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M ay / J une 2 0 1 2
A MOMS Day at the Ballpark
Improving Communication Taking Aim at Legislative Races Member News
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Time to Up Our Game
Legal Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 IRS Payroll Tax Audits: What Every Business Owner or Manager Needs to Know
NMA Message . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Young Physician Report . . . . . . . . . . . . . . . . . . 15 Clinical Update . . . . . . . . . . . . . . . . . . . . . . . . . . 16
EBM: Evidence-based Medicine (Or Mediocrity?)
Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Member News . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Campus Updates . . . . . . . . . . . . . . . . . . . . . . . . . 34
Improving Communication Between Primary Care and Specialists
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An Easy Explanation. . . . . . . . . . . . . . . . . . . 19 Cover Story: July 15 . . . . . . . . . . . . . . . . . . . 21
A Novel Suggestion
Editorâ€™s Desk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
D E P A R T M E N T S
Table of Contents: May/june 2012 A MOMS Afternoon at the Ballpark
NMPAC:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Taking Aim at Legislative Races
Need Derives from Specialization of Care. . . . . . . . . . . . . . . . . . 25 Happy with Her Choices. . . . . . . . . . . . . . . . 28
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may/june 2012 VOLUME 33, NUMBER 3
A Publication of the
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e s s t o B u sin e
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aha Maga z Om
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Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD, P.O. Box 461208, Omaha NE 68046-1208. © 2012. No whole or part of contents herein may be reproduced without prior permission of Omaha Magazine or the Metro Omaha Medical Society, excepting individually copyrighted articles and photographs. Unsolicited manuscripts are accepted, however, no responsibility will be assumed for such solicitations. Omaha Magazine and the Metro Omaha Medical Society in no way endorse any opinions or statements in this publication except those accurately reflecting official MOMS actions.
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A Novel Suggestion Originality counts.
At least when it comes to statements about health-care reform, I’m tired of the same old arguments. On the other hand, I was fascinated when I came across a fresh, original analysis of health care reform. I didn’t read that analysis in the newspaper or in a medical journal. I didn’t hear it on TV, even with all the coverage of the arguments that the Supreme Court heard this spring. Nor was it something I found on the Internet. The original analysis was one I heard at the Nebraska Medical Association’s summer retreat nearly two years ago. Our speaker was Richard Corlin, M.D. He’s a former president of the American Medical Association. He recounted the debates that led up to the Affordable Care Act. The health insurance industry had a lot at stake: its very survival. What if Congress adopted a single payer plan? Existing health insurance companies would see much of their current function disappear. Of course, that didn’t happen. Dr. Corlin explained why it didn’t happen. The insurance industry banded together. It spoke with one voice. It developed a powerful message of competence and value. It achieved its key goal: continued existence. That wasn’t the case, Dr. Corlin went on, for physicians. An important goal for us was eliminating the so-called SGR. The SGR, or sustainable growth rate, is part of a formula for determining Medicare’s payments to physicians. Put its full force into effect now,
10 PHYSICIANS BULLETIN may/june 2012
and we’d see our Medicare payments drop 30 percent. This hasn’t happened. The reason we’ve avoided those pay cuts is that Congress has continued to pass a series of short-term fixes. When a fix is about to expire, typically after six or 12 months, physicians lobby for another fix. When legislation for health care reform was taking shape, physician groups sought to eliminate the SGR formula and its threat of a drastic drop of payments. We did not achieve that goal. Dr. Corlin’s analysis of why we failed to kill the SGR is simple: We were divided. Unlike other interest groups, physicians didn’t speak with one voice. Instead, our opponents succeeded in splintering us into a spectrum of specialty groups. One of Dr. Corlin’s messages for us physicians, as a result, is that we need to go to Washington united. In Lincoln, we’ve seen his message of cooperation and a single voice pay off. The Nebraska ophthalmologists’ specialty group worked closely with the Nebraska Medical Association to speak out on the dangers of expanding the scope of practice for optometrists. Physicians succeeded. Some aspects of health care reform are hard to predict. What will the Supreme Court decide? We expect to know a few weeks after this is published, but at this point it’s hard to say. One prediction that I can make with confidence is that Dr. Corlin is right: Physicians who squabble will suffer legislative losses. When we join together in MOMS, the NMA, and the AMA, we will have a stronger voice.
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members should have received a copy of our 2011 annual report. This year’s theme was “Your Profession Needs You!” The message from current NMA President Chuck Gregorius, M.D., indicated this was not intended to be just a statement, but a call to action. Since he took office last September 30, he has been focused on activating our membership on issues of interest and increasing NMA physician’s activity in the political process. As the annual report pointed out, the NMA offers many different ways to get involved in your association, whether it is on a committee or task force or a specific issue such as our childhood obesity prevention efforts. The variety is extensive and the only requirement for participations is your NMA membership. We always welcome new additions to any of our committees or task forces; let us know your interest and we’ll find a place for you to serve. We consider all NMA members full-time members of our advocacy efforts. Some are perhaps a little more active than others, but as Dr. Gregorius has stated, “It’s time to up our game” with 2012 election just around the corner. Locally, we will elect 25 state senators, with at least nine of those being new to the Legislature. Of the incumbents running for re-election, we have several who have been interested and helpful in issues of key importance to medicine including medical liability, public health
and safety, health care reform and scope of practice. We continue to encourage our members to form a relationship with their legislators, to make contact when appropriate and to support them financially. In advance of the May 15 primary election the NMA surveyed the candidates for their positions on issues of importance to Nebraska physicians. This information was made available under the “Members Only” section of our website giving you the opportunity to better evaluate the candidates. In addition, we will meet individually with candidates running for local and national offices. If you want to be involved in these meetings, just let us know. These small group gatherings are beneficial to candidates and organized medicine alike as we begin a relationship that will last many years. Where do we go from here? While your profession needs you, we also realize so do your partners and your family. Our message is simple in encouraging all NMA members to find a way to get involved in organized medicine. The mission of the NMA is actually pretty simple, “To serve our physician members as advocates for our profession, for our patients and for the health of all Nebraskans.” Can you imagine how much easier this mission could be accomplished if all physicians made even a small effort to get involved in some way or another? We can’t wait to have you join our efforts!
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By Matt Ottemann Partner in the Tax Practice Group McGrath North Mullin & Kratz, PC LLO
IRS Payroll Tax Audits:
What Every Business Owner or Manager Needs to Know Most business owners and managers are well aware of their federal payroll tax obligations. Many an owner or manager has been up until the wee hours of the morning completing payroll tax paperwork. But many owners and managers are not aware of their personal liability for payroll taxes or how the IRS can build a case for an owner’s or manager’s personal liability. A recent IRS memorandum provides guidance to IRS agents on documenting payroll tax cases against owners and managers. A business must withhold income taxes from employee pay. The business must account for this tax money and send it promptly to the IRS. Failure to do so not only makes the business responsible for the shortfall, it may also make an owner or manager personally responsible as well. The IRS views payroll taxes, withheld by a business, as trust fund money. Therefore, business owners and other “responsible persons” have personal liability for these taxes. “Responsible persons,” under the federal tax law, may include owners, company officers, or managers. The IRS can assess a Trust Fund Recovery Assessment—which is essentially a 100 percent penalty—and against every responsible person. In situations where payroll taxes are not properly paid, the IRS often makes an assessment against every manager, officer, or owner and waits for them to turn on each other. One officer or co-owner may get stuck with the penalty while others will owe nothing. A recent IRS memorandum, issued by the National Director of Collection Policy to the IRS’ regional agents, states that IRS agents should determine, on a case-by-case basis, the amount of documentation required to assert a penalty. Key factors for this determination are an individual’s “responsibility” and “willfulness.” In determining “willfulness,” the IRS and federal courts generally focus on an individual’s knowledge regarding the failure to pay taxes and whether the individual showed reckless disregard for tax payments. Unfortunately, an individual need not actually perform the withholding and payment duties to be deemed “responsible.” If an individual has signature authority (even if unexercised) while other payments (not to the IRS) are made, that can be enough for the IRS to assert personal liability. Recently, the IRS has imposed personal liability on owners in the following situations: • A couple formed two companies, held the top management offices for both companies, and managed the companies’ day-to-day business. Both spouses possessed the authority to sign tax returns on behalf of both companies and signed payroll checks for both companies. They also signed for bank notes and security agreements and served as personal guarantors. However, they hired a bookkeeper to be responsible for paying payroll taxes. Their bookkeeper later died and was found to have embezzled
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from the companies. The IRS found willful nonpayment for the couple when the couple sold the companies and chose to pay employees and third-party creditors, rather than the IRS. • A company owner was held liable for back payroll taxes, and the 100 percent tax penalty, despite his claims that he had been duped by his bookkeeper into believing that the taxes were paid. The IRS ultimately dismissed the bookkeeper and pursued the owner. A federal court found that “willfulness” existed when the owner turned over funds to the bank and other creditors rather than the IRS, after it was proven that the owner knew of the tax obligation. The following are the types of documentation which the IRS will use to determine whether an owner or manager should have individual liability: • Form 4180 Interviews: The IRS will conduct interviews with each potentially responsible person using its Form 4180. The IRS will inquire about an individual’s duties with the business, the actions that individual took to ensure that taxes were paid, and the duties of the other owners or managers. • Articles of Incorporation. • Bank signature authority cards. • Copies of cancelled checks which demonstrate payment to other creditors – not the IRS. Of course, if the IRS can’t easily obtain these records from the business itself, it will get these records using a subpoena. IRS agents are directed to exercise their judgment regarding the amount of documentation needed to support a tax penalty. Agents may ask for more documentation. However, the above items are often enough to impose and support the tax penalty. Many physicians own their own practices or have ownership interests in other businesses. Have you verified that federal payroll taxes are being properly paid? If you have reason to believe that payroll taxes are not being paid in a business which you own or manage, you should seek professional guidance.
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of evidence-based medicine (EBM) and a changing health care system. I was recently told that current medical students have a demanding path ahead of us, and we have “more skin in the game than most current physicians.” Speaking with students across the nation at conventions and meetings has assured me that medical students are well aware of this fact. Medicine is going to change radically. It is up to us to advocate for our patients and make sure the direction we are headed doesn’t stray from the principles that Hippocrates established long ago: to put the patient’s well being above all, and to do no harm. There is great power in the technology and statistical analysis we have today. We need to make sure that this power is used to maximize patient benefit. Students have many concerns. One of these concerns is being pressured into a certain diagnosis and treatment course from government and administrative officials who have never opened a medical book. Will this mean sacrificing art for statistical outcomes? This can have a very detrimental affect for the patients who fall into the outlier range of that analysis. When selecting courses of treatment it is essential to take the comprehensive studies underlying EBM into consideration. Yet, EBM shouldn’t exclusively dictate management or override the personal relationship and knowledge we have with our patients. We need to leave room for the outliers and the “zebras” in medicine. A patient should not be treated as a simple array of statistics—even though that would be easy for administrators to plug into an algorithm. Patients in the real world are complex. Few are textbook cases. Often, they simply can’t be reduced to a set of numbers. What about a body builder whose muscularity has given him a body mass index (BMI) in the “overweight” or even “obese” category? Will an administrative official penalize me if I don’t counsel him on weight loss? Many students believe this is exactly what is coming. We fear the consequences of such a cookie-cutter approach to medicine. EBM should be a tool to guide the direction of treatment, and it will inevitably be an essential part of the practice of medicine. We understand this and want to make sure that decision-making lies in the hands of those trained to make medical judgments, without being penalized for individualizing therapy. This is one of the concerns that has led an increasing number of students to get involved with organized medicine. This involvement is an indicator of our respect for physician autonomy and our realization that we need to speak up for our patients on health care reform. At UNMC, many students are attending regional and national meetings, writing resolutions, and getting our ideas out to the physicians implementing these changes. Across the nation, medical students are showing more interest in the policy making affecting medicine. We are interested in the next step in the evolution of medicine, and we want to be a driving force behind it. may/june 2012 PHYSICIANS BULLETIN 15
By Dr. Alan M. Lembitz, COPIC Vice President of Patient Safety and Risk Management
Between Primary Care and Specialists The lines of communication
between primary care providers (PCP) and specialists continue to show issues and inadequacies, according to a recent study published in The Archives of Internal Medicine. The study examined PCP and specialist perceptions regarding referrals using data from the 2008 Health Care Tracking Physician Survey. It indicated a marked difference between the quality and timeliness of information shared between the two groups. The study also identified practice characteristics associated with positive interspecialty communication. Communication inadequacy between PCPs and specialists about chronic conditions and treatments can lead to duplicative testing, unnecessary workups, and potential harm—particularly when two physicians pursue different courses of treatment on the same patient due to a lack of communication. There was a tremendous variation between each group in terms of their self-reported communication: • 70 percent of PCPs reported that they consistently notified the specialist of the patient’s history and the reason for a consultation. Yet only 35 percent of specialists reported routinely receiving such communication. • 80 percent of specialists claimed they always sent reports to PCPs. The PCPs believed they receive this communication about 62 percent of the time. Not surprisingly, those who reported a lack of communication felt this inhibited their ability to provide quality care. While this huge disparity likely indicates that the providers’ beliefs of their own “sending” behaviors are overstated and their belief in “receiving” are understated, it does point out a bigger problem in our fragmented health care system. Without sufficient knowledge of a patient’s history from the PCP (such as prescription medications, tests that have been performed, allergies, co-morbid conditions, etc.), it is difficult for specialists to assess the issues and suggest proper treatment. And, when specialists lack the pertinent information, they are far more likely to make poor diagnostic choices, endangering patients. Meanwhile,
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PCPs may suggest unwarranted work-ups or treatment and may not be able to provide the coordinated care patients deserve. How can we improve this poor communication? The authors of the study suggest that providers consider the following to help improve miscommunication while caring for your patients: • Allow the patient to become the conduit of information between providers by giving them easy-to-understand care reports and a list of medications, allergies, and tests to be performed. • Electronic medical records may allow for easier and sometimes automatic sharing of information between providers. • Make PCPs part of patient centered care organizations in order to have established and open communication with specialists. • Consider having a patient care coordinator who is tasked with keeping the lines of communication open between caregivers. • Perceptions of better communication were strongly associated with providers that spent adequate time with their patients. • When treating the chronically ill, the use of a nurse who helps to coordinate care has a positive effect. By improving the communication between specialists and PCPs, patient experiences will be improved and the chance of medical errors will be reduced.
may/june 2012 PHYSICIANS BULLETIN 17
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An Easy Explanation
No long explanation
is necessary for why the physicians at Midwest Gastrointestinal Associates support Hope Medical Outreach Coalition. “It’s easy,” said Trevor Pearson, M.D. “You give back to those who are less fortunate.” Likewise, no long explanation is necessary for the rewards he receives. “It’s simple. It makes you feel good,” Dr. Pearson said. Hope Medical Outreach has evolved over the years from a primary-care provider to those who could not afford or had no access to medical care to a source for referrals, said David Filipi, M.D., Hope’s volunteer medical director. Now, the area’s federally qualified community health centers—Charles Drew, OneWorld, and Council Bluffs—provide primary care services to the underserved. The community health centers, however, don’t provide certain specialty and inpatient services. Hope Medical Outreach links patients from the community health centers with physicians and hospitals that can provide the care. Hope Medical Outreach makes sure that no participating physician or hospital is burdened with an out-of-proportion number of referrals, said Dr. Filipi, who serves on Hope’s board of directors. “We distribute the services in fair ways.”
In 2011, Hope Medical Outreach arranged for $4.27 million in donated services. During the year, 243 providers at 22 facilities participated. They served 1,269 patients and performed 342 surgeries. This care included 4,231 hours of interpretive services provided when language was a barrier to care. In 2010, Hope obtained $6.48 million in donated medical care. The coalition—by referring underserved patients—keeps medical costs down by keeping the uninsured or underinsured from seeking care in emergency rooms. The three community health centers carry their share of the load. OneWorld coordinates the referrals, Charles Drew runs the interpretive services, and Council Bluffs clinic oversees the finances. Dr. Filipi, a former MOMS president, said the medical society provides valuable assistance to the coalition. MOMS’ president and executive director serve on Hope’s board of directors. MOMS also hosts Hope board meetings. Finally, MOMS makes its membership director available to provide Hope with potential referrals for specialty care.
The Pearson File Hometown: Norfolk, Neb. Undergraduate Degree: Creighton University in science Medical Degree: Creighton University Medical Center Residency: University of Arizona Fellowship: University of Nebraska Medical Center Why I joined MOMS: “I want to stay involved in the community. It (MOMS) makes our medical community stronger.”
may/june 2012 PHYSICIANS BULLETIN 19
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A MOMS Afternoon at the Ballpark MOMS and the Foster Group
are joining forces to provide medical society members with a way to enjoy an afternoon baseball game at Werner Park. The outing—set for Sunday, July 15, as the Omaha Storm Chasers face the Iowa Cubs—will include good food, good baseball, and good company, said Diane Parsons, MOMS executive director. The outing begins with lunch at 1 p.m. in the Hy-Vee Pavilion with burgers, hot dogs, chips, cookies, lemonade, and iced tea on the menu. The game starts at 2:05 p.m. There is no charge for MOMS members and their families to attend, but advanced reservations are required. Space is limited so MOMS members who want to attend should register online at www.omahamedical.com or call (402) 393-1415, by June 29. Parsons said the Foster Group approached MOMS about partnering with the medical society on the outing, which was last held in 2006. “We appreciate their support. Together, we know we’ll provide an enjoyable outing for our members.”
Ross Polking, a life-wealth advisor at Foster Group, said his organization was pleased to participate. “Helping MOMS bring value to the physicians of Nebraska is a core mission of ours,” he said. “We always appreciate the opportunity to socialize with medical professionals in an informal and relaxed setting to get to know them on a more personal level. An afternoon at the ballpark with family and friends is one small way to continue assisting busy physicians in achieving an imperative and critical work-life balance.” The baseball outing is long overdue, said Marvin Bittner, M.D., MOMS president. “Physicians work long hours. They carry a heavy load. It’s important that we take time to enjoy ourselves. What better way than watching baseball?” Dr. Bittner said one of the roles MOMS plays is to provide social opportunities for its members. “It is important that we provide our members with opportunities to interact professionally and socially.”
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may/june 2012 PHYSICIANS BULLETIN 21
Taking Aim at Legislative Races The Nebraska Medical Association’s Political Action Committee is looking for legislative candidates who will represent the interests of medicine. The reward for those who do: financial support for their campaigns during primary and general elections. Dale Mahlman, NMA executive vice president, said the NMA’s PAC is nothing like the Super PACs that are making news in the 2012 election by backing presidential candidates with millions of dollars. The NMA’s PAC focuses mostly on Nebraska’s legislative candidates but will support gubernatorial candidates. “We get involved in state legislative races mostly,” Mahlman said, “and we typically stay clear of the state offices—auditor, treasurer.” 2011-12 NMA president, Chuck Gregorius, M.D., made strengthening the PAC and the NMA’s role in the state political process a priority during his term, Mahlman said. About one in 10 NMA members support the PAC. “We know we can do better,” Mahlman said. The NMA sends legislative candidates a questionnaire. Their responses 22 PHYSICIANS BULLETIN may/june 2012
play a large role in who receives PAC support. Mahlman said he travels the state and meets with as many candidates as his and their schedules allow. He’ll often ask local NMA members to join him on these visits. The input of local physicians is critical, Mahlman said. “There’s no better expert than our physician members.” The PAC review committee, which consists of NMA members, reviews the candidates’ answers to the questionnaires and decide who merits support. In some cases, Mahlman said, the NMA supports both candidates in a legislative race; and, in some cases, the organization passes on both. The method for delivering the PAC funds is just as important as the evaluation process, Mahlman said. “We deliver the contributions face-to-face. We make it in person.” Contributions typically are $250 minimum, and some
Pictured left: Physicians and state senators discussed issues of importance to medicine at the NMA’s 2012 Advocacy Breakfast
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candidates receive support for the primary and general elections. Support in the primary election, however, does not guarantee support in the general election, Mahlman explained. The first $100 on a NMA member’s donation to the PAC goes to the American Medical Association’s Political Action Committee. In 2010, the NMA PAC contributed more than $35,000 to candidates in state races. No donations to the NMA PAC go to support administrative or lobbyist expenses. Mahlman suggested that supporting the NMA’s Political Action Committee is one way for members to get involved in their state medical association. “If you’re in medicine, you’re in politics,” he said. “There are many ways for physicians to get involved in the political process—and the PAC is one way to do it.”
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24 PHYSICIANS BULLETIN may/june 2012
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Need Derives from Specialization of Care The need for Nebraska Spine Hospital boils down to specialization of care, according to its chief executive officer and two of its surgeons. The Nebraska Spine Hospital, situated in the Alegent Health Immanuel Medical Center, was designed to provide the most complex spine surgeries in the region, said Troy Stockman, CEO. “Our strength is that we’re a physician-led specialty hospital,” said Jonathan Fuller, M.D., one of the hospital’s orthopaedic spine surgeons. “Such hospitals routinely provide superior care with more favorable care results. It all comes down to high volume.” J. Brian Gill, M.D., one of the hospital’s orthopaedic spine surgeons, likens the need for the Nebraska Spine Hospital to the necessity of other specialty hospitals. “From the surgeon’s perspective, a positive outcome is a top priority. Doing procedures in a specialty hospital where not only the surgeon is more experienced, but the support staff as well, can lead to better care and better outcomes.” They explained that specialty care involves physicians, surgeons, nurses, nurse navigators, and physical therapists trained in spine care. Stockman said that there are a number of differentiators that make the hospital stand out. “One of the key things that we know helps physicians who refer to us is the continuum of care we provide. Our nurse navigator not only works with patients to answer questions, they also keep in contact with both patient CONTINUED ON THE NEXT PAGE >>
The Gill File: Hometown: Austin, Texas Undergraduate Degree: Furman University in Greenville, S.C., in health and exercise sciences Medical Degree: Texas Tech University Health Sciences Center Residency: Texas Tech University Health Sciences Center Fellowship: Duke University Medical Center in spine surgery Family: wife, Sabrina; sons, Lleyton and Graham Why I joined MOMS: “Three reasons. I want to be part of the medical community in Omaha, I want to interact with my peers and I want be a part of an organization that advocates for medicine and physicians. MOMS pro- vides me with the opportunity for all three.”
The Fuller File: Hometown: New Canaan, Conn. Undergraduate Degree: Columbia College in New York City in German literature Medical Degree: Columbia University College of Physicians and Surgeons Residency: Dartmouth-Hitchcock Medical Center in Lebanon, N.H. Fellowship: Twin Cities Spine Center in Minneapolis Family: wife, Kyoko; daughter, Rebecca; and son, Benjamin Hobbies: Aviation Why I joined MOMS: “I joined MOMS to seek solidarity with my fellow colleagues in Omaha.” may/june 2012 PHYSICIANS BULLETIN 25
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and the referring physician to make sure that everyone is updated on their progress.” The hospital is a joint venture between Nebraska Spine Center surgeons, Alegent Health, and Health Inventures. Stockman shared statistics from the hospital’s first 18 months in operation: • More than 50 percent of the hospital’s surgical cases come from outside the Omaha area. • The majority of hospital patients range from ages 40 to 75, although care is provided to patients of all ages. • Nebraska Spine Hospital has achieved patient satisfaction scores in the 99th percentile, as reported by Healthstreams Database. Dr. Fuller said the spine hospital’s affiliation with Alegent Health has been a huge factor in its success. “The value for us is Alegent Health’s hospital management expertise, its contracting expertise and its market share power.” Dr. Gill said advancements in minimally invasive procedures involving spine care leads to less risk and better care for patients. Among the technology employed by the hospital are: • O Arm – provides real-time, three-dimensional surgical imaging to ensure precision, improve outcomes and reduce time in surgery. • Stealth Navigation – enables surgeons to more precisely view the patient’s spine during surgery, enhancing more precise navigation of instruments. • Intra-operative Neuromonitoring – allows surgeons to monitor the location of nerves during surgery with optimal precision. • Banyan – integrates information from the imaging tools, patient monitoring and other data into a single view, delivered in realtime. For more information on the Nebraska Spine Hospital, go to www.nebraskaspinehospital.com or call (402) 572-3000.
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Happy with Her Choices Before Jennifer Hill, M.D., decided to make a medical career adjustment, she did her homework. Dr. Hill, who started her medical career in family medicine, realized early on her heart was in OB/GYN. “I think different people are suited to take different routes. I knew OB was where I wanted to be.” After completing her residency in family medicine, Dr. Hill headed to Crete, Neb., where she practiced for three years. She had hoped her practice would include more OB/ GYN, but didn’t get her fix. So she started thinking about completing a second residency. The transition started with conversation: with her 28 PHYSICIANS BULLETIN may/june 2012
mentors (from her first residency), with her family, and with her peers in her current specialty and desired one. Her mentors encouraged her make the leap, but with a qualification. “They said they wanted me to be happy, but they also said ‘I would never want to do it again.’” Her family was a different conversation. Her husband, an assistant basketball coach at Doane College, loved his job but was willing to sacrifice. “He stopped coaching. He took care of the kids when I was gone all the time. It was hard. My husband is a saint. He gave up a lot so I could do this.” After 12 months of discussion and another year of plan-
Metro maha Medical Society
ning, the family headed to Kansas. She worked with residents who were fresh out of medical school. “I’m glad it worked out.” Next stop: Omaha, where Dr. Hill said she has found a home in the community and with her colleagues at Omaha OB-GYN Associates. Most of all, Dr. Hill said, she wants to stay busy. “I want to be delivering 20 babies a month. As for Omaha, she said: “We’ve moved around quite a bit. We’re ready to plant ourselves in Omaha.” Dr. Hill took her return to Omaha one step further. She got involved in the Metro Omaha Medical Society for professional and personal reasons. The personal part, she said, is important because she wanted to get to knew her peers better when away from work. “I enjoy hanging out with people you work with. It’s good.” Professionally, she said, MOMS helped her reconnect with contacts from her medical school days and establish a referral base. Dr. Hill participated in the Medical MESS Club and has attended evening social events. The former allowed her to return to her love for music that flourished in high school. Attending MOMS social events, she said, are just as enjoyable. “It’s a laid-back way to meet people without putting yourself on a stage.”
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pick-up & delivery… The Hill File: Hometown: Columbus, Neb. Undergraduate degree: Hastings College in biology Medical degree: University of Nebraska Medical Center Residency: Clarkson Family Medicine in family medicine; Kansas School of Medicine in Wichita, Kan., in obstetrics/gynecology Practice: Omaha OB-GYN Associates Family: Husband, Chad; daughter, Madison; and sons, Evan and Cooper Hobbies: Singing, dancing, reading and running Why she joined MOMS: “I wanted to make connections in the medical community when I returned to Omaha. I wanted to meet people and reconnect with them.”
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Attending a member networking event in April at Brix were Lisa Hardisty, M.D., Heather Zimmerman, M.D., and Jennifer Hill, M.D.
The April Retired Physicians Meeting at the MOMS offices drew a crowd to hear Robert Kelly talk about the status of the countryâ€™s financial crisis.
Members of the AMA student chapters at UNMC and CUMC hosted a mixer in the Glo Lounge. The event was sponsored by MOMS, the NMA and the Foster Group. MOMS President Marvin Bittner, M.D., and past-president Pierre Lavedan, M.D., attended the mixer. At left, AMA student representatives are, from left, Zach Rosol, Creighton Vice President; Jordan Warchol, UNMC Co-President; Jon Hedgecock, UNMC Co-President. At right, Dr. Bittner talks with medical students.
women in Medicineevent MOMS Women in Medicine groupâ€™s April meeting was an interacting cooking demonstration featuring quick-fix healthy meal ideas. At left: Doctors Laurel Prestridge, Jane Bailey, Donna Nelson, Donna Faber, and Sushma Rai. At right: Dr. Katie Mendlick, Dr. Jennifer Hill and Susie Krause, Lutz & Co. (event sponsor).
30 PHYSICIANS BULLETIN may/june 2012
memberbenefits Why Join or Continue to Be a Member of MOMS/NMA? We keep you informed
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Members receive the latest in local, regional and national health-care news through the MOMS eBulletin and NMA STAT email newsletters, as well as the Physicians Bulletin and Nebraska Medicine magazines, and the NMA News.
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We keep you connected Members have unique opportunities through local MOMS events to network with their peers, interact with local medical students and communicate with community leaders. Members also have a wide variety of opportunities to make a difference by serving on MOMS and NMA committees and through involvement with our many local health-care related partners.
We represent physicians and patients MOMS and NMA work diligently to monitor state legislation that will impact the future of health care. Together, our cumulative voice is heard by those who make decisions impacting Medicaid, Medicare, professional liability, insurance, rural health and public health…just to name a few.
Other member benefits •
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Access to the NMA Blue Cross Blue Shield health and dental plans for physicians, their family and staff. Premium reductions for all members utilizing COPIC. Access to services provided by Foster Group Wealth Management. Savings on your annual AAA membership renewals with no initiation fee for new members.
If you would like more information on MOMS membership, call (402) 393-1415 or email Laura@omahamedical.com.
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Dr. Sade Kosoko-Laski
Dr. Thomas Tape
Dr. Kosoko-Laski receives diversity award
Dr. Tape tabbed by American College of Physicians
Sade Kosoko‐Lasaki, M.D., associate vice president of Creighton University’s Health Sciences Multicultural and Community Affairs Office and professor of ophthalmology in the Creighton School of Medicine, has earned the John P. Schlegel, S.J., Diversity Award for Excellence & Innovation. Dr. Kosoko‐Lasaki has expertise as an educator, clinician, and researcher. In each of her roles, she identifies and cultivates talented students capable of great success in the health sciences. She has helped lead the way at Creighton in training and developing leaders who will serve the needs of an increasingly multicultural community. Her insight and experience have helped frame the policies and ethics of many Creighton programs. She has also encouraged the promotion of health and health equality to foster culturally sensitive, community‐based research to address health disparities nationally and internationally. In addition, Dr. Kosoko‐Lasaki is the author of a book on African‐American ophthalmologists and another on cultural proficiency issues. She continues to do research in ophthalmology and perform surgeries. She is responsible for a “glaucoma van,” a mobile community resource for glaucoma prevention and awareness and for offering free glaucoma clinics in Nebraska, Iowa, Kansas, South Dakota, the Dominican Republic and the U.S. Virgin Islands.
Thomas Tape, M.D., was elected 2012-2013 chair of the board of governors of the American College of Physicians (ACP), the nation’s largest medical specialty organization. His term will begin during Internal Medicine 2012, ACP’s annual scientific meeting in New Orleans in April. Dr. Tape has been a fellow of the American College of Physicians (FACP) since 1991. FACP is an honorary designation that recognizes ongoing individual service and contributions to the practice of medicine. He has served as ACP governor for the Nebraska Chapter. Governors are elected by local ACP members and serve four-year terms. Working with a local council, they supervise ACP chapter activities, appoint members to local committees and preside at regional meetings. They also represent members by serving on the ACP Board of Governors. Dr. Tape previously served as chair elect, a position which began in April 2011, before transitioning to chair of the Board of Governors. Board certified in internal medicine, Dr. Tape earned a bachelor’s degree from Dartmouth College and a medical degree from Washington University School of Medicine in St. Louis. He completed an internal medicine residency and fellowship at the University of Rochester in New York. Dr. Tape is a professor of internal medicine in the UNMC College of Medicine, where he serves as chief of the Division of General Internal Medicine. He also is vice chair of clinical affairs of the Department of Internal Medicine.
32 PHYSICIANS BULLETIN may/june 2012
Dr. Dave Filipi
Dr. Filipi is BCBSNE Chief Medical Officer Bill Minier, M.D., will be stepped back from his role as full-time chief medical officer, effective May 1. Dave Filipi, M.D., medical director of Quality Advancement, assumed responsibility as chief medical officer. Dr. Minier will continue at BCBSNE part-time, focusing on medical home, medical policy and member safety. Dr. Filipi has been past president of the Metro Omaha Medical Society, the Nebraska Medical Association, and the Nebraska Academy of Family Physicians. He had been vice president and chief medical officer of Methodist Physicians Clinic before coming to BCBSNE. Serving on several national committees, he is boardcertified in family medicine and earned an MBA from UNO.
inmemoriam Carlyle E. Wilson, Jr., M.D. Feb. 19, 1920 – Jan. 27, 2012
Dr. Peter F. Coccia
Dr. Coccia leads national panel Peter F. Coccia, M.D., a University of Nebraska Medical Center pediatric oncologist, served as chairman of a national panel that developed new guidelines for the diagnosis, treatment, and after therapy for adolescents and young adults with cancer. The adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 years and represents a challenging age group for onocologists to treat successfully. The American Cancer Society’s Cancer Journal for Clinicians notes that remarkable progress has been made in the treatment of children under the age of 15 and in adults over 40 years of age in the last 35 years, but there has been minimal improvement in the survival rate in the 70,000 new AYA patients with invasive cancer diagnosed yearly. The guidelines were developed through the National Comprehensive Cancer Network.® “There is an urgent need for increased awareness of the many unique issues responsible for these poor outcomes in AYA oncology patients,” said Dr. Coccia, who is Ittner professor and vice chairman of pediatrics at UNMC. Dr. Coccia also is chairman of the NCCN AYA Oncology Panel and a member of the cancer network board of directors.
Dr. Joann Schaefer
WELCOM honors Dr. Schaefer Joann Schaefer, M.D., Nebraska’s chief medical officer, received the “Spirit of Wellness Award” during an April awards luncheon sponsored by The Wellness Council of the Midlands. The WELCOM “Spirit of Wellness” Award is presented to a leader and innovator in Nebraska who supports the mission of WELCOM by actively working toward or supporting the efforts of workplaces to create a culture of health and wellness. The individual also serves as a role model for personal well-being due to their passion and commitment to living a healthy lifestyle. Dr. Schaefer has served in a dual role as chief medical officer and director of the Division of Public Health for the Nebraska Department of Health and Human Services since 2005. Prior to that, she was a tenured associate professor in the Department of Family Medicine at Creighton University Medical School and practiced family medicine in her Omaha office. She graduated from Creighton University Medical School and is board-certified in family medicine. She’s been honored by the American Medical Women’s Association as a Local Legend for changing the face of medicine in Nebraska. The Nebraska Medical Association named her its 2004 Physician of the Year.
Myrle F. Marsh, M.D. Jul. 5, 1929 – Mar. 19, 2012 may/june 2012 PHYSICIANS BULLETIN 33
campusupdates Creighton to offer master’s of public health degree Beginning in January 2013, Creighton University School of Medicine will offer an innovative, online master’s degree program in public health (MPH) designed to help individuals in public health and related fields to understand health care reform and address disparities in health care availability. The degree is one of only a few master’s of public health programs that does not require a residency. The community-focused program encompasses core components of public health and includes additional areas such as public health ethics, community assessment, and community-based participatory research that addresses the health care concerns of atrisk populations and contributes to the development of healthy communities. The program includes two concentrations – health policy and ethics, and public health service administration. The health policy and ethics concentration features courses on healthrelated law, social and cultural contexts of bioethics, and mechanisms of health policymaking at the institutional, state and federal levels. The public health services administration concentration prepares graduates to pursue leadership and management roles in companies and agencies that serve the public in healthand wellness-related industries by emphasizing administrative skills and strategies in the rap-
Library receives collection on care of mentally disabled The McGoogan Library of Medicine at the University of Nebraska Medical Center has received a large research collection from the estate of the late Wolf Wolfensberger, Ph.D. (1934-2011). A psychologist, Wolfensberger was a world-renowned expert on the care of the mentally disabled. He was a faculty member and researcher at the former Nebraska Psychiatric Institute at UNMC from 1964 to 1971 and an early promoter and organizer of community services for the mentally disabled. A 1971 article in the Omaha World-Herald called Wolfensberger “one of the prime movers in Nebraska’s development of services for the mentally retarded.” In 1999, he was selected by representatives of seven major mental retardation organizations as one of 35 individuals worldwide who had the greatest impact on mental retardation in the 20th century. Much of Wolfensberger’s work was concerned with ideologies, structures and planning patterns of human service systems, especially concerning persons with intellectual disabilities and their families. A prolific researcher, he authored or co-authored more than 40 books and wrote more than 250 book chapters and articles. His best known books include “The Principle of Normalization,” and “Changing Patterns in Residential Services for 34 PHYSICIANS BULLETIN may/june 2012
CUMC Campus Update idly evolving health care marketplace. The online program is offered through Creighton School of Medicine’s Center for Health Policy and Ethics. For more information visit www.creighton-online.com.
standards for structure, function, and performance are met by medical school education programs that lead to an M.D. degree in the U.S. and Canada. “The Creighton School of Medicine is very proud of its rich tradition of student-focused School of Medicine praised for studentfocused education, diversity education, service to others, and commitThe Creighton University School of ment to a diverse student body,” said Rowen Medicine has been awarded accreditation for Zetterman, M.D., dean of medicine. “We eight years – the maximum period allowed – by are pleased that these are among the areas the Liaison Committee on Medical Education. for which the school is lauded in this latest The renewal of accreditation followed LCME accreditation.” an exhaustive self-study by the School of Medicine as well as an onsite visit by an Dr. Recker honored for his research LCME onsite review team. Robert Recker, M.D., has earned the 2012 In a letter to Creighton University President Timothy R. Lannon, S.J., LCME Creighton University Research Award. Dr. recognized the School of Medicine for facRecker, a 1963 Creighton medical school ulty/administrator accessibility, a diverse graduate, serves as director of the University’s student body, a student-centered environment world-renowned Osteoporosis Research and curriculum, a commitment to serve the Center and as chief of endocrinology. Dr. community and others, and more. Recker, who currently holds the position of “There is a strong sense of community and commitment to service among the student National Osteoporosis Foundation president, body. One hundred percent of students volun- is an internationally recognized leader in tarily participate in community service activithe field of metabolic bone disease research ties,” LCME noted. “The collaborative and supportive student culture is fostered by the faculty, and clinical care. His 40-plus year career as who serve as very effective role models in their physician-scientist includes laboratory and clinical research, teaching, patient care and interactions with students and patients.” LCME accreditation signifies that national professional leadership.
UNMC Campus Update
cancer center would house research facilities, a multidisciplinary outpatient treatment center and clinic, and a new hospital tower. Medical center leaders call it the largest project ever proposed here. “This is a transformational project for all Nebraskans,” said UNMC Chancellor Harold M. Maurer, M.D. “These facilities will elevate our cancer services, enhance our educational programs and provide a central location and synergy that not only will benefit our clinicians and researchers but most importantly, patients.” The new cancer center would be built on the west side of the medical center campus. While A climb in the rankings details of the project are still being reviewed, The primary care, research and rural mediplans call for three facilities — a multidiscicine education programs at UNMC rose in the plinary outpatient clinic, a 98-lab research 2012 U.S. News & World Report rankings of tower, and a hospital tower with 108 beds the nation’s top graduate schools. dedicated to oncology patients. Of the 149 medical schools surveyed in the In addition to the cancer center, project latest rankings, UNMC: plans also call for construction of a fourth · Ranked sixth in primary care, up from sevbuilding – an ambulatory care clinic – to enth last year; be built near 42nd and Farnam streets. This · Tied for 62nd in research, up from 66 last building would provide outpatient clinic space year; and for the medical center’s various programs out· Tied for 12th in rural medicine, up from side of cancer. 15th last year. The new cancer center does not have an Plans for new cancer center unveiled official name yet. Medical center officials refer Leaders from UNMC and its hospital part- to it as the Cancer Center Project. The best ner, The Nebraska Medical Center, announced layout of the three structures in the Cancer preliminary plans for a new cancer center Center Project is still being studied and will be at the medical center’s Omaha campus. The announced as more details come into focus. the Mentally Retarded.” His writing has been translated into 11 languages. Nancy Woelfl, Ph.D., director of the McGoogan Library, characterized the Wolfensberger collection as “a unique, oneof-a-kind resource without parallel in the academic world.” The Wolfensberger collection includes books, archival materials and artifacts. The collection will be sorted, organized and processed over the next several months and will then be available for use by researchers. It is housed in the library’s Special Collections Department.
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MOMS Foundation 7906 Davenport Street Omaha, Nebraska 68114 402-393-1415
may/june 2012 PHYSICIANS BULLETIN 35
Application for Membership This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the Nebraska Medical Association (NMA). I hereby consent and authorize MOMS to use my application information that has been provided to the MOMS credentialing program, referred to as the Nebraska Credentials Verification Organization (NCVO), in order to complete the MOMS membership process.
Personal Information Last Name: _____________________________ First Name: _______________________ Middle Initial: ______ Birthdate: _________________________________________________ Gender: Male or Female Clinic/Group: __________________________________________________________________________________ Office Address: ________________________________________________________________ Zip: __________ Office Phone: ____________________ Office Fax: ___________________ Email: _________________________ Office Manager: _______________________________________ Office Mgr. Email: ________________________ Home Address: ____________________________________________________ Zip: ________________________ Home Phone: __________________________________________ Name of Spouse: ________________________ Preferred Mailing Address: Annual Dues Invoice: Event Notices & Bulletin Magazine:
Home Other: __________________________________
Home Other: __________________________________
Educational and Professional Information Medical School Graduated From: __________________________________________________________________ Medical School Graduation Date: ____________________ Official Medical Degree: (MD, DO, MBBS, etc.) _______ Residency Location: _____________________________________________ Inclusive Dates: _________________ Fellowship Location: _____________________________________________ Inclusive Dates: _________________ Primary Specialty: ______________________________________________________________________________
Membership Eligibility Questions YES
(If you answer “Yes” to any of these questions, please attach a letter giving full details for each.)
Have you ever been convicted of a fraud or felony?
Have you ever been the subject of any disciplinary action by any medical society, hospital medical staff or a State Board of Medical Examiners? Has any action, in any jurisdiction, ever been taken regarding your license to practice medicine? (Including revocation, suspension, limitation, probation or any other imposed sanctions or conditions.) Have judgments been made or settlements required in professional liability cases against you?
I certify that the information provided in this application is accurate and complete to the best of my knowledge.
Fax Application to: 402-393-3216
Mail Application to: Metro Omaha Medical Society 7906 Davenport Street Omaha, NE 68114
Apply Online: www.omahamedical.com
membersupdate New Members In Focus Darin Gregory, M.D.
Mohammed Zahra, M.D.
Dr. Gregory is an avid hunter and enjoys target shooting. He has taken deer with a rifle, muzzleloader and bow. He also enjoys barbequing, and spending time with his wife and three children.
Dr. Zahra enjoys teaching himself music. He has had a love of gardening for many years. He considers his family to be his greatest achievement in life.
Medical School: UNMC Specialty: Family Medicine Location: Bellevue Urgent Care
Medical School: University of Damascus Specialty: Radiation Oncology Location: Immanuel Cancer Center
Brianne Kling, M.D.
Medical School: University of North Dakota, Grand Forks Specialty: Obstetrics & Gynecology Location: Immanuel Cancer Center Dr. Kling is an avid runner, enjoying anything from a weekend 5K to training for a coming marathon. She also spends time reading, having dinners with friends and playing with her dog, Dakota. And of course, cheering for the Husker football team, Go Big Red!
NEW MEMBERS Casey Beran, M.D. Orthopedic Surgery Karl Bergmann, M.D. Orthopedic, Trauma Walter Duffy, M.D. Psychiatry Megan Irwin, M.D. Obstetrics and Gynecology
Hadi Zahra, M.D.
Medical School: UNMC Specialty: Radiation Oncology Location: Immanuel Cancer Center Dr. Zahra spends his leisure time playing tennis, cooking and traveling to new places. When choosing to unwind in the evening, he and his wife enjoy watching “Saturday Night Live” and “Conan O’Brien.”
Jeffrey Jenkins, M.D. Family Medicine Dong-Kyoo (Richard) Kang, M.D. Pediatric Otolaryngology Lois Starr, M.D. Genetics, Clinical Molecular Sonya Tran, M.D. Obstetrics and Gynecology Jason Untrauer, M.D., DDS Surgery, Oral & Maxillofacial
Interested in becoming a MOMS Member?
Call 402-393-1415, apply online at www.OmahaMedical.com or complete the application on page 36. may/june 2012 PHYSICIANS BULLETIN 37
Your home...your builder.
Exceptional. Selecting a builder is as much an expression of taste as it is a statement of confidence. No one understands this better than Curt Hofer & Associates. As one of the area’s most respected custom homebuilders, we provide a one-of-a-kind experience in creating your once-in-a-lifetime home. Your wants, your needs, your style, your preferences – everything we do at Curt Hofer & Associates is advanced with the thought of you in mind. That means spending time with you, from the very beginning and at every step along the way. From individual rooms, to how these rooms come together to create a home, to the landscape and exteriors that immediately bid you welcome, the team Curt Hofer & Associates knows how to bring the best ideas to life – yours. The result? Your home...your builder. Exceptional.
HOFER & ASSOCIATES
Your home...your builder. Exceptional.
2332 Bob Boozer Drive Omaha, NE 68130 Phone: 402.758.0440 n
WHERE CAN YOUR PATIENTS GO FOR HEART CARE THAT DOESN’T SKIP A BEAT?
Here. Less than two years after combining two successful open heart surgery programs into one, the Alegent Health Heart & Vascular Institute now stands alone as the highest quality program in the Omaha-Council Bluffs metro. At Alegent Health we’ve developed standardized processes that allow us to provide consistent care and ex traordinary outcomes. Out of four metro programs reviewed by the Society of Thoracic Surgeons, Alegent Health was the only one to receive three out of three stars for overall quality. The rating is based on multiple measures of quality including pre-op care, survival rate and lack of complications following surgery. At Alegent Health we understand it’s about more than providing better care. It’s about getting patients back to their lives and the things that matter most. Check out every thing we’re doing to make healthcare healthier at Alegent.com/Hear t.
Alegent Health is a faith-based health ministr y sponsored by Catholic Health Initiatives and Immanuel.
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha, NE 68114
ADDRESS SERVICE REQUESTED
One number accesses our pediatric surgical specialists, any problem, anytime.
Physicians’ Priority Line
When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small. www.ChildrensOmaha.org
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PERMIT NO. 838 OMAHA, NE