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Metro Omaha Medical Society 7906 Davenport St. • Omaha, NE 68114 (402)393-1415 • www.omahamedical.com OFFICERS President | Debra L. Esser, M.D. President-Elect | David D. Ingvoldstad, M.D. Secretary-Treasurer | Lori Brunner-Buck, M.D. Past President | Marvin J. Bittner, M.D. Executive Director | Carol Wang EXECUTIVE BOARD Debra L. Esser, M.D. David D. Ingvoldstad, M.D. Lori Brunner-Buck, M.D. Marvin J. Bittner, M.D. Mohammad Al-Turk, M.D. Jane Bailey, M.D. David Filipi, M.D. Harris Frankel, M.D. Michelle Knolla, M.D. Jason Lambrecht, M.D. William Orr, M.D. William Shiffermiller, M.D. Gamini Soori, M.D. Jeffry Strohmyer, M.D. EDITORIAL/ADVERTISING STAFF Publisher | Omaha Magazine, LTD Editor | Marvin Bittner, M.D. Art Director | John Gawley Director of Photography | Bill Sitzmann Senior Graphic Designer | Kristen Hoffman Graphic Designer | Rachel Joy advertising sales Todd Lemke • Greg Bruns Gwen Lemke • Gil Cohen • Vicki Voet Sandy Besch • Alicia Smith • Sydney Stander Jessica Linhart • Dawn Dennis for advertising information: 402-884-2000 Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD, P.O. Box 461208, Omaha NE 68046-1208. © 2014. 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.
4 Physicians Bulletin May/June 2014
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May/June 2014 Physicians Bulletin 5
THIS Issue 18
May/June 2014 20
22
FEATURES
DE PA RTM E NTS
18
8
Ready to Run? Candidate Campaign School
2 0
No Topics are Off-limits
CLER Guidelines A Call for Transparency and Collaboration
6 2
COVER: A View from the Other Side of the Room Tom Tonniges, M.D.
10
12 14 15
Financial Update How to Reduce Your Tax Bill
MOMS Message
31
Member News
Putting Perspective on What is Important
32
Campus & Health Systems Update
3 4
MOMS Events
3 5
Coming Events
Departure from Practice
37
Member Benefits
Young Physician Report
37
New Members
NMA Message The Inner Workings of the NMA
Risk Management
Advocating for Your Future
16
Legal Update When was your last HIPAA check-up?
6 Physicians Bulletin May/June 2014
17
Zombies in Omaha?
When Docs and OSS Students Come Together
2 2
Editor’s Desk
26
Patients with ID Problems? We provide team-based care for: • Infectious Diseases Inpatient/ Outpatient Consultations • Office Infusion Therapy • Vaccine Management
FOR ASSISTAnCE AnD COnSulTATIOn COnTACT uS AT
402-934-6504 OR
www.idmidwest.com
Robert G. Penn MD, FACP, FSHEA, FIDSA
Board Certified: Infectious Diseases Douglas Penington, APRN Stacey Shinaut, APRN Elizabeth Jacobsen, PA-C Courtney Sullivan, ACNP Erin Thoman, APRN
2014 Physicians • Omaha, 8111 Professional Building • 8111 Dodge Street, Suite 363May/June NE 68114Bulletin 7
EDITOR’S desk
Zombies in Omaha? Marvin Bittner, M.D. Editor
Steer Clear
Physicians Bulletin
F
OR SEVEN MONTHS, I served as both “chief of
staff” and “chief of staph” at the VA Medical Center. “Chief of staff”—because I filled in as acting chief of staff before a permanent one was chosen to fill a vacancy. “Chief of staph”—well, maybe “chief of Staphylococcus aureus” would be more precise – because I continued my role in the infection prevention program. People ask me: “What was it like to be chief of staff?” It’s hard to sum up my reactions in just a few words. However, if there’s one word that encapsulates my experience, it’s “zombies.” “Zombies” arose in an episode that started with a report comparing Omaha to other VA medical centers. The report looked at the number of deaths in Omaha. The report took into account the number of patients we saw and their underlying conditions. This particular report had a disturbing conclusion: We had too many deaths. One of our physicians was particularly concerned. He obtained the list of 20 dead patients on which the disturbing report was based. He looked through their records. He thought there might be a pattern of mismanagement. He thought he’d find it and fix it. He pored over the records. Soon he became alarmed. Of the 20 dead patients, six were actually alive. What was going on? How could the authors of the disturbing mortality report have mistaken living patients for the dead? Are there zombies in Omaha? If you step into an elevator at the Omaha VA, are you liable to see a zombie pushing an elevator button?
8 Physicians Bulletin May/June 2014
The concerned physician told the authorities that the disturbing mortality report was based on an erroneous assumption. He told them six of the “dead” patients were actually “undead.” Reduce our death list from 20 to 14 – and we might not have a problem with excess mortality. The authorities retorted: “Stop arguing with the data! Accept the fact that you had 20 dead patients! Fix your problem!” That response was, to me, almost as bizarre as standing in the elevator and noticing a zombie at my side. Sadly, this example of badgering a physician with bad data is not an isolated occurrence. I remember when Medicare, using a flawed study contradicted by many infectious diseases specialists, gave bad marks to any hospital that didn’t start antibiotics in pneumonia patients within four hours. Do you recall its flip-flop on peri-operative beta blockers? It doesn’t have to be that way. Indeed, VA surgeons showed how valuable data analysis can be when it’s directed by physicians. They developed the Veterans Health Affairs (VA) Surgical Quality Improvement Program (VASQIP). It rigorously adjusts data on surgical complications to account for underlying conditions. As I found out, though, bad bureaucrats are still lurking – so bad that they can’t tell the living from the dead. That’s why it’s important for all of us to speak up as informed citizens through our medical organizations to help steer clear of the perils of zombies.
MOMS message
Putting Perspective Carol Wang Executive Director
on What is Important
Metro Omaha Medical Society
O
NE-HALF OF 2014 IS over. That realiza-
tion always bowls me over at this point in the year. The thoughts then race, “What did I do with my time? I haven’t even started all the things I meant to do.” This musing may sound familiar to all of you. These days, we’re pulled in more directions, trying to squeeze in more meetings, be more present in our families and give 100 percent to everything we care about. Sometimes, while we’re so busy juggling our to-do list, life is passing by in a blur. It is why Dr. Tom Tonniges’s article has been so important to me and I hope it will make an impact on you. Since I joined MOMS almost a year ago, I’ve been lucky to meet many of you, learn about your work and hopefully, in turn, deliver the programs and opportunities you want and need. And if there is something you want to see offered, I want to hear from you. This is your organization. What has struck me in all these interactions is how lucky our area is to have so many physicians passionate about providing the best health care to their patients and willing to invest sweat equity in our community. I know many of you volunteer at organizations such as Hope Medical Outreach Coalition, provide your services to area nonprofits, go on international missions – all to improve the lives of other people. I also realize maintaining your work and these commitments come at great personal cost. And that the business of health care can be overwhelming, scary, plus not to mention, exasperating. But then you cross paths with someone like Dr. Tonniges and he gives you perspective. Dr. T sits on our Foundation Board and on our House of Delegates. This past year, his health has
10 Physicians Bulletin May/June 2014
forced him to miss out on some meetings, but I always know his heart is with us. At a time when others would focus 100 percent of their efforts on fighting for their health, Dr. T has come into MOMS wanting to make sure we’re growing our Foundation so that we can make a bigger impact in Omaha or volunteering in whatever capacity he can. For everyone who knows him and sees him in action, he has come to epitomize generosity, grace and an indomitable spirit. So when I asked him if he would share his journey as a doctor becoming a patient, of course, he said yes. His very personal story is a visible reminder that health is not guaranteed and life will throw you some curveballs. But I hope it makes us all think about our humanity, how we treat each other in good times and bad. Maybe you’ll also hear in his lessons, things you want to incorporate in the way you care for patients. Or inspiration that what you do matters when you’re facing burnout. Or it will spur you to make the time to support friends and colleagues in their time of need. For me, I want his optimism and smile to be what I think of when I’m feeling frazzled; the voice in my head inspiring me to breathe deep, to take time to enjoy where I am at that moment. Above all, he has impressed on to me the importance of nurturing a deep sense of gratitude. I know Dr. T has been thinking about his legacy. It is a thought we all inevitably face. From the people he’s treated and healed, to the ripple effects felt from all his philanthropy and kindnesses, his is one we can all aspire to. Thank you, Dr. Tom, from the bottom of so many hearts.
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NMA message
Dale Mahlman Executive Vice President
The Inner Workings of the NMA
Nebraska Medical Association
J
UST WHO IS THE Nebraska Medical Association
and what do we do? Since our legislative session has just ended, it’s that time of the year where we turn our attention to the last half of the year: campaigns, elections, and preparing for next year. We kind of sound like the Chicago Cubs, don’t we? Just who is the NMA? The NMA is composed of more than 2,500 actively practicing physicians across the state: 78 percent male, 22 percent female. Of this membership number, 40 percent are under the age of 50, 47 percent are between the age of 50-69, and 13 percent are still actively practicing medicine at 70 years of age and beyond. Our membership for 2014 is approaching an all-time high, and our focus has been on encouraging active participation by physicians of all ages as medicine remains in the spotlight as the debate on health care reform continues. Your NMA Board of Directors includes 15 physicians, one resident physician, and student representatives from both UNMC and Creighton, along with a representative of the Nebraska Medical Association Alliance. This diversity serves us well as we discuss issues, policy and potential opportunities confronting organized medicine in Nebraska. Your NMA staff remains committed to supporting the efforts of the Board and physicians. This summer will be busy with candidate forums and face-to-face meetings across the state. With term limits affecting 17 outgoing senators, the need to familiarize ourselves with the potential replacements and their positions on our issues will be in the forefront. Of the 17, we are losing the speaker of the Legislature and seven legislative committee chairs. That is a significant loss of leadership, and while we are excited about many of the candidates,
12 Physicians Bulletin May/June 2014
we need to get to know them and vice-versa. This summer we will host candidate forums in Omaha, Lincoln and Kearney with other health care-related associations, including the Nebraska Hospital Association, Nebraska Health Care Association and the Nebraska Pharmacists Association. Having multiple sponsors together will be new to us, but we look forward to the opportunity to hear candidates respond to health care related issues. The recently concluded session highlighted the need for medicine to be represented in the Legislature. While we have one physician candidate in the May primary, we definitely need to increase our efforts to attract physicians of all ages to consider a run for office. Of our current Legislature of 49 senators, 12 are attorneys, a similar number own their own business or are consultants, 10 are farmer or ranchers, and seven are educators or former educators. You can see from this brief breakdown of the current Legislature, backgrounds in medicine or health care-related topics are essentially nonexistent. This edition of The Bulletin has a feature article on candidate training programs in the Omaha area. I trust you will review it. As I have said in previous articles on elections and running for office, if you have any interest or desire to run, please let us know and we can put you in touch with available resources at both the state and national level. We hope that many of you will add this to your career plan at some point. In closing, the staff of the NMA and I believe it’s a privilege to work for and represent the physician members of the association, “Advocating for Physicians and the Health of all Nebraskans.” Tell us how we are doing and how we can help you as you serve your practice and community.
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The College of Saint Mary Physician Assistant (PA) Program has applied for provisional accreditation from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). College of Saint Mary anticipates matriculating its first class of PA students in fall 2016, pending provisional accreditation in spring 2016. Provisional accreditation is an accreditation status for a new PA program that has not yet enrolled students, but at the time of its comprehensive accreditation review, has demonstrated its preparedness to initiate a program in accordance with the accreditation Standards. College of Saint Mary is accredited by The Higher Learning Commission of the North Central Association of Colleges and Schools, 230 South LaSalle Street, Suite 7-500, Chicago, IL, 60604-1413. 800-621-7440.
May/June 2014 Physicians Bulletin 13
RISK management
Departure from Practice AMA resources regarding physician and patient records for this type of situation By Dr. Dan Rosenquist COPIC’s Patient Safety and Risk Management Department
U
NDER THE NEBRASKA ADMINISTRATIVE
Code, disciplinary actions may be taken against a physician’s license for unprofessional conduct, which includes “a departure from or failure to conform to the ethics of the medical profession, which ethics are found in the American Medical Association’s Code of Medical Ethics and Opinions.” 172 NAC §88-010.01; 172 NAC §88-010.02. The following AMA ethics opinions are relevant to a physician’s departure from a practice: 7.01-RECORDS OF PHYSICIANS: AVAILABILITY OF INFORMATION TO OTHER PHYSICIANS
The interest of the patient is paramount in the practice of medicine, and everything that can reasonably and lawfully be done to serve that interest must be done by all physicians who have served or are serving the patient. A physician who formerly treated a patient should not refuse for any reason to make records of that patient promptly available on request to another physician presently treating the patient. Proper authorization for the use of records must be granted by the patient. Medical reports should not be withheld because of an unpaid bill for medical services. http://www.ama-assn.org/ama/pub/physicianresources/medical-ethics/code-medical-ethics/ opinion701.page 7.03-RECORDS OF PHYSICIANS UPON RETIREMENT OR DEPARTURE FROM A GROUP
A patient’s records may be necessary to the patient in the future not only for medical care but also for employment, insurance, litigation, or other reasons. When a physician retires or dies, patients should be notified and urged to find a new physician and should be informed that upon authorization, records will be sent to the new physician. Records which may be of
14 Physicians Bulletin May/June 2014
value to a patient and which are not forwarded to a new physician should be retained, either by the treating physician, another physician, or such other person lawfully permitted to act as a custodian of the records. The patients of a physician who leaves a group practice should be notified that the physician is leaving the group. Patients of the physician should also be informed of the physician’s new address and offered the opportunity to have their medical records forwarded to the departing physician at his or her new practice location. It is unethical to withhold such information upon request of a patient. If the responsibility for notifying patients falls to the departing physician rather than to the group, the group should not interfere with the discharge of these duties by withholding patient lists or other necessary information. http://www.ama-assn.org/ama/pub/physicianresources/medical-ethics/code-medical-ethics/ opinion703.page 7.05-RETENTION OF MEDICAL RECORDS
Physicians have an obligation to retain patient records which may reasonably be of value to a patient. The following guidelines are offered to assist physicians in meeting their ethical and legal obligations: 1. Medical considerations are the primary basis for deciding how long to retain medical records. For example, operative notes and chemotherapy records should always be part of the patient’s chart. In deciding whether to keep certain parts of the record, an appropriate criterion is whether a physician would want the information if he or she were seeing the patient for the first time. 2. If a particular record no longer needs to be kept for medical reasons, the physician should check state laws to see if there is a requirement that records be kept for a minimum length of time. Most states will not have such a provision. If
they do, it will be part of the statutory code or state licensing board. 3. In all cases, medical records should be kept for at least as long as the length of time of the statute of limitations for medical malpractice claims. The statute of limitations may be three or more years, depending on the state law. State medical associations and insurance carriers are the best resources for this information. 4. Whatever the statute of limitations, a physician should measure time from the last professional contact with the patient. 5. If a patient is a minor, the statute of limitations for medical malpractice claims may not apply until the patient reaches the age of majority. 6. Immunization records always must be kept. 7. The records of any patient covered by Medicare or Medicaid must be kept at least five years. 8. In order to preserve confidentiality when discarding old records, all documents should be destroyed. 9. Before discarding old records, patients should be given an opportunity to claim the records or have them sent to another physician, if it is feasible to give them the opportunity. http://www.ama-assn.org/ama/pub/physicianresources/medical-ethics/code-medical-ethics/ opinion705.page ADDITIONAL RESOURCES:
• Link to Nebraska Department of Health and Human Services medical records statutes: http://dhhs.ne.gov/publichealth/Documents/ Medical%20Records.pdf • Link to full list of AMA’s Code of Medical Ethics: http://www.ama-assn.org/ama/pub/ physician-resources/medical-ethics/codemedical-ethics.page PLEASE NOTE: The above information was current based on what was published online as of 4/7/14
YOUNG PHYSICIAN repor t When you need it.
Advocating for Your Future Travis Teetor, M.D. Staff Anesthesiologist Boys Town National Research Hospital
A
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S A YOUNG PHYSICIAN entering practice,
I did not realize the role that advocacy has played, not only in my practice, but in the overall practice of medicine. We are living in an era where medical decision-making is no longer being dictated by physicians, but is now becoming more legislative and policy driven. As an anesthesiologist, we have experienced constant scope of practice issues in our profession. With the recent passage of LB916 and LB526, these scope of practice issues are spilling over into other areas, such as ophthalmology and primary care in Nebraska as well. (Editor’s note: Governor Heineman subsequently vetoed LB916) New physicians entering their initial years of practice have many items to tend to, and advocacy issues are usually not on the forefront of focus. When talking with other young physicians, many feel that advocacy is something others will address, whether it is more senior physicians or their local and national societies. Frequently they also feel that advocating for medical changes will take a great amount of time and effort. Others feel that if proposed regulations do not concern their area of practice, their involvement will be of no benefit. However, none of these are justifiable reasons for avoiding involvement in shaping the future of health care in Nebraska. Many times, a simple call or email to a senator or representative’s office will help clarify misconceptions that may accompany a piece of legislation under consideration. Elected officials can learn a great deal by hearing from those on the front lines of patient care. Although state and national societies may be advocating on issues, elected representatives will frequently rely on opinions of constituents in their districts for local feedback on issues. Another opportunity would be to volunteer to serve as a medical liaison for
an elected official and volunteer to offer input on any bills that pertain to the field of medicine that may arise while they are in session. Physicians have also been called to testify or have volunteered to testify concerning bills that have been sent to committee in Lincoln. With the coming elections this year, another beneficial way to become involved is to volunteer for a candidate’s campaign or to contribute to his or her campaign. Volunteering for campaigns allows contact not only with the individual running for office, but also his or her campaign staff. Frequently, campaign staff members are carried over to an elected official’s legislative staff if they succeed in their candidacy. Connections that have been established during the campaign may then become useful to allow better access to the candidate and his or her staff once elected. A significant way to become involved with shaping the future of medical care is to run for political office. Currently in Nebraska there are no state senators who are physicians. In Washington D.C., there are only 20 of 535 members in both houses of Congress who are physicians. In Nebraska, this year, we had one physician, Bob Rauner, who ran for Legislature in District 28. Although legislation may arise that does not directly impact your area of expertise, it is important to assist your fellow physicians with issues that deal with their practice. Scope of practice will continue to be a greatly contested issue with the passage of the Affordable Care Act. Many different specialties will likely have upcoming scope of practice issues. If we as physicians can work together, we can ensure that all Nebraskans will have access to the quality of medicine that they deserve. Please join me in advocating for the future of medical care for citizens of Nebraska.
May/June 2014 Physicians Bulletin 15
LEGAL update
Jill Jensen Partner, Cline Williams Wright
When Was Your Last HIPAA Check-up?
Johnson & Oldfather, L.L.P.
I
T’S A BRIGHT AND clear May Monday morning.
As you drive to work, you think to yourself that things have never been better since you took over as the administrative partner for your group. The retirement of the practice founder, recruiting a new partner – that’s all behind you. Your practice is growing and a new doctor just joined you and your partners. All systems are “Go.” And then, your cell phone rings. It’s your practice manager telling you that one of your back office staff had an office laptop and unencrypted thumb drive stolen from her car last night. The office laptop and the unencrypted thumb drive contained the electronic protected health information (ePHI) of approximately 2,200 of your practice’s patients. Your practice manager was now on the phone to you giving you the bad news and asking you what she should do. The scenario above happened to one Massachusetts medical practice that settled with the federal HHS Office of Civil Rights (OCR) late last year. That case resolution provides a wake-up call for physician practices about the importance and seriousness of protecting the privacy and security of patient information. If you think it couldn’t happen to you, think again. The OCR investigated the Massachusetts practice after it received a report that an unencrypted thumb drive containing the ePHI of approximately 2,200 individuals was stolen from the practice staff member’s vehicle. The thumb drive was not recovered. The OCR’s investigation revealed that the practice • Had not conducted “an accurate and thorough analysis of the potential risks and vulnerabilities
16 Physicians Bulletin May/June 2014
to the confidentiality of ePHI as part of its security management process.”1 • Did not comply with requirements of the Breach Notification Rule by having “in place written policies and procedures” about HIPAA’s patient information privacy and security requirements.” • The OCR also found that the training provided to workforce members of the practice had been deficient. In addition to the shareholders of the practice having to pay HHS $150,000 on behalf of their practice, the practice also was required to implement a corrective action plan to fix deficiencies in its HIPAA compliance program.2 The practice is required to develop a risk analysis and risk management plan to address and mitigate any security risks and vulnerabilities it has and to report back to OCR the implementation of the plan. And, this settlement occurred after the practice had notified promptly all the patients by mail (postage costs X 2200, large mailing preparation and processing costs), reported the breach to the OCR, and notified media about the breach. This case demonstrates that not complying with HIPAA’s requirements can be both embarrassing and expensive. When was your practice’s last HIPAA checkup? Have you trained your staff about HIPAA, particularly since the new Omnibus regulations issued last year? What about training new staff about HIPAA when they are first hired? Have you sent to your business associates revised business associate agreements and have they been signed, returned, and safely filed? Have you performed a risk analysis to identify the
gaps in your PHI and ePHI privacy and security? How mobile is PHI and ePHI in and from your office? Are information technology assets password protected and encrypted so that the data maintained on laptops, hard drives, thumb drives, iPads, tablets, cell phones, and other devices will be unreadable and inaccessible should they fall into the wrong hands? How does your practice maintain and ensure proper back-ups for ePHI? Encrypting the thumb drive in the Massachusetts case would have prevented a breach and its related expenses. If your office is “behind the curve” in having good HIPAA privacy and security compliance in place, take steps now to plug those gaps. You will be glad you did.3
1.
U.S. Dep’t of Health & Human Services, Office of Civil Rights, “Dermatology practice settles potential HIPAA violations,” (available at www.hhs.gov/news/ press/2013pres/12/20131226a.html) (last visited April 18, 2014).
2.
A link to the Resolution Agreement entered into by the practice is found at www.hhs.gov/ocr/privacy/hipaa/ enforcement/examples/apderm-resolution-agreement. pdf (last visited April 18, 2014).
3.
This article is for educational purposes only and is not intended to be legal advice. Please contact your legal counsel should you have specific questions related to this topic.
FINANCIAL update
How to Reduce Your Tax Bill
Roger Howard Partner Seim Johnson
S
TARTING IN 2013, HIGH-INCOME taxpayers
are faced with: • Higher tax rates on ordinary income. • Higher tax rates on capital gains. • And two new taxes—a 3.8 percent Net Investment Income Tax (NIIT), and a 0.9 percent additional Medicare tax on wages and self-employment income.
We told our clients: • If you earn more than $250,000 ($200k single) Washington wants a little more tax. • If you earn more than $450,000 ($400k single) Washington wants significantly more tax. • Here’s an overview of these new taxes and what they mean to you: • New tax bracket > $450,000 ($400k single) = 39.6 percent rate. • If you fall in the 39.6 percent bracket, your long-term capital gains are taxed at 20 percent. • You also are subject to the Net Investment Income Tax (3.8 percent (after $250k). We call that “hitting the trifecta,” and not in a good way. SOME BACKGROUND, THEN TAX-SAVING IDEAS: 3.8 PERCENT NET INVESTMENT INCOME TAX (NIIT)
Starting in 2013, high-income taxpayers face a 3.8 percent tax on their net investment income (in addition to regular income tax). Previously, Medicare taxes only applied to earned income (wages and self-employment income), but in order to help pay for ObamaCare, the NIIT essentially subjects your investment income to Medicare tax. Your net investment income (NII) includes your interest, dividend, annuity, royalty and rental income (unless those items were derived in the
ordinary course of an active trade or business), and passive activities. Capital gains may also be subject to the tax. Assume a married physician earns $250,000 in wages, has $100,000 in profits from an Ambulatory Surgical Center (ASC) and $20,000 in dividends. The ASC profits may be NII and subject to the 3.8 percent NIIT in addition to regular income tax. The dividends will be subject to the NIIT. If however, the physician works in the ASC more than 500 hours, the activity is no longer passive and not subject to the NIIT. What if the physician only works 200 hours in the ASC? You may be able to make a grouping election with the physician’s practice to qualify under the 500 hour test. So let’s suppose you manage to achieve material participation in the ASC, what have you really accomplished? Well, you eliminated the NIIT, but now you may be subject to selfemployment tax on the ASC income. However, the self-employment tax can be avoided with proper planning. If you own your own medical office building and rent to your practice, profits from “selfrentals” are not subject to NIIT.
capital gain rate from 20 percent to 15 percent. A cash balance defined benefit pension plan will increase tax deductions now and generate future income that may be exempt from the NIIT. CHARITABLE DONATIONS: Donate appreciated securities. PASSIVE ACTIVITIES: Increase your level of participation in an activity so that the business income becomes non-passive. For physicians there are some unique considerations with respect to active participation in physician-owned hospitals and ASCs that present significant tax planning opportunities. GROUPING ELECTION: You may qualify for “active” status if you work 500 hours in the activity, or you may be able to group multiple activities.
STRATEGIES FOR AVOIDING THE NIIT AND REDUCING YOUR ‘TOP BRACKET’ TAXES INCOME EXEMPT FROM THE NIIT?
Aggressive planning now for 2014 could have significant value to you.
SUMMARY OF KEY PLANNING STRATEGIES:
• Maximize qualified plan contributions, consider a Cash Balance Plan. • Achieve material participation status in all your trades or businesses. • Implement additional strategies to avoid paying self-employment tax. • If your income is above $450k, use a combination of strategies.
• Tax-exempt interest. • Excluded gain from the sale of your personal residence. • Distributions from qualified retirement plans (including IRAs). • Wages and self-employment income. QUALIFIED PLANS: This is the good trifecta, meaning lower your income in the top tax bracket, reduce your exposure to NIIT, and reduce your
May/June 2014 Physicians Bulletin 17
feature
Ready to Run?
K
ATIE UNDERWOOD WASN’T SURE if she
was ready to run for public office. Underwood, a civil engineer, knew the issues school districts faced as she comes from a family of educators. And she was versed in how government works. “But I was a very green candidate,” she said. Credit the Greater Omaha Chamber of Commerce with an assist for helping turn Underwood into an Omaha School Board candidate who garnered 76 percent of the vote in the most recent general election. Would-be candidates often don’t realize what’s involved in running for public office, said Joe Young, the chamber’s senior director of public policy. “It’s a good idea to run when you’re at the bar with your buddies, but many people are surprised how hard you actually have to work as a candidate.” Candidates for public office must be versed in a variety of topics, Young said. It can be a
18 Physicians Bulletin May/June 2014
challenge to understand the campaign finance laws administered and enforced by the Nebraska Accountability and Disclosure Commission. And then there is understanding the value of micro-targeting. For those unfamiliar with the concept, Young explained, that’s knowing everything about the registered voters in one’s district short of for whom they actually voted. Young suggested that would-be candidates participate in two chamber programs: • LEADERSHIP OMAHA— a program launched in 1978 to develop leaders who will strengthen and transform their community. The 10-month class is open to participants who live or work in the greater Omaha area and focuses on community trusteeship, leadership styles and community awareness. “The program takes emerging leaders and helps them become more aware of their community.” Underwood had her own take about the value of Leadership Omaha: “You go from figuring how things
work (in Omaha) to asking yourself ‘How can I make an impact?’” For Underwood, that meant running for school board. • CANDIDATES’ SCHOOL— a program that debuted early last year with an initial halfday session. The chamber will offer full-day sessions this fall and next spring. “The focus is on how to run and how to serve.” Topics include media relations, donor targeting and budgets. Others involve accountability and how to form campaign committees, including the importance of recruiting a campaign treasurer. Underwood attended the inaugural session and said she left feeling more confident about her decision to run. She learned about details, such as that campaign signs cannot be placed between the curb and sidewalk – “that’s public property.” She also learned the importance of establishing a core group of campaign volunteers. “Those are the people who will knock on doors.”
feature ONE OF THE NEBRASKA MEDICAL ASSOCIATION’S CHARGES IS TO ENCOURAGE PRACTICING AND RETIRED PHYSICIANS TO RUN FOR OFFICE.
“We need candidates for state office and the Nebraska Legislature who understand the many aspects of health care,” said Dale Mahlman, executive vice president. “Who better than physicians to look out for their peers and champion the health of all Nebraska?” In addition to the chamber programs, Mahlman suggested another opportunity for Omahaarea physicians contemplating a run for office: Attend the healthcare forums held for legislative candidates, beginning June 19 in Lincoln. Other forums are June 24 in Kearney and June 26 in Omaha. For more information, visit www.nebmed.org
Dale Mahlman, executive vice president of the Nebraska Medical Association, encouraged both practicing and retired physicians in the Omaha area who are considering a run for public office to take advantage of the two programs. “Get the facts,” he said. “Then, you can make an educated decision whether to run.” Young said the chamber relies on its members to help identify emerging and established candidates. The chamber assists them in figuring out how to run and how to win, Young said, and, in some cases, provides financial assistance. “We help them identify if they’re ready to run – and then they can select out or select in.”
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Omaha Magazine 5_1_14.indd 1
May/June 2014 Physicians Bulletin 5/1/2014 12:29:04 PM19
feature Photography by Justin Barnes
The Woodward File Hometown: Walhalla, N.D. Undergraduate Degree: University of North Dakota in Grand Forks in natural science Graduate/Medical Degrees: Master’s of science degree in medicine from the University of North Dakota; medical degree from Northwestern University in Chicago Residency: Surgical internship at the University of Iowa in Iowa City; residency in orthopedic surgery at the University of Chicago Fellowship: University of Rochester in Rochester, N.Y., in spine surgery Specialty: Orthopedic spine surgery Locations: Nebraska Spine Hospital & Nebraska Spine Center Family: wife, Connie; children, Miranda, Chase, Kiel and Courtney (all in medicine) Hobbies: Reading and puttering around his acreage Why He Joined MOMS: “No. 1, I wanted to interconnect and network with like-minded physicians.”
No Topics are Off-limits When Physicians and OSS Students Come Together
20 Physicians Bulletin May/June 2014
K
OOL-AID IS OUT. So are soda and juice
drinks. Alicia Tyson also has dropped fried and greasy foods from her diet. Her reward: losing several pounds in just the first few weeks since she decided to drop unhealthy foods. Tyson, 19, is a student at the Omaha Street School, a faith-based alternative high school that helps at-risk youths. The school focuses on dropout prevention by offering its students a personalized education, a moral code and tools for self-sufficiency.
feature
(Seated at table) Aryka Nasiatka (left), vocations teacher at Omaha Street School, and presenter Dr. H.R. Woodward, along with students from both classes that participated in the health curriculum classes.
Tyson decided to drop the unhealthy staples from her diet after H.R. Woodward, M.D., spoke to her class about health. During his presentation, Dr. Woodward, chairman of the Nebraska Spine Hospital Board of Managers and an orthopedic surgeon with Nebraska Spine Center, showed the students a Body Mass Index calculator. Tyson admitted she didn’t like her results – and aimed to make some changes in her life. “I’ve had enough greasy food to last a lifetime,” she said. Physicians are regular visitors to Omaha Street School as part of its partnership with the Metro Omaha Medical Society. The MOMS Foundation provided Match Program funds, while MOMS physicians are volunteering in the classroom helping the school add health and fitness components to its curriculum. The physician presenters have instant credibility with OSS students, said Aryka Nasiatka, who teaches vocations classes. They share statistics with the students that support their statements. “Our students put them on a high pedestal,” she said. “They hear their parents tell them and we
tell them. When a doctor tells them the same thing, it confirms what we have been telling them. They appreciate hearing it from someone else.” Nasiatka said no topics are off limits for her students and their guests. She only asked her students to stay awake, ask questions and avoid texting. Her students took special interest in exercise stress management, including a session on yoga taught by Susan Keasling, M.D. Other topics have included cancer, obesity and eating disorders, diabetes, high blood pressure and cholesterol, and STDs, as well as suicide, depression and dying. “The girls ask most of the questions. They’re close to their grandparents, and topics like diabetes hit home.” Dying is an appropriate topic for discussion, she said. “It’s relevant. It hits close to home.” Dr. Woodward said he was familiar with the Omaha Street School and its work because he and other members of Christ Community Church had visited previously to help with spring cleanups. He said he left impressed with the nonprofit organization.
“These folks are doing a job that needs to be done, the teachers and staff. It’s a difficult situation.” So when he heard about MOMS involvement at OSS, Dr. Woodward said he quickly agreed to participate. He was asked to discuss how to maintain a healthy spine, and worried that the students’ interest might wane. He was wrong. He discussed the importance of regular exercise – “exercises to do and not to do.” He encouraged the students to not use tobacco. He explained the BMI calculator and discussed the importance of proper nutrition. The students surprised him with their questions about calcium and vitamin D supplements – “Where do we get them and how much do we take?” Dr. Woodward said he had much more to tell them. He could have discussed the mechanics of surgery – “Things like how to put screws and hooks into someone’s back. That’s a little more exciting.” He will, next time. “I’d go back.”
May/June 2014 Physicians Bulletin 21
feature
Dr. Neil Hamill (center) puts CLER Guidelines into action at Methodist Hospital while supervising medical students and residents.
CLER Guidelines: A Call for Transparency and Collaboration
22 Physicians Bulletin May/June 2014
J
OSEPH VAVRICEK, M.D., HAS already seen the benefits.
The fourth-year radiology resident at the University of Nebraska Medical Center said he can offer first-hand testimony to the value of the Clinical Learning Environment Review Program, or CLER. “The overall intent of CLER is positive,” Dr. Vavricek said. “For the university to embrace these guidelines is good for patients and physicians.” Himself included. Dr. Vavricek, who serves on UNMC’s Graduate Education Committee, received an early introduction to six focus areas instituted for the review program by the Accreditation Council for Graduate Medical Education (ACGME). The guidelines call for more transparency from medical institutions and more collaboration among physicians, including residents – which can only help him provide better quality care, he said. The ACGME established the CLER program as a component of its accreditation system for the graduate medical education learning environment at each sponsoring institution and its participating sites. According to the ACGME website – www.acgme.org – the intent for CLER is “to generate national data on program and institutional attributes that have a salutary effect on quality and
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Free one-to-one education and support for psoriasis If you have psoriasis, the Psoriasis Patient Advocate Program* from AbbVie is here for you. safety in settings where residents learn and on the quality of care rendered after graduation.” CLER, through frequent on-site visits to sponsoring institutions, will • Increase the educational emphasis on public safety called for by the public. • Provide sponsoring institutions with opportunities to demonstrate leadership in patient safety and quality improvement, and a reduction in health-care disparities. At nearby Methodist Hospital, Neil Hamill, M.D., serves as a maternal fetal medical specialist and supervises medical students and residents. He said he has yet to see improvements made through the
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May/June 2014 Physicians Bulletin 23
feature CLER guidelines, but is willing to keep an open mind. “I just hope this is not new frosting for the same cake,” he said. Dr. Hamill said the importance of patient safety has been driven home since he served his medical residency. He said he expects most medical institutions have policies and procedures—to the tune of those called for by CLER—already in place. Should the CLER guidelines lead to improved patient care and improved communication among all members of the patient-care team, he said, he’s on board. The faculty development component for the CLER program is yet to be formalized and rolled out, said Michael Wadman, M.D., and Joann Porter, M.D., who respectively serve as associate dean for graduate medical education at UNMC and at Creighton University School of Medicine. “Bear with us,” Dr. Porter said. “This is so important. We will devote the time necessary.” Both institutions already have received an initial site visit by the AGCME – and will benefit from the feedback received, Drs. Wadman and Porter said. “It puts you on the clock, so to speak,” Dr. Wadman said. Dr. Porter added: “It (the visit) didn’t have a bearing in accreditation. But you must place the bar.” Dr. Wadman said the visit was productive because it placed hospital leaders, graduate medical education director and CLER investigators at the same table for discussion. Between meetings, he said, CLER investigators visited with residents and received their feedback. Drs. Wadman and Porter said their institutions received initial feedback for areas to address before AGCME representatives return for a more official visit in the coming year. In UNMC’s case, Dr. Wadman said, one area for improvement is resident involvement in incident reporting. Dr. Porter said Creighton officials – following their visit – are working to provide residents with an efficient, anonymous way to report incidents. “We had a clunky system. It wasn’t easy to access.” Drs. Wadman and Porter said they are confident the CLER guidelines will lead to increased resident involvement in patient care, which will lead to better outcomes for patients. “Residents receive better training. They complete their training, and practice medicine that way,” Dr. Wadman said. The focus is on a team approach to health care, which includes residents, Dr. Porter said. “CLER creates the expectation that residents are interacting with hospital administrators – finding opportunities for improvements.”
24 Physicians Bulletin May/June 2014
THE CLINICAL LEARNING ENVIRONMENT REVIEW PROGRAM WILL ASSESS SPONSORING INSTITUTIONS ON SIX FOCUS AREAS: • Patient safety, including opportunities for • Duty hours oversight, fatigue management residents to report errors, unsafe conditions and mitigation, including how sponsoring institutions and near misses, and to participate in teams to demonstrate effective and meaningful oversight promote and enhance safe care. of duty hours across all residency programs • Quality improvement, including how institution-wide; design systems and provide sponsoring institutions engage residents in the use settings that facilitate fatigue management and of data to improve systems of care, reduce healthmitigation; and provide effective education of care disparities and improve patient outcomes. faculty members and residents in sleep, fatigue • Transitions in care, including how sponsoring recognition and fatigue mitigation. institutions demonstrate effective standardization • Professionalism, with regard to how sponsoring and oversight of transitions of care. institutions educate for professionalism, monitor • Supervision, including how sponsoring behavior on the part of residents and faculty, and institutions maintain and oversee policies of respond to issues concerning accurate reporting of supervision according to ACGME requirements program information, integrity in fulfilling educational in an environment at both the institutional and professional responsibilities, and veracity of and program levels that assures the absence scholarly pursuits. of retribution.
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COVER feature
A View from the Other Side of the Room By Tom Tonniges, M.D., ttonniges@cox.net Photography by Bill Sitzmann
26 Physicians Bulletin May/June 2014
L
IFE HAS A WAY of surprising you. This happened to me two times
during my professional career as a pediatrician. I, like many MOMS members, grew up in small-town Nebraska. Gresham in fact. My father owned a small “produce store” where the town folk bought their chicks, garden seeds and Philco TVs. I was truly raised by a village – my parents, the postman, the butcher and the local welder (that welder a few years ago left $4 million to the University Foundation). Growing up in the ’50s and ’60s meant broken bones and way too many tetanus shots. The doctor was consulted only for an emergency and sometimes not even then. Immunizations were given in mass clinics in York – polio was being defeated one community at a time. After graduation from high school, there were three years at Doane College, four years at UNMC, two years in Bridgeport, Conn., for pediatrics and back to Nebraska for one more year before moving to Hastings to start essentially a solo pediatric practice. Being in solo practice for 14 of our 18 years in Hastings meant working 24/7. A day in Omaha or Kansas City every six months was a real treat – we had a Level 2 NICU that needed coverage. When I got sick in Hastings, I would call Docs Hervert or Little, and the problem was taken care of. If I needed to see a specialist (like when I developed a myocarditis), it was taken care of. We had the care of the village. As my practice developed, we practiced like we wanted to be treated. Life had few hassles. We had developed a “medical home” practice long before it became a buzzword of health-care reform. Our practice had onsite specialty clinics, a social worker, a health educator, and mental and behavioral health services. Very few patients needed to travel to Lincoln or Omaha for the services they needed. In 1995, our family moved to the Chicago area where I worked at the American Academy of Pediatrics to develop the Medical Home program into a national program, as well as develop approaches to solve pediatric problems at the community level by integrating medical care and public health. The first mantra was community-based, comprehensive and coordinated care. About the time that we moved there, I developed some bizarre symptoms – acute nausea, ptosis, arms falling asleep and muscle twitching, and the list goes on. I started with my primary care doc. He was only interested in prescribing medication without a real diagnosis. I was referred to multiple specialists without anyone connecting all the dots. I was operated on and treated like a healthy middle-aged doctor whose problems generally go away. I initially did not tell anyone I was a physician, unless they asked. There was one stretch of 20 visits to doctors, nurses, lab technicians or radiology techs before anyone introduced themselves and stated what they were going to do with me. I remember hugging the technician who told me his name. In almost all settings, I was considered a number. I always told my patients or their parents my name (it may have been that I knew they would have trouble pronouncing it). Being a physician-patient was difficult because I think that, in general at that time, sick health-care professionals were not considered authentic. Once I asked for a neurology referral from my primary doc and I was told the only referral he would give was to psychiatry. I said fine. I went to a very good psychiatrist and, after a battery of tests and interviews, he said that all I needed was to find a doc that could diagnosis my medical condition. I heard his nurses talking about me as the patient who was a “crock.” Out of the 20-plus physicians I saw, there were only four doctors who delivered patient-centered care. Most were hurried or not interested. Those who thought something was wrong: my final internist (long distance from Chicago to Nebraska), an immunologist, an ophthalmologist and a neu-
May/June 2014 Physicians Bulletin 27
COVER feature rologist. Of course with my spinal fluid protein being 150 (four times what’s normal) it caught the attention of these four people whom I trusted. I felt I was going to die without a diagnosis. My last attempt came when a friend referred me to a pediatrician at Johns Hopkins whom she felt was the greatest diagnostician. Johns Hopkins had an adult diagnostic clinic at one time but closed it because it was a loss leader. After probably a million dollars spent on me over a six-year period (IVIG was very expensive back then and still is), I went to Baltimore to see a pediatric adolescent specialist. He saved my life. He spent four hours taking the history, 15 minutes doing a physical and in 10 minutes came up with a critical cervical stenosis. Three neurologists, three orthopedists and two neurosurgeons had felt my spine was normal. A flexed MRI of my cervical spine showed otherwise and surgery became an emergency. When I woke up from surgery I knew that my symptoms were getting better. I asked my wife, Jane, if I was moving my toes. She said I was. I asked if I could move my arms. She said no. I had a temporary paralysis of both arms that lasted about two months. Having gone through all that made me more certain that a medical home could be a much better model of care and how American health care needed to change. It solidified my ideas on the importance of family-centered care. Quality care, cost-effective care and patient satisfaction can all be achieved. During my 10 years at AAP, I was able to get parents on key committees, participate in all our federal projects, and take the family-centered care and medical home models to about 15 countries, including Czech Republic, Kosovo, Argentina and the Philippines, to name a few. In 2005, we moved back to Omaha to be close to our kids, and I became responsible for the youth at Boys Town. Seeing about 125 new young people per year, I was amazed their experiences were not a whole lot different than mine in Chicago. For the first time in many of their lives, they were treated as almost adults. Very few of them arrived at Boys Town with a complete medical workup. Very bad acne, undetected serious medical problems, labeled as allergic to penicillin (but never having it prescribed), and bad feet from serious bunions,
28 Physicians Bulletin May/June 2014
athlete’s feet, plantar warts. The list goes on. Since continuity was my major concern, pretty soon the youth were saying “Hi, Doctor Tom” in the office and would stop by to say “hi” when at an athletic event. I think they began to approach their health care as personal, positive and something someone else was interested in.
Fast forward to December 2011. I began to have difficulty singing and drinking red wine, and noticed some mild changes in my voice. To make a long story short in August 2012, I was given a diagnosis of “possible ALS,” in August 2013, “probable ALS,” and a little later, “ALS.” I can still remember in Hastings taking a beautiful newborn in to see his grandmother who was in the hospital with end stage ALS. All I could tell her was that her grandson was beautiful, that I would be there to support this new generation of her family…and that I loved every one of them. I decided right then and there that ALS was one of the most horrible diseases because it meant daily loss. My symptoms have progressed rather rapidly. I cannot talk and can only walk with great assistance. I just got my motorized wheel chair and am being pushed to take all my nutrition through a g-tube. I know many reading this article would disagree, but the internet has been a godsend for someone like me with a complicated history. I found out that the only thing on the horizon for treatment for ALS has been stem cell transfusion. Even though not approved in the United States, NIH had funded studies in Israel that have shown promising results. So in October 2013 and January 2014, my son, Jane, and I made trips to Tel Aviv for autologous stem cell transfusion. Now it is watch and wait. By the
end of spring, I should see results. I remain positive. I hope that someday all health-care professionals (my hope is expressed by using the word “professionals” rather than “providers”) will truly practice family-centered care or patient-centered care. I hope that someday every health-care professional will see patients as experts in their health problems, and partners in their care. If they are not experts, it is our job to make them experts. And YES, it can be done with people with low incomes, people with disabilities and people on Medicaid. I feel strongly about the last statement and that is why over 30 years ago, I hired a health educator as part of our little emerging medical home in Hastings. I have experienced all the health-care systems here in Omaha. We have a long way to go. In the past two months, I have experienced the following: Major HIPPA violation: Was I Thomas or Fred Tonniges? (My cousin was in for surgery the same day in the same facility.) Worse yet, his clothes were put in my post-op room. I was to be a direct admit, but was kept in the ER for more than six hours. I fell at home and knew that I had fractured my neck. At home, my neck was not stabilized with more than eight first responders in our bedroom. Someone said, “Should we stabilize his neck?” and since I could not talk, only grunt, they proceeded to pick me up. When in an ER, a resident said he wanted to do a bunch of testing that I felt unnecessary. I refused to get a chest X-ray and I asked why, the resident said that I might have an aspiration. I had zero pulmonary symptoms. One has to have a major sense of humor if one has frequent contact with the health-care system. On a recent visit to an outpatient clinic, my daughter went with me. I communicate with a Boogie Board – essentially a high-tech erasable pad. When in the room, I told the staff person via my Boogie Board that I could understand everything that she would say, but would have to write down my response because I could not talk. She kept talking louder and louder. I responded once, and my daughter twice, that I was not deaf. Finally, the staff person asked my daughter (not looking at me) “Are you his care taker? What facility are you from?”
The Metro Omaha Medical Society Foundation identifies and provides support to community priorities where physician involvement can make a difference in improving the health of the Metro Omaha Community.
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NEBRASKA CANCER SPECIALISTS IS NOW QOPI® CERTIFIED! Nebraska Cancer Specialists was recently awarded QOPI® Certification for our outpatient oncology-hematology practice by ASCO, the largest oncology society in the U.S. Based on careful analysis and on-site inspections, we met core standards in all areas of treatment, including:
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Midwest Cancer Center Legacy (402) 334-4773 Fremont (FAMC) (402) 941-7030
May/June 2014 Physicians Bulletin 29
COVER feature
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY. To speak with a dedicated specialist from our Health Care Banking Division call Ed Finan at 402-399-5028.
www.anbank.com • 33 locations in Nebraska and Iowa. Call 402-457-1077 or 800-279-0007.
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Call (402) 298-5727 to further relieve your patient’s condition Revealing God’s Love Through Excellence in Healthcare 12702 Westport Parkway, Ste. 101 LaVista, NE 68138 www.heartlandvein.com 30 Physicians Bulletin May/June 2014
Thomas B. Whittle, M.D. Vascular Surgeon
So what suggestions do I have for the healthcare system and for doctors? • Consider that your patients may really be experts in what they need, especially those with chronic disease. Consult for them. • Read about family-centered or patient-centered care. It isn’t light medicine, but part of the science of medicine. • Be your own greatest critic. Instead of thinking you’re in the Top 10 percent of docs, think that you might be around 50 percent. This will change how you approach your practice. • Follow the footsteps of someone with a disability in your office and hospital. You will be amazed that what they have to go through to land in a 10-foot-by-12-foot room. • When you see something that is not good, take a few minutes to do something about it. Recently, I had to use a restroom in a major retail store. The handicapped bathroom was so big I think I could have turned my Jetta around in it. Of course, the toilet paper holder was five feet away and there was no way I could reach it. When I told the manager, her reply was only to state that she had not heard that complaint before. Obviously, she didn’t understand. • Embrace good change. Practicing like we did the last day of our training isn’t going to cut it in the future. • Question whether current attempts at gathering information about patient satisfaction give us anything helpful. The patient may not know difference between superb care and OK care. • See that health professionals can be great historians and an opportunity to learn more about the disease process. They can help us broaden our knowledge of disease. Crocks eventually expose themselves. I could go with more examples, but I think you get the point. As a physician with a major health problem, my view point from the exam table is completely different. I am convinced that “the other side of the room” viewpoint is critical to all of us as we continue to experiment with health care reform. This different view is best observed by physicians and those around us. I think primary care physicians have the great opportunity of adding to our knowledge of disease. They still have an opportunity to observe disease and health in a way that no one else can do. My hope is that all of us take a little time to be our own greatest critic—we all become part of making our communities’ health the best they can be. We have all probably heard the answer to “How do you eat an elephant?” -- one bite at a time. Thanks for doing your part.
MEMBER news
Dr. Romberger
receives UNMC Spirit of Community Service Award
D
EBRA ROMBERGER, M.D., PROFESSOR and vice chair of research for
the University of Nebraska Medical Center Department of Internal Medicine, received the Spirit of Community Service Award at the UNMC annual faculty meeting in April. Dr. Romberger, who grew up in a farming community near Abilene, Kan., earned her undergraduate degree from Kansas State University and her medical degree from the University of Kansas Medical Center. She did fellowships in internal medicine and pulmonary/critical care at KUMC before coming to UNMC in 1988 for a two-year pulmonary research fellowship. She joined the UNMC faculty in 1990 as assistant professor and was elevated to associate professor in 1998 and professor in 2005. Since 2000, she has served as vice chair of research for internal medicine. She also served as interim chairman of the department in 2004-2005. Dr. Romberger works in the section of pulmonary, critical care, sleep and allergy medicine. She also serves as associate chief of staff/research at the Omaha Veterans Administration Medical Center. Her parents taught her early on about the importance of volunteering and giving back to the community. She currently volunteers at the TB clinic for OneWorld Health Clinic in Omaha and serves on the board for the Josie Harper Hospice House. She is a past board member of Ted E. Bear Hollow, Omaha’s grief center for children and teens. During the past 20 years, she has volunteered for a variety of organizations, including the Visiting Nurse Association Hospice Program, Heartland Urban Ministries Center, Omaha Together One Community, First United Methodist Church and the Institute for Public Life. “My parents imparted in me the concept that volunteering in the community is central to having a vibrant space for all of us,” Dr. Romberger said. “I am trying to do my small part to contribute to the common good by being involved in community service. “I started volunteering as an M.D. at OneWorld (before it was called OneWorld) around 1995. I had experienced a death in my family and it became clear to me that I needed to start giving back to the community. My involvement in my faith community also has given me lots of opportunities to be involved in the community that are not dependent on my medical background.” A prodigious researcher, she has received funding for 35 research grants. In addition, she has been involved in producing nearly 130 articles for science journals and 17 book chapters and reviews. Her research focuses on understanding the cellular and molecular mechanisms of environmentinduced inflammatory airway disease.
Dr. Michael Westcott
is new NeHII board president
M
ICHAEL WESTCOTT, M.D., HAS assumed the role of president of
the NeHII Board of Directors. The transition from Harris Frankel, M.D., occurred early this year with a vote by the NeHII Board of Directors. The NeHII Executive Committee made the recommendation to the Board of Directors as they felt it was critical to have the position remain with a physician at the helm of the state-wide health information exchange. Without a doubt, Dr. Westcott is duly qualified to lead NeHII going forward,” Dr. Frankel said. “He brings with him legacy knowledge about NeHII, from its earliest days to the present, having been engaged with various committees, as a board member, and most recently as a member of the executive committee. His passion for information technology in healthcare is indisputable and his desire to improve the delivery of care via health information exchange, for all Nebraskans, is second to none.” Dr. Westcott has served as chief medical information officer for Alegent Creighton Health in Omaha for the past 10 years. He serves as the regional chief medical informatics officer for Catholic Health Initiatives. Dr. Westcott is board certified in emergency medicine and has served as co-chair of the NeHII HIE Advisory Council and as a member of the NeHII Executive Committee prior to accepting the role as president of the Board. He too was involved in the early beginnings of the health information exchange from 2005. “I am very much looking forward to continuing the terrific work that has been done under Dr. Frankel’s excellent leadership the past several years. We will continue to enhance NeHII to make it even more useful to Nebraska physicians and providers and thereby contribute to the quality and safety of patient care for all patients participating in NeHII,” Dr. Westcott said.
May/June 2014 Physicians Bulletin 31
CAMPUS & HEALTH SYSTEMS update
Governor honors Alegent Creighton Health Faith Community Health Network
G
OV. DAVE HEINEMAN AND First Lady
Sally Ganem honored the Alegent Creighton Health Faith Community Health Network (FCHN) with the Governor’s Points of Light group award. The volunteer-based service group was started in 2005 and has impacted more than 13,000 individuals with more than 105,000 volunteer hours, saving more than $1.9 million by avoiding emergency room visits, surgical procedures, advocating for treatment and providing no-cost fitness classes and health screenings. The FCHN is comprised of 50 congregations and 73 active faith community nurses and health ministers. The group builds capacities in congregations by leveraging the resources of Alegent Creighton Health and the strength of faith communities to build a culture of health and healing within the congregation and community it serves. This empowers people to make positive choices for whole-person health. The program promotes the health of body, mind and spirit; collaborating with state and community agencies and groups to share resources and expertise. With chronic conditions on the rise and the population aging, changes in health care are making preventable re-hospitalizations a priority issue, and the need for prevention and health promotion is increasingly important. Rather than practicing from a medical or home health model, the program strives to promote healthy lifestyles for all ages, advocate for those who are ill, encourage social justice and refer when necessary. For more information, go to AlegentCreighton. com/faith-community-health-network.
32 Physicians Bulletin May/June 2014
Center targets behavioral and mental health problems
B
OYS TOWN IS LAUNCHING the Center for
Neurobehavioral Research in Children. The effort is a collaboration between Boys Town National Research Hospital and Boys Town Youth Care Services. The center will study and improve methods for intervening early in the lives of children with behavioral and mental health problems. “Research has deepened our knowledge of the factors that contribute to behavioral and mental health problems,” said Kayla Pope, M.D., J.D., director of neurobehavioral research. “This knowledge has profound implications for prevention and intervention, the most important of which is that we can change the course of a child’s life if we intervene early and effectively.” Many of the children who come to Boys Town have been exposed to significant trauma, violence, abuse and neglect. These early life experiences often cause serious mental health problems, such as mood disorders, problems with impulse control, self-harm and aggression. Mental health and behavioral experts now have a better understanding of how these early life experiences alter brain development and function. The center will use this knowledge to develop better intervention methods. Boys Town’s long history of providing effective treatment for children with a wide range of disorders and Boys Town National Research Hospital’s successful history of research during the past 40 years position the center to become a stateof-the-art collaborative research effort that will offer evidence-based solutions for treatment to the larger mental health community. The research studies will combine the latest brain imaging technology with behavioral measures that are already well established as part of the Boys Town program. The center will focus on research programs in four areas: • Mood and anxiety disorders – depression, PTSD, generalized anxiety. • Disruptive behavior disorders – conduct disorder, oppositional defiant disorder, ADHD. • Substance abuse. • Web and computer-based therapeutics.
Children’s HematologyOncology Clinic and Infusion Center in new location
A
NEWLY EXPANDED HEMATOLOGYONCOLOGY CLINIC and Infusion Center
are up and running at Children’s Hospital & Medical Center. Both areas opened to patients in April on the third floor of the Children’s Specialty Pediatric Center, 84th Street and West Dodge Road. The new Hematology-Oncology Clinic added three exam rooms for a total of eight, plus an additional room for clinic lab draws and a larger, dedicated reception area for families. The Infusion Center, which serves families with many different diagnoses, now has five private exam-infusion rooms and a significantly larger open-area infusion space with upper level windows spanning 25 feet. The Infusion Center is adjacent to the Hematology-Oncology Clinic. Nearly 5,000 patient visits are made to Children’s Hematology-Oncology Clinic annually, while the Infusion Center recorded nearly 3,600 patient encounters in 2013. Both areas had been located on the first floor of the Specialty Pediatric Center, completed in 2010. That space is now being renovated for cardiac services clinics and an expanded Cardiac Diagnostics Center. Children’s Hospital & Medical Center is also in the middle of construction on a new hospitality house, a redesign of the current Carolyn Scott Rainbow House, which opened in 1983. Located at Farnam and Beverly drives, the new Rainbow House will feature 56 guest rooms, a large kitchen with four cooking stations, a large dining room and entertainment spaces. It is on track for completion in early 2015.
CAMPUS & HEALTH SYSTEMS update
Bioethics subject of podcast series
T
HE CENTER FOR HEALTH Policy and Ethics at
Creighton University and the Ethics Center at Alegent Creighton Health have launched a new podcast series, “Bioethics Beyond the Bedside.” Each episode is dedicated to a different ethical issue encountered in an ambulatory care setting. In the inaugural episode, which launched in February, Amy Haddad, Ph.D., director of the Center for Health Policy and Ethics, discussed the ethics challenges in outpatient settings and the overall purpose of the podcast series. Subsequent episodes, which are also currently available for download, have addressed ethics from the perspective of a primary care physician, caring for refugee populations and living the legacy of our founders. Mark Goodman, M.D., associate professor of medicine at Creighton University School of Medicine, hosts the podcast alongside Leslie Kuhnel, MPA, from the Alegent Creighton Health Ethics Center. The series can be found online at CHPE.Creighton.edu. Interested providers can also register to receive e-mail notifications when new episodes are published.
Methodist foundation hits fundraising mark early
T
HE TIMELINE TO GENERATE more than $40
million in donations for the Methodist Hospital Surgery Renovation and Expansion Project was five years. The Methodist Hospital Foundation said forget that – and through the generous efforts of physicians, Methodist employees and donors from throughout the state – raised $40.8 million in two years. That’s three years ahead of schedule. The fundraising effort was initiated on April 1, 2012, and the foundation hit their mark in March 2014. “We launched this campaign with a matching gift challenge,” said Cynthia Peacock, foundation president and CEO. “We had a generous donor who agreed to match every gift, dollar for dollar, and gave us five years to accomplish the task. The grant agreement also called for the physicians of Methodist to contribute $2.5 million. They responded with great enthusiasm and have given $4.6 million to date. In these times, this is a tremendous accomplishment.” Methodist Hospital’s $90 million surgery renovation and expansion project will expand the existing 12 operating rooms to 15, including two heart and one endovascular suites. The size of the surgery suites will grow from 420 square feet to 650, and the current 32 prep and recovery rooms will expand to 44 private rooms. Methodist Hospital’s cardiac services will also be located in one convenient area. “Physicians recognize that while they could go other places, they don’t. Methodist is their place of choice,” said Scott Rose, M.D., a general surgeon. “The health of the hospital is important and that is why physicians responded the way they did. It wasn’t just the surgeons. Every specialty decided it was a good investment.” Construction is underway at Methodist Hospital, both on the exterior and interior of the 84th Street Campus. Completion date for the project is projected for 2017.
UNMC lands two Top 10 rankings
T
HE UNIVERSITY OF NEBRASKA Medical
Center is ranked in the top 10 in two areas in the latest U.S. News & World Report rankings of the nation’s top graduate schools. UNMC remains the sixth-ranked primary care medical program in the United States, tied with the University of Minnesota. In addition, UNMC tied for ninth in the list of top rural medicine programs. “The recognition of UNMC in the fields of primary care and rural medicine is gratifying,” said Jeffrey P. Gold, M.D., UNMC chancellor. “These are areas of vital importance to the people of Nebraska, and it is a testament to the physicians, researchers and staff members at UNMC that their efforts have been acknowledged as among the nation’s finest.” U.S. News surveyed 153 institutions during 2013-2014 in compiling the rankings. Schools surveyed included medical schools accredited in 2013 by the Liaison Committee on Medical Education and schools of osteopathic medicine accredited in 2013 by the American Osteopathic Association. According to the U.S. News website, rankings are based on two types of data – expert opinions about program excellence and statistical indicators. Primary care rankings included indicators such as the student admissions statistics (scores on the Medical College Admission Test, grade point averages and acceptance rates), the proportion of graduates entering primary care specialties, peer assessment, assessment by residency directors and other factors. UNMC remained at No. 64 for research in the new rankings. Although new rankings aren’t available in all categories for 2015, UNMC continues to be rated in four other programs: • 16th in physician assistant programs (last ranked in 2011). • 32nd in pharmacy programs (last ranked in 2012). • 34th in physical therapy programs (last ranked in 2012). • 36th in nursing master’s programs (last ranked in 2011).
May/June 2014 Physicians Bulletin 33
MOMS events MEDICAL LEGAL DINNER
The Metro Omaha Medical Society, in partnership with the Omaha Bar Association, hosted the annual Medical Legal Dinner on March 18 at Champions Run. Dr. Rowen Zetterman, director of UNMC Faculty Mentorship Development, presented “Are Changes in Medical Education Improving Health-care Delivery?” 1. (From left) Nebraska State Bar Association President and Creighton Law Professor G. Michael Fenner, MOMS and NMA Past President and keynote speaker Dr. Rowen Zetterman, and MOMS president Dr. Deb Esser. 2. Dr. Tom Tonniges, foreground, and Dr. John Donaldson converse. Also at the table were Drs. James and Myrna Newland. 3. (From left) Drs. Anthony Yonkers, Linda Ford, Peter Silberstein and Eric Phillips enjoy dinner.
1
Coming Events
2
3
34 Physicians Bulletin May/June 2014
COMING events MOMS PRE-CAUCUS MEETING JUNE 2 6 – 7:30 P.M. MOMS BOARD ROOM – 7906 DAVENPORT ST.
All members are encouraged to participate in discussion of potential resolutions for MOMS to present at the NMA House of Delegates.
WOMEN IN MEDICINE TRAP SHOOTING JUNE 11 6 P.M.: DINNER & NETWORKING 6:30 – 8 P.M.: SHOOT TRAP VALLEY TRAP RANGE
No experience necessary. Equipment and safety gear provided. Members of the Marian High School Trap Team and Coach Bruce Esser will be on hand to provide instruction. Child care available in the clubhouse with advanced request. RSVP by June 9.
YOUNG PHYSICIANS VS. YOUNG ATTORNEYS PUB QUIZ JUNE 24 LIV LOUNGE (AKSARBEN VILLAGE) 5 P.M.: NETWORKING 6 – 8 P.M.: PUB QUIZ
Metro maha Medical Society STRATEGIC PARTNERS
The Metro Omaha Medical Society Strategic Partners offer a variety of expertise, products and services to assist physicians and practices in addressing their needs and achieving success. We encourage you to talk with our Strategic Partners when making decisions for yourself or your practice.
PLATINUM PARTNERS www.CallCopic.com
www.FosterGrp.com
MOMS Young Physicians have been challenged by the Omaha Bar Association Young Attorneys to an evening of trivia. Beverages and hors d’oeuvres will be served. RSVP by June 18.
MOMS CAUCUS MEETING JULY 15 6 – 7:30 P.M. MOMS BOARD ROOM – 7906 DAVENPORT ST.
www.corebank.com
http://tmsassocgen.com
GOLD PARTNERS www.YourFutureCounts.com
www.nebraskamed.com
All members are encouraged to participate to vote on the proposed resolutions for the NMA House of Delegates.
www.nebraskaspinehospital.com
QUICK TAKES: MINI EDUCATION SESSIONS
SILVER PARTNERS
JULY 31 OMAHA MARRIOTT (REGENCY) 11:30 A.M. – 1 P.M.: PRACTICE MANAGERS 6 – 8 P.M.: PHYSICIANS
Choose from a variety of 20-minute topics presented by local industry experts. Gather valuable information on the topics of most interest to you and without a big time commitment. Legal • Financial • Employee Benefits • Practice Management Cost-saving Measures • & More. RSVP by July 28.
www.AlegentCreighton.com
www.ClineWilliams.com
www.KoleyJessen.com
www.BestCare.org
NETWORKING EVENT - JAZZ ON THE GREEN AUG. 7 CANTINA LAREDO (MIDTOWN CROSSING) 6 – 7:30 P.M.
Join your peers for networking and sample Mexico City-style cuisine, then head out onto the grass and enjoy Jazz on the Green. RSVP by Aug. 5. Call (402) 393-1415 or email Laura@OmahaMedical.com for more information or to RSVP for any of these events.
www.SeimJohnson.com
BRONZE PARTNERS www.GoNines.com
www.LutzCPA.com
www.NebMed.org
For more information on our Strategic Partners visit www.omahamedical.com May/June 2014 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:
Office
Home Other: __________________________________
Office
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
NO
(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.
_____________________________________
Signature
___________ Date
B
Fax Application to: 402-393-3216
36 Physicians Bulletin May/June 2014
Mail Application to: Metro Omaha Medical Society 7906 Davenport Street Omaha, NE 68114
Apply Online: www.omahamedical.com
MEMBER benefits
NEW MEMBER update
Did You Know? MOMS Collaborates to Benefit Public Health
As part of its mission of improving the general health of the community, the Metro Omaha Medical Society collaborates with many local agencies and organizations by offering grants and funding, informationsharing, physician volunteers and leaders, and meeting space.
MOMS collaborates with: • Charles Drew Health Center • CHIP (Community Health Improvement Project) • Douglas & Sarpy County Health Departments • Habitat for Humanity • Hope Medical Outreach Coalition • Immunization Task Force – Metro Omaha • Live Well Omaha & Live Well Omaha Kids • National Safety Council, Nebraska • NMA Childhood Obesity Prevention Project • Omaha Street School • OMMRS (Omaha Metropolitan Medical Response System) • OneWorld Community Health Centers
When you choose to be a MOMS member, you help to strengthen these efforts. Want to get involved and help to make a difference? Call (402) 393-1415 today.
Nirmal Raj, M.B.B.S. Medical School: St. John’s Medical Academy of Medical Sciences, Bangalore, India. Residency in Family Medicine: Creighton University Medical Center Residency in General Surgery: National Health Services Hospitals, London Fellowship in Surgery: Royal College of Surgeons Specialty: Family Medicine Location: Family Medicine and Surgery, P.C.
Dr. Raj moved to Omaha in 1989 to join a family medicine residency at CUMC after training in general surgery in the UK and United States. He chose to stay and practice in Omaha. After some 14 years in solo practice, he is evaluating exit strategies from solo private practice and looking at possibilities. He also enjoys traveling, teaching medical students and reading.
Cliff A. Robertson, M.D. Medical School: Ohio State University College of Medicine Residency in Family Medicine: Madigan Army Medical Center Other Post-Graduate Education: MBA – Pacific Lutheran University Specialty: Family Medicine Title: CEO and president of Alegent Creighton Health
In addition to medicine, Dr. Roberston has always had an interest in business and became a franchise owner in 1996. He currently owns and operates 28 Great Clips hair salons in two states.
OTHER NEW MEMBERS: Chinyere Oarhe, M.B.B.S. Neonatalogy
Interested in becoming a MOMS Member? Call 402-393-1415, apply online at www.OmahaMedical.com or complete the application on page 36.
Kelli Rudman, M.D. Otolaryngology Alexis Sawyer, M.D. Pediatrics Jennifer Uggen, D.O. Anesthesiology
May/June 2014 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 at Curt Hofer & Associates knows how to bring the best ideas to life – yours. The result? Your home...your builder. Exceptional.
CURT
HOFER
& ASSOCIATES
Your home...your builder. Exceptional.
2332 Bob Boozer Drive Omaha, NE 68130 Phone: 402.758.0440 n
www.cur thofer.com
38 Physicians Bulletin May/June 2014
YOUR dream OUR VISION
Perfection!
“eLite L andscaPing has continued to impress me with constant attention to detaiL and creativity in their LandscaPe designs.
Jason decker is
always prompt, responsive to our needs and ProfessionaL at aLL times. i would recommend him and his team at eLite L andscaPing without hesitation!”
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Metropolitan Omaha Medical Society 7906 Davenport Street Omaha, NE 68114
ADDRESS SERVICE REQUESTED
PRSRT STD U.S. POSTAGE
PAID
PERMIT NO. 838 OMAHA, NE