADILLAC score is one such scale that has been validated in predicting 30day and 1 year mortality in patients

undergoing primary PCI.6 Patients receive 4 points for left ventricular ejection fraction <40%, 3 points for renal insufficiency, 3 points for Killip class 2 or 3, 2 points for final TIMI flow grades of 0 to 2, 2 points for age greater than 65, 2 points for anemia, and 2 points for triple vessel disease (figure 3). Higher scores correspond to increased mortality, and as such a potential survival benefit with WCD therapy exists. Presently, there is a lack of clear evidence regarding the use of risk factors as predicators for mortality from SCD. It is known that HTN, diabetes, and smoking are independent risk factors for death. However, stratification modalities based on risk factor screening to select patients likely to benefit most from ICD implantation still elude us. Our data demonstrates that patients with nonischemic cardiomyopathy appear to have a higher risk for sudden cardiac death when compared to their ischemic counterparts. However, both arms had a significant survival benefit, and as such it appears all patients with an ejection fraction of less than 35 percent are likely to benefit from WCD until either ejection fraction recovers or an ICD is implanted. Further long term prospective trials are needed to not only determine the overall long term mortality benefit of WCD therapy in patients with cardiomyopathy, but also the cost effectiveness of this modality. Conclusion: At OSUMC our data revealed 20 cases of decompensated nonischemic cardiomyopathy, and 30 cases of ischemic cardiomyopathy that were treated with a WCD. Overall two patients received appropriate defibrillations for VT/VF, one in each arm. Based on our results it appears the greatest survival benefit with WCD therapy may be conferred to the nonischemic group. Our findings demonstrate that WCD therapy confers a significant mortality benefit in appropriately selected patients. However, the sample size of this study is too small to establish an algorithm for improved risk stratification to identify the subgroup of patients that would benefit most from WCD therapy. Hence, further follow up and large prospective studies are needed to achieve this goal. In the interim WCD therapy should be offered to all patients with an ejection fraction of less than 35% until the either the EF improves or an ICD is implanted.

References: 1. Goldenberg I, et al “Eighteen month results from the prospective registry and fol low-up of patients using the Lifevest Wearable Defibrillator (WEARIT-II Registry)” HRS 2013; Abstract LB02-02. 2. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH; for the SCD-HeFT Investigators: Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225-237. 3. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M; for the Multicenter Automatic Defibrillator Implantation Trial Investigators. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996;335: 1933-1940. 4. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.N Engl J Med 2002;346:877-883. 5. Gerhard Steinbeck, Dietrich Andresen, Karl heinz Seidl, Johannes Brachmann, Ellen Hoffmann, Dariusz Wojciechowski, Zdzisława Kornacewicz-Jach, Beata Sredniawa, Géza Lupkovics, Franz Hofgärtner, Andrzej Lubinski, Mårten Rosenqvist, Alphonsus Habets, Karl Wegscheider, Jochen Senges; Defibrillator Implantation Early after Myocardial Infarction N Engl J Med 2009; 361:1427-1436. 6. Amir Halkin, Mandeep Singh, Eugenia Nikolsky, Cindy L. Grines, James E. Tcheng, Eulogio Garcia, David A. Cox, Mark Turco, Thomas D. Stuckey, Yingo Na, Alexandra J. Lansky, Bernard J. Gersh, William W. O’Neill, Roxana Mehran, Gregg W. Stone; Prediction of Mortality After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction The CADILLAC Risk Score; J Am Coll Cardiol. 2005;45(9):1397-1405. doi:10.1016.

Oklahoma D.O. | May / June 2014


Classified Advertising OFFICE BUILDING FOR SALE: 6501 S. Western, OKC, OK 73139. Over 1 1/2 acres total size, 10,000 sq ft building divided into 3 doctors offices. 1200 sq foot private office upstairs with private bathroom and shower. 2 double sided fireplaces, over a dozen chandeliers, rough wood cathedral ceilings. Alarm and phone system in place, double glass doors in entrance, back patio with separate storage building. Larger office is fully equipped with exam tables, Pap table, chairs, medical instruments, QBC (CBC) machine, autoclave, medical supplies, and much more. For information contact: Captain David Simpson at (405) 820-5360. CLINIC FOR SALE: By owner. Fully equipped: LAB, XRAY, EKG. Well established clinic, near Integris Southwest Medical Center is available for sale. Clinic is well equipped and is ideal for one or more physician practice as well as a variety of specialties. Clinic has: waiting room with refrigerated water cooler, wheelchair accessible restroom, reception and staff work stations, Nurses station, 5 - 7 exam rooms with sinks and running water, large multipurpose procedure room, 3 private offices with built-in bookcases, (One Office with 3/4 Bath), additional staff and patient restrooms, large upstairs (currently used for storage) and variety of other medical equipment. Misys Medical Software. Large Parking Lot. “Must See Inside” the all steel building located at 2716 S.W. 44th St. in OKC to appreciate the effort placed upon providing convenient and up to date medical care. PRICE IS NEGOTIABLE. Doctor prefers to sell, but would consider leasing. If interested, please call: Evelyn Francis at (405) 249-6945.

DOCTORS WANTED: to perform physical exams for Social Security Disability. DO’s, MD’s, residents and retired. Set your own days and hours. Quality Medical Clinic-OKC, in business for 16 years. Call Jim or JoAnne at 405-632-5151. PHYSICIAN NEEDED: The practice of Terry L. Nickels, DO is currently seeking a part-time Family Physician with OMT Skills to help cover the office. If interested please contact Dr. Terry Nickels at (405) 301-6813. FAMILY, URGENT CARE, AND EMERGENCY PRACTITIONERS – IMMEDIATE OPPORTUNITIES for FT/ PT and temp positions. Oklahoma physician owned placement company is hiring now. Offering top wage, flexible schedules, paid malpractice and travel expenses. Call Rachelle at 877-377-3627 or send CV to rwindholz@oklahomaoncall. com

Oklahoma D.O.

IMMEDIATE OKLAHOMA OPPORTUNITY with largest family medicine clinic in Muskogee, Ok. Excellent opportunity to assume a practice that is up and running. Senior physician of four physician group leaving to pursue new career opportunities. 2,000 active patients need a physician. Two physicians currently practice OB. Surgical OB experience a plus. On site x-ray and CLIA certified lab. Nursing and support staff in place. Income guarantee. Be your own boss, work hard and practice family medicine in its historical tradition with respect and loyalty of small town patients. Contact Evan Cole, DO, 918-869-2456, ecoledo@yahoo.com, Brad McIntosh, MD, 918-869-7356, drbamc@yahoo.com Jason Dansby, MD, 918-869-7387, jasonddansby@yahoo.com or Judy Oliver, RN, practice administrator, 918-869-7357. (leave a message if temporarily unavailable) Find us on the web at www.mfpclinic.com.

STAFF PHYSICIAN NEEDED: The Oklahoma Department of Corrections is seeking applicants for Staff Physician at our correctional facilities statewide. The state of Oklahoma offers a competitive salary and benefits package which includes health, dental, life and disability insurance, vision care, retirement plan, paid vacation, sick days, holidays and malpractice insurance coverage. For more information and a complete application packet contact: Becky Raines 2901 N. Classen Blvd., Suite 200 Oklahoma City, OK 73106-5438 (405) 962-6185 FAX (405) 962-6170 e-mail: braines@doc.state.ok.us

PAGE 51

Oklahoma D.O. | May / June 2014


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Oklahoma DO May/June 2014  

The May/June issue of the Oklahoma DO features the inaugural address of President Michael K. Cooper, DO, FACOFP, and a recap of the 114th A...

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