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thisissue

Finance Update . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Rewards Should Return

Young Physician Report . . . . . . . . . . . . . . . . . . 17 Finding Balance in Nature

Clinical Update . . . . . . . . . . . . . . . . . . . . . . . . . . 18 What are Your Chances of Being Sued?

Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Member News. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Campus Updates . . . . . . . . . . . . . . . . . . . . . . . . . 35

6 PHYSICIANS BULLETIN November/December 2011

E S

Truth in Advertising

NMA Message . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Making Hospital Design a Team Sport . . 20

Cover story: . . . . . . . . . . . . . . . . . . . . . . . . . . 23

My Rule was Made to be Broken

A Long, But Rewarding Journey

A T

Editorâ€™s Desk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Where is Health Reform?. . . . . . . . . . . . . . . 26

F E

D E P A R T M E N T S

Table of Contents: NOVEMBER/DECEMBER

Lending Local Nonprofits a Hand. . . . . . . 28

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editor’sdesk

Marvin Bittner, M.D.

My Rule

was Made to be Broken

In this issue,

I broke one of my rules for this magazine.

“You are the only hospital designing with

is at its best five years after construction. By

The rule is: “Don’t give a lot of attention

this system,” remarked Mark Eney, who is a

that time, errors in design are recognized.

to the Omaha VA.” Here’s the basis for that

project manager from the VA Central Office

Staff members have whined about the errors.

rule: I spend the lion’s share of my profes-

in Washington, DC.

The first round of remodeling has fixed

sional time at the VA Medical Center in

them. In a phrase, this approach is “Design

More typical is what happened at the

and Whine.”

Omaha. I want to be fair to the entire

University of Minnesota hospital. I was an

medical community. I recognize the risk of

infectious diseases fellow there. An architect

overemphasizing my own institution. That’s

involved in planning a new hospital was

Whine,” I was very, very enthused. I wanted

why I made the rule. In this issue, I broke

assigned to an unused office. The infection

to publicize this. I broke my rule about not

that rule.

control staff was in a nearby office. As a

giving a lot of attention to the VA.

Because the VA rejected “Design and

Flip a few pages. You will find a promi-

result, the architect and the infection control

This approach to planning is what should

nent article about the VA. By insisting on

staff got to know one another. The infection

be done, not just in planning buildings, but

publishing this article, I broke my rule. I had

control staff saw some early plans, identified

also in planning other aspects of health care.

good reason to do so. The VA is doing some-

some problems and were able to get the plans

Ask yourself: When an electronic medical

thing very special. The VA is planning a new

changed. This occurred by happenstance, not

record was adopted in your setting, were

hospital. What is very special is the way the

because of a system of planning.

dozens of physicians who would actually use

In contrast, the Omaha VA’s system of

it consulted in the early stages of planning?

In planning for the new hospital, the

planning deliberately brought staff together

Were the designers of the electronic medical

VA is involving hundreds of staff members

with architects. The planning even included

record concerned about maximizing

throughout the institution—including physi-

multiple “Design Accelerator” sessions with

physician productivity? At this point, some

cians. This makes sense. After all, shouldn’t

scores of staff at Alegent Health’s Right Track

of you may be rolling on the floor laughing.

plans for a new hospital reflect the knowl-

planning venue at its McAuley Center on

Unfortunately, the exclusion of most users

edge and experience of those who will work

West Dodge Road. Joel Fadem, a facilitator

from the process of planning is no joke. We

there?

from Los Angeles, directed sessions, which

need to recognize health-care managers, like

typically lasted a day or more.

those of the Omaha VA, when they stop

planning is proceeding.

Nonetheless, this degree of staff involvement is not the norm, particularly in the VA.

I had been of the opinion that a hospital

treating health care as a joke.

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NMAmessage “As physicians, we have so many unknowns coming our way...

One thing I am certain about is my malpractice protection.”

Truth in Advertising

One of the resolutions

at our 2011 House of Delegates proposed

team;” the physician takes the leadership or

requiring health-care providers to wear iden-

supervisory role. Unfortunately, time and

tification and prominently display their level

again the focus shifts from appropriate care at

of state licensure and credentials, among

the appropriate provider to an access to care

other items. The resolution, introduced by

issue. This often translates to convenience for

the Nebraska Eye Physicians and Surgeons

the patient and we seem to have lost sight

and the Nebraska Dermatology Society

of the real issue. Our leadership still believes

passed unanimously.

that providing the best care to the patient is

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a consideration, it should not outweigh

touting the benefits of a new treatment or

patient safety.

procedure, patients are left to sort through

MDs and DOs of Nebraska, we will

some very complicated subject matter, usually

continue to advocate for physicians and

at a vulnerable time.

patients alike. Membership in MOMS

The NMA partnered with the AMA on

and the NMA shows your commitment to

a tool for legislators titled, “Know your

support the mission of our organization,

Doctor.” This pocket tool highlights the dif-

and this is an important time to represent

ference in training and education between

your profession. Our focus for 2012 will be

physicians and health-care providers. If we

to make sure that physicians are accurately

had 1 million additional copies, it would

represented in both the Nebraska Legislature

serve as an excellent patient resource as well.

and the community as well. We will

In most cases, it’s like comparing an Olympic

never take the short cut or easy way out.

gold medalist with a college athlete. There is

Understanding the requirements fulfilled by

no substitute for education and training.

physicians, we hope that when the question of “Is there a doctor in the house?” is

sion, we continue to monitor the provider

answered, it is answered by a physician – and

efforts to either expand their scope of practice

one who belongs to the NMA.

sion requirement. Whatever the case may be,

12 PHYSICIANS BULLETIN November/December 2011

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financeupdate By Kent Kramer, Foster Group

Rewards Should Return

Unemployment

in the United States is still over 9 percent. Growth of the global economy is slowing. European banks are mired in crisis due to bad sovereign debt and . . . well, you’re familiar with the list. So, what kind of return should investors “expect” from their stock portfolios in the face of such bad economic news? Professors Eugene Fama (University of Chicago Booth School of Business) and Kenneth French (Tuck School of Business at Dartmouth College) answered this question in a short blog post dated March 11, 2009, within days of “the” market low point following the 2007-2008 financial crisis. At the time, they wrote: “The market has declined sharply in response to rough times and forecasts of future rough times. The decline in market prices combines two effects: lower current and expected future profits, and higher discount rates for the expected future profits. The discount rate, in turn, has increased because uncertainty about future profits (in other words, risk) has increased and, apparently, because investors have become more risk averse. Higher discount rates for expected profits translate into higher expected stock returns. “In short, the two of us believe that the expected return on stocks is currently high. But beware: the high expected return is compensation for the risks associated with different possible outcomes. If the quite pessimistic

14 PHYSICIANS BULLETIN November/December 2011

assessments of future economic performance built into current market prices turn out to be right (which is our best single guess), realized returns will be high… “On the positive side, there is a substantial chance that the current assessments of future economic performance built into market prices turn out to be too pessimistic. If so, realized returns will be even higher than expected. But there is also a substantial chance that the current quite pessimistic assessments of economic performance built into market prices turn out to be too optimistic. In that case realized returns will be low, perhaps quite low. This is always the general nature of the risks in stock market investing. The story is more poignant at the moment because risk is so high.”* Fama and French make three critical observations applicable to today’s economic environment. The first is that investors have responded to bad economic news by demanding a higher return for stock investments. This has resulted in lower prices for a company’s expected future earnings. Investors, as a group, currently think those earnings are at greater risk. Interestingly, in 2011, corporate earnings have been relatively strong. The second key point is captured in the statement, “In short, the two of us believe that the expected return on stocks is currently high.” Why? They were observing that the decline in prices reflects a de facto increase in

the risk premium demanded by investors. Finally, their perspective on risk is extremely important. Risk does not guarantee higher return, but as risk increases, investors require the possibility of a higher return. Fama and French envisioned three possible outcomes in 2009: the expected outcome, the betterthan-expected outcome, and the worse-thanexpected outcome. None could be guaranteed, though the expected (higher) return was the most probable. This same observation holds today in October 2011 relative to stock prices in June 2011. In retrospect, 2009 and 2010 were years of very high returns for stocks around the world. Recent circumstances have increased the perceived risk of investing in stocks, driving prices lower. At today’s lower price, expected returns have again risen. The risks are real, but patient investors have been rewarded in the past for participating in stock markets and it is our expectation that they will be rewarded in the future as well. *http://www.dimensional.com/famafrench/2009/03/qa-expected-return-in-a-badeconomy.html Kent Kramer, CFP, is a partner with the Foster Group Inc., 1001 Grand Ave., West Des Moines, Iowa. More information about the Foster Group can be obtained by calling (515) 226-9000 or at www.fostergrp.com

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By Matin Ebneshahrashoob

young physicianupdate

(L to R) Creighton University medical students Matin Ebneshahrashoob, Ariel Postone and Adam Kincaid.

Finding Balance in Nature

Grasping onto the braided steel cables bolted into the granite rock face 400 feet above ground, I had no choice but to ask myself what had driven me to climb to the top of the iconic granite monolith, Half Dome, in Yosemite National Park. When I got to the top, just more than four years ago, and peered over the beautiful Yosemite landscape, I felt a distinct satisfaction that I had accomplished a feat that my mind was telling me I could not complete. In many ways, my journey through life to the present day, as a secondyear medical student, has been punctuated by challenges that have tested my limits, and have pushed me beyond my personal comfort zone. Nowadays, in the time I do have off from medical school, I take every opportunity to reconnect with my outdoor passion, as each experience has been so personally fulfilling. Just this past summer, I returned to Yosemite, along with two other medical students, and took part in a three-day backpacking trip through the national

park that included a return to Half Dome. Looking back on this wonderful excursion, I recognize that part of what drove me back to guide my friends up those same steel cables is what drives me toward becoming a compassionate physician – an intense desire to empower others by sharing the perspectives and values I have gained from my experiences. Beyond the personal enrichment I have gained from life outdoors, spending time away from the amenities of modern civilization has provided me with an opportunity to spend time with friends and family. If one trip to Yosemite was not enough, I paid the park a second visit this summer, this time to show my parents exactly what I had been trying to convey to them before in images. Whether strolling through the lush green meadows or peering up at the towering waterfalls, the experiences we shared in nature were ones that provided us with the chance to be in each other’s company, and that further

strengthened our bond. As I see it, the outdoor life provides an astounding balance to my professional pursuits. From the time I’ve spent in nature, I have become mentally and physically conditioned. I have learned how I may become a more effective physician, and I have been able to connect with the important people I value spending time with, now more than ever. In just a few short years, when I become a physician, I resolve to remind myself of the idea conveyed best in words by the famous American naturalist, John Muir, who wrote quite elegantly, “Lie down among the pines for a while then get to plain pure white love – work to help humanity and other mortals.” Ebneshahrashoob is a M.D. candidate in the Class of 2014 at Creighton University School of Medicine.

November/December 2011 PHYSICIANS BULLETIN 17

clinicalupdate

By Dr. Alan M. Lembitz, COPIC Vice President of Risk Management

What are Your Chances of Being Sued?

According to a recent

New England Journal of Medicine article1, 99 percent of physicians in high-risk specialties will experience a claim by age 65. The data for the lowest risk physicians are only slightly less startling with 77 percent facing a claim by age 65. The malpractice claims information in this article came from a large, nationwide professional medical liability insurer. It examined data from 40,916 physicians from all 50 states, with active policies from 1991 to 2005. The study is likely the most comprehensive analysis of its kind. Annual Likelihood of Claims by Specialty High-risk specialties: • Neurosurgery: 19.1 percent • Cardiothoracic surgery: 18.9 percent • General surgery: 15.3 percent • Orthopedic surgery: 15 percent Lower-risk specialties • Family medicine: 5.2 percent • Pediatrics: 3.1 percent • Psychiatry: 2.6 percent The average for all physicians annually is 7.4 percent. However, the data did not analyze whether any difference exists between urban and rural practice sites. The good news is that 78 percent of all claims do not result in payment to claimants. While difficult to quantify, the burden of claims may also increase the possibility of practicing “defensive” medicine—which has been shown to increase costs for everyone. The article notes that, “Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work and reputational damage.” The following are some specific patient safety and risk management basics to practice that might help ease this burden. Informed consent process The informed consent creates the first defense against cases, particularly of known complications. Informed consent facilitates shared decision-making with patients and can greatly improve the disclosure process that occurs after an adverse event.

18 PHYSICIANS BULLETIN November/December 2011

Recognition, rescue and resolution Adverse surgical outcomes/complications are defensible provided there is early recognition, rescue to best baseline, and resolution of the patients’ needs due to the complication. Communication with patients Communicate with patients on how to reduce errors in their own care. Their understanding of subsequent care needs and procedures are critical to preventing adverse events. Communication with colleagues Effectively transfer patient information. Miscommunication causes adverse events regardless of the skills or experience of an individual physician working within a health-care team. Office systems Inefficient office procedures are often cited in malpractice claims such as systems to notify patients of test results and systems for review of incoming reports and correspondence. Knowledge of high-alert conditions More than two-thirds of malpractice claims in primary care specialties are for delay in or failure to diagnose certain high-risk diagnoses and conditions. Given the 99 percent likelihood of high-risk specialties and 77 percent risk of lower-risk specialties to face a malpractice claim by age 65, improving patient safety and risk management becomes increasingly important. The article’s findings may be disconcerting, especially with situations beyond our control. However, focusing on things within our control is a key step to keeping patients safe. 1New

England Journal of Medicine, 2011. 365:629-36.

feature

Photos by minorwhitestudios.com

VA staff in a small group discussing an aspect of design for the new VA Medical Center in Omaha as part of the Design Accelerator at Alegent Health’s Right Track facility on Oct. 21, 2011

Making Hospital Design a Team Sport For Dr. Subhash Bhatia,

involving physicians in the design process of a new hospital for the VA Nebraska-Western Iowa Health Care System means adding clinical relevance. “It enhances efficiency, safety and satisfaction, and it promotes collaborative interdisciplinary mental health care to address the bio-psychosocial, cultural and spiritual needs of people.” said Dr. Bhatia, chief of the VA Omaha’s Mental Health and Behavioral Sciences Department. Dr. Bhatia, along with over 75 colleagues – including 25 physicians – are collaborating with the architects, engineers and designers to create the plans for the $560 million facility that is expected to be built at the VA’s current location in Omaha. (Other MOMS members involved in the design process are Drs. Laurel Preheim, Gary Gorby, Naresh Dewan and Marvin Bittner.) Although Congress has not yet committed funds for the project, VA officials 20 PHYSICIANS BULLETIN November/December 2011

hope to begin construction in 2013 on the 40-month project, said Robert Yager, chief of engineering services. For now, VA officials are making sure their hospital will be patient friendly and promote collaboration throughout the healthcare team, Yager said. For assistance with the design process, the VA turned to Alegent Health System and its Design Accelerator model, which provides for rapid decision-making involving a representative group of stakeholders. Yager described the model as a visioning instrument. “It’s a way to rapidly come to decisions with broad consensus.” In this process, stakeholders include the full gamut of VA staffers, from radiologists to food service workers, from floor nurses to housekeeping staff, Yager said. “Every department has a seat at the table.” Dr. Preheim, a staff physician with the VA Omaha, said the

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Design Accelerator challenges participants to think what medicine will be like in 50 years. At the same time, the new hospital and its staff must be unified in their approach to serving all veterans – rural and urban, men and women, those who served their country decades ago and those who served in Iraq and Afghanistan. “The Design Accelerator has been a good exercise in bringing individuals together to discuss how to meet each veteran’s needs. That is our challenge,” said Dr. Preheim, who also serves as a professor of medicine and medical microbiology at Creighton University Medical Center and professor of medicine at the University of Nebraska Medical Center. Dr. Gorby, chief of medicine, said the VA design must be logical from the patient’s point of view. Departments that interact through their patients should be located near one another, said Dr. Gorby, >> who also serves as the co-director of the Center for Preparedness Education. In addition, he said, the hospital must be free of any physical challenges for its patients. Health-care professionals are busy people, Yager said, but he has noted how engaged participants are in the design process. “They aren’t sitting in the back of the room working on their Blackberrys. Everyone at the table has been fully engaged.” Participants met two times last summer – each session lasting several hours – and recently met again for an additional two days. During the most recent sessions, Yager explained, participants conducted a milestone review session. “We looked at the work we have accomplished in the last 12 to 15 months since the first Design Accelerators and asked ourselves if we are accomplishing what we initially set out to do, build a Veteran Centric Hospital.”

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The Bhatia File: Medical School: Punjab University in Chandigarh, India Residency: Creighton University School of Medicine Family: Wife, Dr. Shashi Bhatia (also a MOMS member); and three children who are all in medical-related fields Hobbies: Self-development-related activities. Enjoys learning, teaching, mentoring and writing Why I joined MOMS: “I see value in organized medicine and its positive impact on our profession through representation.” November/December 2011 PHYSICIANS BULLETIN 21

feature An artist graphically summarized the group’s planning discussion.

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For guidance in creating their hospital design, Yager said, VA officials looked at VA facilities being built in Denver and New Orleans. They will follow a federal mandate that requires 35 percent of the square footage in a new facility be within 16 feet of a window. The mandate ensures that new facilities don’t sport “big cavernous interior spaces,” Yager said, while making the hospital less institutional and more comfortable, therapeutic and open. VA officials also tapped into the concepts espoused by Planetree, an internationally recognized leader in patient-centered care. The Planetree model of care is a patientcentered, holistic approach to healthcare, promoting mental, emotional, spiritual, social, and physical healing.

Yager said three principles are guiding the design team’s work: • To create therapeutic spaces for patients, which includes honoring and recognizing their service to their country. “This is something we need to embrace. This is something we’ve gotten away from.” • To foster collaboration through patient outcomes. “We’re making this (health care) a team sport.” • To embrace continuous improvement. For Dr. Bhatia, a successful outcome for the design process will mean a facility that promotes patient-centered care in a pleasing environment. “And includes a healing garden.”

The Gorby File Medical School:

Northeastern Ohio Universities College of Medicine Residency: Wake Forest Medical Center in Winston-Salem, N.C. Family: Wife, Kathy; sons, Connor and Hunter Hobbies: Digital painting and singing Why I joined MOMS: “I wanted to be more involved in the medical community in Omaha and more involved in the issues and politics of medicine.” The Preheim File

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Medical School: Northwestern University in Chicago Residency: Medical College of Wisconsin in Milwaukee Why I joined MOMS: “I find it useful to be in an organization that allows physicians from different parts of the city and different specialties to communicate together. It’s a worthwhile organization.”

Photos by www.minorwhitestudios.com

cover story

A Long, But Rewarding Journey The Recker File: Medical School: Creighton University Residency: Creighton University Medical Center Family: Wife Susan and four children Hobbies: Racing Snipe sailboats and singing in Creightonâ€™s St. Johnâ€™s choir Why I joined MOMS: Membership in MOMS provided opportunities to support his interests in promoting ethics as well as medical research and advocating for patients.

This story about how to apply for a patent started when Dr. Robert Recker began treating an 18-year-old woman who had been injured in a car accident. X-rays showed she had unusually dense bones.

continued on page 25

NOVEMBER/DECEMBER 2011 PHYSICIANS BULLETIN 23

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cover story

Dr. Recker collaborated with other researchers and discovered that certain members of the woman’s ftamily possessed a rare genetic mutation that made their bones unusually dense and resistant to fracture. Could this genetic mutation be used in the fight against osteoporosis, Dr. Recker asked. Two years after Dr. Recker’s first encounter with the woman, the first patent resulting from their work was filed in collaboration with Creighton University’s Intellectual Resource Management Technology Transfer Office. A pharmaceutical company later licensed the discovery for drug development. Several years later, Dr. Recker and a colleague published their discovery in American Journal of Human Genetics. Dr. Recker, director of Creighton’s Osteoporosis Research Center, said applying for patents didn’t encumber his work. That’s by design, said Desarae Mueller-Fichepain, director of Creighton’s Intellectual Resource Management and Technology Transfer Office. Her office does the heavy lifting, she said. The process of obtaining a patent can take five years or more, but the rewards, if successful, include licensing to market the patented product and are invaluable, she said. The process also can be frustrating so the office takes a large portion of the burden off the researcher, she added. A majority of academic institutions established technology transfer offices after the Patent and Trademark Law Amendments Act was passed by Congress in 1980, Mueller-Fichepain said. Also known as the Bayh-Dole Act, the legislation dealt with intellectual property arising from research funded by the federal government. Among other things, the act gave U.S. universities, small businesses and non-profits intellectual property control of their inventions that resulted from such funding. Mueller-Fichepain explained the patent process, which begins when a scientist or inventor has a discovery or solution to a problem – a good one with potential to impact society. “At the point when they have something that is novel, it’s time to fill out an invention disclosure form.” This form asks the inventor to speculate as to the applications of the discovery and what companies might have commercial interest in it. The form also asks if the scientist used grant monies to develop the intellectual property and if the idea has been publicly disclosed? Patent filings may need to be reported to the funding organization if grant monies are involved. If the idea has been disclosed publicly – for example, at a conference, during a class or published in a journal prior to the patent – the ability to obtain a patent in many international countries will be lost. Most countries operate on a first-to-file basis, which

the United States will adopt – due to recent federal legislation – in September 2012. Thus, timing is crucial. Some technology transfer offices will turn to patent attorneys to conduct patent searches and some handle the task internally. The primary purpose is to determine whether someone has previously patented the idea or publically reported similar findings. The search is conducted to evaluate the idea. “It is novel?” Is it non-obvious?” The latter question is critical. If others working in the discipline would think the scientist’s solution is the next best step, the patent claim will be rejected. “It’s when you take 1 + 2 and get 4, you took it in a direction people haven’t thought about, then it becomes of interest to us.” If, after the search, the idea appears novel and non-obvious, the office’s next step, in most cases, is to file for a provisional patent, which lasts for 12 months. Think of a provisional patent as a time stamp, which is recognized internationally. The provisional patent allows the researcher or inventor and the technology transfer office to thoroughly evaluate the idea, including asking who might be interested in licensing it. As the provisional patent is timing out, a technology transfer office may seek a Patent Cooperation Treaty, which is recognized in many countries internationally and provides an extra 18 months of coverage. This allows more time to find a potential licensee and determine which companies are interested in pursuing a patent. Another option is to apply for a U.S. Non-Provisional patent, which spells out all the claims made by the scientist. It is best when the scientist works closely with his or her technology transfer office throughout the process. Then comes the waiting – approximately 18 months later the U.S. Patent Office will publish the application, and then another year or so later a patent examiner will take the case and evaluate the claims. “We explain all these things to the inventor,” Mueller-Fichepain said. Most likely, the patent examiner will reject much of what is claimed in the patent application, which requires a response from the applicant. “We expect two or three office actions.” During this time of reply and respond, the Intellectual Resource Management office will work with the inventor to seek licensees for the product. In some cases, the inventor may seek to build a commercial business based on the invention. When the patent is finally granted, Mueller-Fichepain said: “It’s always very exciting. It’s exciting for the inventor. It’s exciting for us. Now, you have something solid to offer to the market.” November/December 2011 PHYSICIANS BULLETIN 25

feature Story by Mark Bowen, Director of Government Relations, University of Nebraska Medical Center

Where is Health Reform?

A year ago

there was a flurry of headlines as the first series of federal health reform consumer benefits began taking effect. During the past year, implementation has begun on 26 provisions of the health reform law. Some have been very popular, such as the provision that extended dependent coverage for adult children up to age 26 for all individual and group policies. Reports indicate that seven months into implementation, more than 600,000 formerly uninsured young adults are now covered by the parents’ policies. Other items, such as the establishment of the National Health Care Workforce Commission to coordinate federal workforce activities and make recommendations on workforce goals, have had slower implementation. Fifteen appointees from across the nation – including University of Nebraska Medical Center Chancellor, Dr. Harold M. Maurer – were named to the commission, but funds have not been appropriated for the commission to start its work. Implementation is on an eight-year schedule and, while the U.S. Department of Health and Human Services has been drafting rules and regulations to guide it, the states have begun their work. In 2012, health reform will likely take center stage at the state level. All states, except Alaska, applied for and received a $1 million federal planning grant to determine whether to operate an Insurance Exchange or defer to the federal government. While Massachusetts and Utah had Insurance Exchanges that existed prior to passage of the federal health reform laws, California is the only state since the health reform law passed to enact a state law to create a state Insurance Exchange. About a dozen other states have passed state legislation that could lead toward establishing a state Insurance Exchange. The remaining states are in various stages ranging from pending legislation to considering nonlegislative action to set up an exchange. Nebraska has a variety of activities occurring. The Insurance Department conducted a series of public education and outreach 26 PHYSICIANS BULLETIN November/December 2011

meetings to gather feedback about the federal health reform law and the options for creating an Insurance Exchange in Nebraska. In addition, the state has hired two consultants to help assess the feasibility of the state establishing an Insurance Exchange. One consultant is examining the information technology issues of operating an exchange and whether the current state IT system could handle it or what modifications would be necessary. The second consultant is gathering and analyzing the statistical data needed to examine potential business models and governance options, and to provide actuarial services and assist with policy questions. The consultants are expected to complete their work and deliver their reports to the administration this fall. The Legislature is actively engaged in examining the potential for an Insurance Exchange. The Health and Human Services Committee and the Banking and Insurance Committee are monitoring the activities and recently held a joint public meeting to receive an update from the Department of Insurance on the progress of their work. Much of the work is contingent on the federal agencies finalizing new regulations in a timely manner. Among the key regulations are those dealing with what the “Essential Benefits Insurance Package” will cover for policies sold through the exchange. Another factor is whether the state will add to the required minimum benefits to be covered. Another important consideration is how state Medicaid and an Insurance Exchange could interact in an efficient manner. Based on the number of legislative resolutions dealing with health care, it seems clear that the Legislature will have an active role on the question of whether to establish an Insurance Exchange. By Jan. 1, 2013, states will need to declare to the federal government if they will set up an exchange. If they decide to set up an exchange, states will have until January 2014 to make it operational. For the states to meet the deadline, expect 2012 to be a year of state health reform discussion and decisions.

Mark Your Calendar! MOMS Medical/Legal Dinner March 8, 2012 Champions Run

All MOMS members are invited to attend the annual joint meeting of the Metro Omaha Medical Society and the Omaha Bar Association. Visit www.OmahaMedical.com or watch for more information coming soon.

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feature

Lending Local Non-profits a Hand, Showing the Community We Care

The federal mandate to get rid of baby cribs with drop-down sides by next year put the Omaha Ronald McDonald House in a bit of a pickle. The mandate meant the nonprofit organization, which provides a temporary housing for families that bring their sick children to Omaha for medical care, needed to replace its baby cribs. Providing our families – and especially their babies – with a safe environment is most important, said Doug Zbylut, chief executive officer of Ronald McDonald House Charities in Omaha. Replacing the cribs, however, wasn’t in the budget, he said. continued on page 30 28 PHYSICIANS BULLETIN November/December 2011

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The organization turned to the Metro Omaha Medical Society Foundation for support. “We can’t thank the MOMS Foundation enough for supporting our efforts to help families in need,” Zbylut said. RMHC Omaha was one of eight local nonprofit organizations that received 2011 grants from the MOMS Foundation totaling more than $22,000. Providing the Omaha Ronald McDonald House with funding for new, safe cribs fits the foundation’s mission, said Dr. James Newland, president. “We support are local community programs in which physicians are involved,” Dr. Newland said. “We want to show the community that we care.” Other 2011 grant recipients were: • ALS in the Heartland, to provide Patient Resource Bags to current patient families. The bags contain a patient folder with written resources for necessary referrals to mobility services, home health care, hospice, AAC supports and other critical services for ALS patients. The bags also will include ALS: a guide for patients and families, hand sanitizer, disinfectant wipes, a cup and straw to allow patients to remain hydrated, and a journal and pen to allow patients and caregivers to make notes during medical appointments. • Child Saving Institute, for Real Care Baby Starter Packs, which contain one Real Care Baby, control center software and wireless communication adapters, program materials and supplies, and Real Care Baby Add-on baby (warranty and second baby). The RealCare Baby gives expectant parents a hands-on understanding of parenting. RealCare Baby’s computers track care and safe-handling. • Children’s Respite Care Center, to purchase and equip Emergency Medical Carts. The sturdy and lightweight PVC 30 PHYSICIANS BULLETIN November/December 2011

•

carts are designed specifically for oxygen and other emergency supplies. The carts are equipped with portable, manual handoperated emergency suction pumps and replacement parts, handheld pulse oximeters and emergency packs for summer camps and field trips. Completely Kids, to enable the Liberty Project at Liberty Elementary School to incorporate a health and wellness series into the rotation of classes offered for Liberty parents. The holistic approach to women’s health will focus on topics such as heart disease, mental health, gynecological-breast health and pregnancy. OneWorld Community Health Centers, to provide Centering Pregnancy Program educational materials. The program is an innovative model of group care that integrates the three major components of care: health assessment, education and support into a unified program within a setting of eight to 12 women. Women with similar gestational ages meet together for 10 sessions in which they learn care skills, participate in a facilitated discussion and develop a support network with other group members. Prevent Blindness Nebraska, to provide lost cost ($3 to $9) and free vision screening and education to prevent vision loss through its Star Pupils Program. Vision screening occurs in day cares and preschools, and at community venues situated in underserved areas of Omaha. Project Harmony, to support and cover the medical expense for assessments to include hair testing of child abuse victims to determine if the child has been exposed to illegal drugs and to determine if these drugs are in the child’s system. No other funding sources cover this type of service.

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It’s Time to Renew Your MOMS/NMA Memberships for 2012

If you are currently a member of the Metro Omaha Medical Society and the Nebraska Medical Association, you should have received your notice for 2012 membership renewal.

Why Join or Continue to Be a Member of MOMS/NMA? We keep you informed

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.

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.

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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

• • • •

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. November/December 2011 PHYSICIANS BULLETIN 31

MOMSevents WOMENin medicine

Drs. Carol Drake (left) and Sushma Rai, along with Drs. Jane Dahlke (from left), Michele Marsh and Susan Boust attend Women in Medicine event in September.

RETIREDphysicians The MOMS Retired Physicians group gathered in late September with Roger Dixon (far right), president and CEO of the Metropolitan Entertainment & Convention Authority.

Senatorbreakfast

Attending the Senator Breakfast featuring State Sen. Pete Pirsch (second from left) were (from left) Drs. Pete Whitted, Gamini Soori, John Peters, David Ingvoldstadt and Hans Dethlefs. The breakfasts, hosted by MOMS each fall, provide member physicians with the opportunity to discuss health-care issues with the state legislators that represent the metro Omaha districts and candidates for the Legislature during election years.

Dale Mahlman (left), executive vice president of the Nebraska Medical Association, and Dr. Richard Baltaro (center) were among the attendees in early October at the Senator Breakfast featuring State Sen. Jeremy Nordquist of Omaha.

Member NETWORKINGevents

Drs. Linda Collins (left) and Jennifer Hill along with Drs. Ebrahim Shakir (from left), Dr. Alain Taylon, Dr. Marvin Bittner and Dr. Sonya Tran were among the MOMS members who gathered in late September at CRAVE in Midtown Crossing to network and sample the restaurants most creative menu items. 32 PHYSICIANS BULLETIN November/December 2011

membernews

Dr. Rodney Lusk

Dr. Syed Mohiuddin

Dr. Lusk named to academy’s top post Dr. Rodney Lusk, director of Boys Town Ear, Nose and Throat Institute, recently was named president of the American Academy of Otolaryngology-Head and Neck Surgery. Dr. Lusk, who also serves as director of the Boys Town National Research Hospital’s Cochlear Implant Center, was named to the post at the organization’s recent annual meeting. As president of the academy, Dr. Lusk will keep patient care his focus by rebuilding the Academy’s web site to offer easier site navigation by incorporating today’s technology, including videos, podcasts and mobile applications in an effort to increase accessibility of medical information. The American Academy of Otolaryngology-Head and Neck Surgery is one of the oldest medical associations in the nation, representing more than 12,000 medical specialists who diagnose and treat diseases and disorders of the ear, nose, throat, head and neck. These medical conditions include chronic ear infection, sinusitis, snoring and sleep apnea, hearing loss, allergies and hay fever, swallowing disorders, nosebleeds, hoarseness, dizziness, and head and neck cancer. Dr. Lusk, who received his medical degree from the University of Missouri in Columbia, has served in a number of leadership positions both locally and nationally. He has been president of both the American Society of Pediatric Otolaryngology and the American Broncho-Esophagology Association.

MOMSnews

Dr. Devin Fox

Drs. Mohiuddin, Fox recognized at awards ceremony Drs. Syed Mohiuddin and Devin Fox of Creighton University School of Medicine, were recognized during a 2011 American College of Physicians Nebraska Chapter awards ceremony. Dr. Mohiuddin, chair of the School’s Department of Medicine, received the chapter’s 2011 Laureate Award for demonstrating by example and conduct an abiding commitment to excellence in medical care, education and research, and service to the community and ACP. Dr. Mohiuddin joined Creighton as a fulltime faculty member in 1970 and served as chief of cardiology and director of the Creighton Cardiac Center, 1996-2007. The School of Medicine presented him with its Master Clinician Award in 1999 and Distinguished Professor Award in 2001. In 2005, he became the first holder of the Richard W. Booth, MD, Endowed Professorship in Cardiology. He was named 2006 Medical Professional for the Cause by the Metro Omaha Tobacco Action Coalition.

Dr. Fox receives award

Dr. Fox, an internist and assistant professor of medicine, was recognized with the chapter’s 2011 Volunteerism and Community Service Award. He has participated in medical missions to Jamaica and the Dominican Republic. He also is involved with the homeless clinic at Sienna-Francis House. He recently began his second term as a board member of the Nebraska AIDS Project.

Seibel Retires from MOMS

A familiar face at Metro Omaha Medical Society, Lorraine Seibel, retired in September after 34 years of service to Omaha physicians. Seibel started with the Omaha Midwest Clinical Society in 1977 as executive secretary. She joined the MOMS staff some 10 years ago as project coordinator/Foundation when the clinical society dissolved. Among her responsibilities were working with the MOMS Foundation, the community internship program, The Bulletin and the Retired Physicians group.

Seibel will be missed, said Diane Parsons, MOMS executive director. “Lorraine’s dedication, knowledge and commitment to the physicians in the Omaha area have been invaluable and greatly appreciated. We wish her the best as she enjoys her well-deserved retirement.”

November/December 2011 PHYSICIANS BULLETIN 33

campusupdates Health Sciences first to achieve joint accreditation Creighton University Health Sciences Continuing Education, formerly known as Creighton Continuing Medical Education, has become the first U.S. academic health sciences center to earn joint accreditation from three professional organizations. The joint accreditation was made available for the first time in 2010. It includes endorsements from Accreditation Council for Continuing Medical Education, Accreditation Council for Pharmacy Education and American Nurses Credentialing Center, and recognizes organizations that offer team-focused continuing education to health-care providers with the ultimate goal of improving patient care. To achieve joint accreditation, continuing education providers must meet rigorous standards for educational quality and demonstrate their programs are free from commercial bias, based on valid content, and effective in improving the quality and safety of health care delivered by multidisciplinary teams. “Our unique joint accreditation underscores the depth of Creighton’s commitment to enhancing the quality of health care in the 21st century,” said Dr. Donald R. Frey,

CUMC Campus Update vice president for health sciences. “As health care is increasingly delivered by inter-professional teams, it is vital that the latest in medical knowledge and expertise be delivered to each team member in a comprehensive fashion. With this one-of-a-kind accreditation, health practitioners are now assured that Creighton’s high standard of educational excellence will be imparted to each team member across the full spectrum of health professions.” Nipper to lead national FDA board Dr. Henry Nipper has been appointed chair of the U.S. Food and Drug Administration’s Center for Devices and Radiologic Health Panel on Clinical Chemistry and Toxicology Devices for a four-year term, ending in 2015. Dr. Nipper, director of clinical chemistry and toxicology at Creighton University Medical Center and professor of pathology at Creighton University School of Medicine, will oversee a 10-member panel that provides independent, professional expertise on the development, safety and effectiveness of in-vitro devices used in clinical laboratory testing for toxicology, clinical chemistry, endocrinology and oncology.

Dr. Huggett to lead medical education committee Dr. Kathryn Dey Huggett, assistant dean for medical education for the School of Medicine, has been elected president of the Society of Directors of Research in Medical Education Executive Committee. Dr. Huggett, who also serves as Creighton’s director of medical education development and assessment and associate professor of medicine, is the co-author of 23 articles on medical and dental school curriculum, collaborative research in medical education and more. She is co-editor of the book, “An Introduction to Medical Education.” Penn State recognizes faculty member Dr. Roger Brumback, professor of pathology, psychiatry and neurology, has been recognized by his alma mater, Penn State College of Medicine. Dr. Brumback graduated with Penn State’s first medical class in 1971. His accomplishments are featured in the college’s recently published book “Forty Careers in Medicine – Four Decades of Shaping the Future of Medicine.” The book highlights key milestones in Penn State College of Medicine’s history as well as profiles on famous alumni.

UNMC Campus Update Researchers to study role of tumor microenvironment in pancreatic cancer With the recent deaths of Apple founder Steve Jobs and Nobel Prize winner Dr. Ralph Steinman, pancreatic cancer is once again on the public’s radar screen. People want to know -- can anything be done to halt this lethal form of cancer? That’s the question UNMC researchers will try to address through a $4.2 million grant from the National Cancer Institute, one of the divisions of the National Institutes of Health. “Our ultimate goal is to determine what makes pancreatic cancer so lethal,” said Dr. Surinder Batra, professor and chairman of the Department of Biochemistry and Molecular Biology and the principal investigator on the five-year grant. “We want to develop new therapeutics that work on pancreas cancer, because the drugs currently being used are not working.” Dr. Batra’s research team will study animal models and human pancreas tissue. The human tissue is provided by UNMC’s Rapid Autopsy Program, which allows scientists to study the cancer tissue acquired shortly after the death of a pancreatic cancer victim. “We will look at the role of the tumor 34 PHYSICIANS BULLETIN November/December 2011

micro-environment of cancer cells,” Dr. Batra said. “We will try to figure out what makes these cells so aggressive, so resistant. We will study the pancreas, which is loaded with insulin, and try to determine if this environment is what makes pancreatic cancer so hostile.” Dr. Batra said it is becoming increasingly evident that the microenvironment of the pancreas is critical. “Rather than serving as an inert scaffold for tumor cells, the microenvironment of the pancreas appears to be an active and possibly equal ‘partner-in-crime’ in the transformation of normal cells into cancer cells,” Dr. Batra said. “The objective of this grant is to understand how this nexus between the microenvironment and tumor cells operates during both early and late stages of tumor formation.” Clinical trial to focus on non-invasive treatment for depression The University of Nebraska Medical Center is one of 10 universities across the country conducting a clinical research trial with a transcranial magnetic stimulation device, known as NEST, or NeoSync EEGSynchronized TMS.

“We have recognized that there are a group of people with major depression who don’t benefit from available treatments,” said Dr. William Burke, A.O. Stake Professor of Psychiatry at UNMC. “The device we are evaluating is easy to administer, smaller and potentially more cost-effective than currently available devices.” NEST uses low energy, synchronized transcranial magnetic stimulation (sTMS) as opposed to the strong pulses utilized with repetitive transcranial magnetic stimulation, which was recently approved by the FDA, but is expensive, complex and has the potential to induce seizures. With NEST, the low energy sTMS waves are synchronized to each patient’s brain waves under the belief that the brain can be “tuned.” The clinical research trial is designed to determine whether this individualized therapy restores normal brain rhythms and eliminates the depressive symptoms. The research study will enroll 10 patients at UNMC who have been diagnosed with major depressive disorder and have failed to respond to exactly one medication in the current episode of illness or are medication intolerant. They must be between the ages of 22 and 65.

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Dr. Siobahn Bower

Dr. Chris Cornett

Medical School: Creighton University Specialty: Internal Medicine Location: Boys Town National Research Hospital and Boys Town Medical Office Building

Medical School: University of Nebraska Medical Center Specialty: Orthopedic Spine Surgery Location: University of Nebraska Medical Center and The Nebraska Medical Center

Dr. Bower is an avid mountain bike rider. Her favorite local trails include the Lewis & Clark, Jewel and Swanson. Her fiancĂŠ, Dr. Paul Hruby, is in training as a Retina Fellow in Omaha. You can usually find them on the weekly Wabash Taco Ride.

Dr. Cornett enjoys outdoor activities and has been an avid hunter and fisherman since he was young. He also enjoys spending time with his wife and four children.

Dr. Ryan Dvorak

Medical School: Creighton University Specialty: Diagnostic Radiology & Nuclear Medicine Location: Methodist Health System Dr. Dvorak and his wife started hiking in the past five years while completing his training in Michigan. They especially like hiking through the Upper Peninsula of Michigan and along the Lake Michigan coastline.

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