November/December 2013 Physicians Bulletin

November/December 2013 • USA $1.95

Weighing in on Nebraska Medicaid Expansion ALSO INSIDE A Call for Candidates Residency Slots

The Numbers Don’t Add Up

A Perfect Match

MOMS Foundation and Omaha Street School A Publication of the Metro Omaha Medical Society • www.OmahaMedical.com

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THIS Issue NOVEMBER/DECEMBER 2013

features

departments

16

Residency Slots:

8

Editor’s Desk

2 0

COVER: Taking Sides on Medicaid Expansion

10

NMA Message

2 2

A Call for Candidates

27

A Perfect Match:

12

Legal Update

13

Young Physician

14

Clinical Update

2 8

MOMS Events

2 9

MOMS Coming Events

3 0

Member News

3 5

Campus Update

37

New Member Update

The Numbers Don’t Add Up

MOMS Foundation and Omaha Street School

4 Physicians Bulletin November/December 2013

A time to say thank you A call to action

Social media in the workplace Welcome to medicine

Conflict in the physician-patient relationship

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November/December 2013 Physicians Bulletin Securities offered through Securities America, Inc., member FINRA/SIPC. Jerome P. Bonnett, Jr., CFP®, ChFC®, Registered Representative. Advisory services offered through BWM Advisors, LLC. Jerome P. Bonnett, Jr., Investment Advisor Representative. BWM Advisors, LLC (dba Bonnett Wealth Management) and Securities America companies are unaffiliated.

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2013 VOLUME 36, NUMBER 6 A Publication of the

Metro Omaha Medical Society 7906 Davenport St. • Omaha, NE 68114 (402)393-1415 • www.omahamedical.com OFFICERS President | Marvin J. Bittner, M.D. President-Elect | Debra L. Esser, M.D. Secretary-Treasurer | David D. Ingvoldstad, M.D. Past President | Pierre J. Lavedan, M.D. Executive Director | Carol Wang EXECUTIVE BOARD Marvin Bittner, M.D. Debra Esser, M.D. David Ingvoldstad, M.D. Pierre Lavedan, M.D. Mohammad Al-Turk, M.D. Jane Bailey, M.D. Lori Brunner-Buck, M.D. David Filipi, M.D. Harris Frankel, M.D. Michelle Knolla, M.D. Jason Lambrecht, M.D. William Orr, M.D. Laurel Prestridge, 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 Senior Graphic Designer | Katie Anderson Junior Graphic Designer | Paul Lukes Junior Graphic Designer | Marti Latka Director of Photography | Bill Sitzmann advertising sales Todd Lemke • Sandy Besch • Greg Bruns Gwen Lemke • Gil Cohen • Alicia Smith • Vicki Voet • Paige Edwards • Jessica Linhart • Dawn Dennis

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for advertising information: 402-884-2000 Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD, P.O. Box 461208, Omaha NE 68046-1208. © 2013. No whole or part of contents herein may be reproduced without prior permission of Omaha Magazine or the Metro Omaha Medical Society, excepting individually copyrighted articles and photographs. Unsolicited manuscripts are accepted, however, no responsibility will be assumed for such solicitations. Omaha Magazine and the Metro Omaha Medical Society in no way endorse any opinions or statements in this publication except those accurately reflecting official MOMS actions.

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EDITOR’S desk

A Time to Say Marvin Bittner, M.D. President

Thank You

Metro Omaha Medical Society

N

OW THAT MY TERM as president of MOMS

is drawing to a close, I want to say “thank you” many times. Indeed, so many people deserve thanks that I could hardly begin to acknowledge them in the space of this column.

Two physicians, however, do deserve special thanks. Each has been president of MOMS and has been inaugurated as president of the Nebraska Medical Association. Each is continuing to make special contributions. Both need your support in their ongoing work.

One is Dr. Kevin Nohner, a family physician who has been in private practice and affiliated with Alegent. The other is Dr. Rowen Zetterman, a specialist with involvement in our academic institutions. Dr. Nohner is NMA president.

At this year’s annual meeting of the NMA, I once again realized how important the work of the NMA is – and why Dr. Nohner needs our support. One speaker presented data on rural health. One of his slides demonstrated some of the challenges by showing a map of the United States. Many states, according to his data, faced some difficulties – but, at least for this metric, not Nebraska. I thought about it for a bit. I realized there is something different about Nebraska’s health policy. In 1976, the state was facing a loss of medical practitioners as the malpractice crisis worsened. In response, the state passed malpractice reform. A key goal of malpractice reform was to ensure the supply of physicians and medical care. Sometimes it’s hard to link a particular policy decision with a particular outcome. However, I wonder if our malpractice reform is one reason, at least on that one slide, Nebraska was a bright spot.

Repeatedly, plaintiff’s malpractice attorneys have fought malpractice reform. Repeatedly, the

8 Physicians Bulletin November/December 2013

NMA has defended it. The threat to malpractice reform is only one threat that the medical profession faces every time the Legislature assembles.

There are many reasons we need a strong NMA and many reasons Dr. Nohner needs our support as he leads the NMA. Dr. Zetterman is continuing to serve the medical community and the general public in a less visible, yet very important, position. He is on the board of the Accreditation Council for Graduate Medical Education. This is the key agency for setting the standards for residencies and fellowships. Limits on the hours worked by residents have gained much attention. This is an area where the ACGME has played an important role. An emerging initiative from ACGME calls for more involvement of trainees in a hospital’s quality and safety programs.

These are important initiatives. Implemented well, they enhance the profession. Done poorly, they overload training programs with meaningless bureaucratic tasks. In his role on the ACGME board, Dr. Zetterman can guide ACGME staff toward actions that can reap benefits for decades.

I hope you will join me in thanking Dr. Nohner and Dr. Zetterman – and in supporting their efforts. And, in addition, I offer my thanks to the many people who have worked with MOMS and NMA to strengthen our medical community and promote the health of our community at large.

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November/December 2013 Physicians 8111 Professional Building • 8111 Dodge Street, Suite 363 • Omaha, NE 68114Bulletin 9

NMA message

Dale Mahlman Executive Vice President

A Call to Action

Nebraska Medical Association

I

N PAST ARTICLES FOR this publication, I have

written about change, summarized the past legislative session, and spoke of our “passion” for advocating for physicians and patients.

As you will read in the article on former State Senator Joel Johnson, M.D., of Kearney, we have not had a physician in the body since his departure in 2008. You will also read about Bob Rauner, M.D., of Lincoln, who is running for a term-limited seat in 2014. While Dr. Rauner is the only known physician who has announced his bid for office, I’m aware of others who are at least considering the possibility in 2016.

What do Drs. Johnson and Rauner have that other physicians have but exhibit in other ways?

Passion! Sen. Johnson was instrumental in many important pieces of legislation, but none more important than the passage of LB 395 in 2007.

LB 395 created the Clean Air Indoor Act and the result is the smoke-free eating and public places we enjoy today. If I’ve heard him say it once, I’ve heard him say it 100 times: This one piece of legislation will save more people than he did in his long and distinguished medical career as a surgeon. Perhaps an understatement on his part, but his passion for serving the citizens of Nebraska was highlighted by his leadership on this important public health policy.

Dr. Rauner has similar passion for public health and education issues. He has been the driving force behind our Child Health and Obesity Policy Group (CHOPG) and public health committee during his time as an NMA member.

His leadership with the CHOPG has created a broad based coalition of educators, public health officials, hospitals, physicians, legislators, and others to highlight the importance of health and wellness to the learning process. His passion for

10 Physicians Bulletin November/December 2013

creating a healthier student population has raised the issue at the State Capitol and his candidacy will continue to keep the issue on the forefront.

These are just two examples of physicians with a passion that can benefit the citizens of the state.

We have many other physician members of the Nebraska Medical Association who are passionate about organized medicine, public health and public safety issues, health-care transformation, medical liability, taking care of the underserved, and so on. Our past issues of Nebraska Medicine have focused on the views of resident physicians toward medicine today, doctors in transition, and our most current edition focuses on physicians and patients taking better care of themselves, incorporating exercise, and better nutrition into their daily routines. Each of these issues was dependent on our contributor’s passion for their subject matters.

My plea in this column and my ask of our members in 2014 is to get involved on an issue(s) of importance to you and contribute in any way you can by reaching out and either emailing, making personal contact, sending a letter, or hosting an event, with your elected officials at either the local, state or national level. The 2014 election, like all previous elections, will be important for physicians and patients alike and if every physician took just one hour in the next year to express his or her passion to our elected officials, our efforts would be noticed and our association would be better off as a result.

“Advocating for Physicians and the Health of all Nebraskans,” that’s the passion of the Nebraska Medical Association. As a member, we hope you’ll make it yours as well.

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November/December 2013 Physicians Bulletin 11

LEGAL update

Social Media in the Workplace

Margaret C. Hershiser Member of Koley Jessen P.C.’s Employment, Labor and Benefits Practice Group

S

OCIAL MEDIA IS ESSENTIALLY a countless

array of internet based tools and platforms that increase and enhance the sharing of information.

Social networking is two-way communication using social networking sites. Conversations are at the core of social networking. Four of the most popular platforms are Facebook, YouTube, Twitter and LinkedIn. There are more than 1 billion users of Facebook, and the average Facebook user has approximately 130 friends.

People under 35 check their social media devices more than people over age 35, and 2.5 billion text messages are sent per day in the United States.

So how does this impact the workplace? Below are a number of issues that employers should consider with respect to social media.

SOCIAL MEDIA AS A PRE-EMPLOYMENT TOOL

The majority of U.S. hiring managers and recruiters have reviewed online information about job applicants, and most HR professionals have rejected a job applicant based on what they found out about that individual by searching online. The top online factors for rejecting a job applicant based on online information are 1) unsuitable photos; 2) concerns about a candidate’s lifestyle; and 3) inappropriate comments written by the candidate. Conducting an internet search on an applicant seems like an inexpensive and relatively harmless way to vet a candidate. But what if such a search reveals “protected class information” about a candidate such as the candidate’s race, gender, age, disability, religion, national origin or sexual orientation? While it is not illegal for an employer to know this information about an applicant, employers are expected to use fair and objective criteria when selecting employees, so the “rule of thumb” is to avoid inquiries that are unrelated to the job so knowledge of such infor-

mation cannot later be considered evidence of discrimination if the applicant does not ultimately get hired for the position. Employers also need to be aware of state laws that prohibit employers from taking an adverse employment action based on an employee’s lawful conduct on their own time (i.e., off the job). These statutes often extend to prospective employees.

There are private companies that will generate applicant background reports (i.e. “consumer reports”) from social media sites “based on employer pre-defined criteria, both positive and negative.” Negative applicant criteria, for example, would include racist remarks or activities, sexually explicit photos or videos, and illegal activity such as drug use. Positive criteria could include charitable or volunteer efforts, participation in industry blogs, professional honors, etc. Like other background checks, applicant consent and Fair Credit Report Act (FCRA) compliance is required before a third-party company can lawfully furnish a consumer report regarding an applicant’s character, general reputation, personal characteristics or mode of living. Is it worth the time and expense? One company that specializes in social media background checks advertises that it found a prospective employee on Craigslist looking for OxyContin, and a woman applying for a hospital position who was found posing naked and posting pictures on an image-sharing site. A third applicant was flagged for “demonstrating potentially violent behavior” because of a posted picture of the applicant holding a gun on his Facebook account.

Recently, some employers have asked employees to turn over their usernames or passwords for their personal accounts – claiming that access to personal account information is needed to protect proprietary information or company trade secrets, or to prevent the employer from being exposed to legal liabilities. Employees, however, view such requests as an invasion of their privacy and many states now agree.

The National Conference of State Legislatures has compiled data on state laws related to this issue. According to their data, legislation addressing the issue has been introduced or is pending in 36 states. The link to the NCSL data is: http://

12 Physicians Bulletin November/December 2013

www.ncsl.org/issues-research/telecom/employeraccess-to-social-media-passwords-2013.aspx Before using social media as a pre-employment tool, establish internal procedures to avoid running afoul of anti-discrimination and privacy laws; use a person outside the hiring process to review social media sites and to filter out all protected class information or outsource this process. Additionally, keep copies of information reviewed and used, remain cognizant of FCRA obligations, and obtain applicant authorization for social media background checks. Finally, do not attempt to bypass personal privacy settings, do not assume managers will know how to use social media and do not make employment decisions based on lawful “off-duty” conduct if prohibited by law.

PROHIBITING EMPLOYEES FROM USING SOCIAL MEDIA AT WORK

Employees can be prohibited from engaging in personal social media communications during working “time” and regardless of whether they are using their own equipment (i.e. smart phones, iPads, etc.) or company equipment. In fact, companies are in violation of the Occupational Safety and Health Act (OSHA) if, by policy or practice, they require texting while driving, or create incentives that encourage or condone it, or they structure work so that texting is a practical necessity for workers to carry out their jobs.

OSHA will investigate worker complaints, and employers who violate the law will be subject to citations and penalties. But is it practical to totally prohibit employee use of personal social media communications at work or is it better to have a policy that outlines the expectations and parameters of such use, such as during break time or for occasional communications that cannot be completed during nonworking hours? According to the National Business Ethics Survey of Social Networkers: New Risks and Opportunities at Work, issued July 17, 2013, 72 percent of employees spend time each workday on social networking sites, with 28 percent saying they spend an hour or more. “Overall, two out of five social networkers who connect at work spend an >> Continued on page 24

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LIKE PEOPLE. I LIKE talking to people. It

doesn’t make me uneasy. But when I walked into a patient room alone for the first time I was nervous. When the door shut behind me and I was face to face with my first patient my mind blanked and my white coat felt like it weighed 10 pounds. I remember thinking, “Be natural, I know how to do this. I definitely know how to do this.” The patient must have been my mother’s age and so I am very sure she probably saw the moment of hesitation and confusion that flickered across my face. She smiled at me as I introduced myself as a first-year medical student and my mind slowly began to clear. Even though we had practiced patient visits, this experience was different. Rummaging through my brain, which seemed to be more cluttered than my room on a bad day, I began addressing pertinent questions and exam topics. I was so busy trying to figure out the next question to ask in order to avoid a long awkward pause that I felt half-engaged.

When I exited the patient room, I was flushed.

After that first patient visit, many thoughts flushed into my head. I had so much to learn! I thought clinic and talking to patients was going to be the easy part of medical school. I was caught off guard at how hard it could be to take a blood pressure reading without making a patient feel uncomfortable. I also realized that patients and clinicians think about pertinent clinical symptoms from different angles and juggling that balance is not easy either.

In fact, it is overwhelming to realize how much as students we still have to learn. The most terrifying aspect is possibly that we are never going to learn everything. Within a few months, we will be starting our third-year rotations and will be exposed to various general specialties.

Within a year into a clinical exposure, we have to decide what our ambitions will be for the rest of our lives. And that is scary.

As I think about medicine and the health-care system that seems so much bigger and complicated than I can conceive at this point, I realize how often I use the words “terrified” or “scary.”

Although these words may not be ideal, they are words that reflect emotion and keep students on their toes. These words reflect the many decisions and changes we face in an evolving system that is entwined with our academic and personal lives.

Getting to medical school was definitely a challenge, but growing into a future physician may just be the steepest hill in this journey. It no longer is about just regurgitating answers on a class test. Rather, as I have learned, it is about changing and evolving as a whole person.

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November/December 2013 Physicians Bulletin 13

CLINICAL update

Dan Rosenquist, M.D., COPIC’s Patient Safety and

Conflict in the Physician-Patient Relationship

Risk Management Department

S

TUDIES SUGGEST THAT BETWEEN 10 to 15

percent of patient visits are described by the physician as “difficult.” These concerns are important for a variety of reasons. Patient satisfaction is now a frequently measured parameter and poor interactions may lead to bad ratings.

Personal satisfaction on the part of the provider is also an issue, and frustrating interactions can leave the physician unhappy as well. If the patient interaction is sidetracked into an angry discussion, important parts of the clinical history might be missed. Finally, increased legal issues are seen in physicians who have frequent difficult interactions. Board complaints, and even lawsuits may result. Even physicians with the best bedside manner encounter difficult interactions.

CASE STUDY

A primary care physician saw a 45-year-old woman for diffuse aches and pains. She felt the symptoms were most compatible with fibromyalgia.

A thorough workup was negative. The patient demanded that she be referred to the rheumatologist who saw her for one visit and outlined a treatment plan. Multiple medications were tried, but the patient was intolerant or had side effects to all medications. The patient returned with widespread pain and stated she felt she had multiple sclerosis (MS). The neurologic exam was normal and the symptoms seemed mainly musculoskeletal. The physician suggested not doing a referral to a neurologist as the symptoms were not suggestive of MS. The patient became angry and stormed out. The physician drafted a dismissal letter, but it was not sent immediately.

When the patient called to make a new appointment, the receptionist stated she would have to check with the physician first. The patient swore

at the receptionist and hung up. She then wrote a complaint letter to the state medical board.

fear or concern, then he or she and the patient can work toward a mutual understanding, healing and common ground.

UNDERSTANDING CONFLICT

Clear communication is essential when there is conflict or misunderstanding. Physicians should start all visits with setting the agenda by asking “what are we talking about today?” If the physician has issues that need to be discussed, he or she should let the patient know these intentions as well. If the interview turns bad, one needs to have a clear understanding of why the patient is angry, upset or concerned.

Sometimes we get upset as the patient triggers our own “pet issues” (narcotics, boundaries, multiple somatic complaints, reminds us of our last difficult patient, etc.). Care should be taken to not interpret conflict as personal. Finally, conflict may be inevitable, but deescalating it early is vital.

In the previous case study, the issue is that the patient was making unnecessary or unreasonable requests. Other behaviors that can be an issue include not following instructions, reacting with anger toward the physician or undermining a therapeutic alliance with the physician. Managing conflict is especially challenging when the patient is angry, intimidating or even threatening. We need to understand the behavior of the patient in the context of his or her conditions. Conflict may arise when the patient has unmet expectations.

In the case study, there was a deep fear of MS, which had struck a friend of the patient. Conflict resolution required the physician to understand the patient’s concerns, address them and verbalize his or her understanding about how scary MS can be. This reflection technique would have developed empathy and possibly defused the situation. When the physician can identify the

14 Physicians Bulletin November/December 2013

MANAGING CONFLICT

Your communication skills and demeanor are paramount in a conflicted situation: • Remember to use non-confrontational language such as “I” statements to verbalize your own feelings and thoughts such as “I can see that you are upset…I will help you through this situation.”

• Expressing feelings in a non-blaming way can help build empathy.

• Stay calm and speak politely in a soft voice.

• Use active or reflective listening to verbalize what you heard and what the patient said.

• Recognize your own negative feelings.

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Residency Slots: The Numbers Don’t Add Up

A

SHLEY BAUER ISN’T IN panic mode.

The fourth-year medical student realizes that securing a residency slot following medical school may not be automatic. The Scottsbluff, Neb., native understands she should have a back-up plan when it comes time for seeking her match.

She’s heard the number of residency slots has not kept pace with the recent spikes in the number of students being admitted to medical schools. “I’ve even heard the number of slots has decreased,” she said.

The deans at Omaha’s two academic medical institutions said they are well aware that a gap exists between the number of available residency slots and the number of students seeking those slots.

“There is increased competition for a fixed number of (residency) positions,” said Bradley Britigan, M.D., dean of UNMC’s College of Medicine. “More competitive are the specialty areas. Students who would have found a posi-

tion five years ago, no longer are able to match in that specialty.”

Dr. Britigan and his counterpart on the other side of Dodge Street – Robert “Bo” Dunlay, M.D., interim dean of Creighton University’s School of Medicine – explained that their institutions expanded the number of slots in their medical schools in recent years: • Creighton now accepts 152 first-year students each year – up from between 126 three years ago. Dr. Dunlay pointed out that 42 of those students go to Creighton’s Phoenix campus.

• UNMC increased its class size from 120 to 132 about five years ago.

“The increases are in response to a national demand for more physicians,” Dr. Dunlay said.

“The expectation for the provisions of health care is increasing.”

Part of the need for more physicians, Dr. Britigan said, is the need for physicians in rural areas. “The rural health-care provider shortage

16 Physicians Bulletin November/December 2013

is not unique to Nebraska.”

Adding to shortage in residency slots is the emergence of new medical schools in the United States, and others in the planning stage, along with the influx of graduates from international institutions, numbering in the thousands, looking for positions. “In some cases, it’s the cream of the crop that’s coming to the U.S. looking for residency slots,” Dr. Britigan said.

Off-shore for-profit medical schools are increasingly offering to fund residency slots at U.S. health-care institutions – provided the spot goes to one of their graduates.

Another cause of the shortage is competition for residency slots from graduates of colleges of osteopathic medicine, said Dr. Dunlay. (According to the American Association of Colleges of Osteopathic Medicine, more than 4,200 new osteopathic physicians enter the workforce each year.)

The number of slots for medical residents, at

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The Britigan File Hometown: Red Wing, Minn.

Bachelor’s degree: Cornell University in biology Medical degree: University of Southern California Residency: Rhode Island Hospital in internal medicine Fellowship: University of North Carolina in infectious diseases Title: Dean, UNMC College of Medicine Family: wife, Denise Britigan, Ph.D. (an assistant professor of public health); daughter, Laura Lala; and son,Brian Britigan.

Why I joined MOMS: “As a new person to the community, I saw joining MOMS as an opportunity to get to know physicians across the metropolitan area and to learn their concerns.”

best, has remained stagnant, the deans said. In 2013, according to the National Resident Matching Program (www. nrmp.org) 34,355 applicants competed for 29,171 first-year or second-year residency positions. Looking at available first-year residency slots alone, 25,682 U.S. medical and osteopathic graduates (not including international medical graduates) applied for the 26,392 available first-year residency slots in 2013.

Among the reasons for the growing shortage of residency slots are: • In 1997, the federal government froze the number of new Medicare-funded residency slots under the Balanced Budget Act of 1997. That dictum remains in effect.

• Because federal funding for Graduated Medical Education has remained flat, the burden has fallen on hospitals and other sources to fund residency slots.

With increased pressure on hospitals to keep costs in check and a decline in reimbursement payments, funds to support additional residency slots aren’t available.

• Residency slots can cost up to $200,000 each, with salaries accounting for 30 to 35 percent of that total.

“A strange scenario would be to send our students overseas for residency training and then have them come back to meet our country’s health-care needs,” Dr. Britigan said.

Drs. Dunlay and Britigan said they noticed increased competition for their institution’s most recent graduates: • Three of UNMC’s graduates, all solid students, were initially unable to find a residency position through the Match and subsequent post-Match process for filling unmatched positions called the Supplemental Offer and Acceptance Program, or SOAP. Two eventually secured residency positions, while the third decided to take a research position and reapply in their preferred specialty area rather than opt for a position in another specialty.

• 94 percent of Creighton’s graduates received their specialty of choice, with several students not matching.

18 Physicians Bulletin November/December 2013

“The SOAP was more intense,” Dr. Dunlay said.

Coming up with a solution to boost federal support for Graduated Medical Education isn’t easy, the deans said.

Legislation in Congress to expand funding hasn’t met much success, they said. “Unfortunately, many legislators don’t seem to appreciate that increasing the number of medical student graduates does not increase the number of practicing physicians unless there is a corresponding increase in residency positions,” Dr. Britigan noted.

Dr. Dunlay said the solution must come from a combination of funding from the federal government, state government and the larger private health-care organizations. In addition, he said, medical students must be encouraged to consider primary care as their career track, in part, to help alleviate the shortages of this type of physician.

In the meantime, the deans said, their institutions will make sure their medical students are aware that a match with their first choice for a residency slot isn’t a lock – especially if they pursue one of the more coveted specialties.

“We make our students aware of these changes and how competitive the spots are,” Dr. Britigan said. “Our students are encouraged to submit applications to more programs – to increase their chances.”

Dr. Dunlay added: “For students not at the top of the class, we encourage them to have a back-up plan – which is a part of life.”

Nick Ingraham, a fourth-year medical student, has heard the message. “He (Creighton’s dean of student affairs) has been very open and honest with us. He let us know the facts.

“I think they tell us this to motivate us. You have to have a good resume.”

The recipe for success: Do your research, do well on tests, be wellrounded and volunteer, Ingraham said.

“And when volunteering, it can’t just be an hour here and an hour there. You need to be committed to something – so you can talk about it.”

The Dunlay File Hometown: Iowa Falls, Iowa Medical degree: Creighton University Medical Center Residency: CUMC in internal medicine Fellowship: Oklahoma University Health Sciences Center in Oklahoma City in nephrology and Jewish Hospital at Washington University Medical Center in St. Louis Title: Interim Dean, Creighton University School of Medicine Family: wife, Kathy; children, Ryan, Drew and Mary.

Why I joined MOMS: “I think it’s good to support physician advocacy groups.”

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November/December 2013 Physicians Bulletin 19

COVER feature

Taking Medicaid

Nebraska Governor Dave Heineman

N

EBRASKANS HAVE MANY QUESTIONS about the new federal

health-care law. I would like to share with you the state’s perspective on several of the larger issues regarding this law and the choices the state has had to make.

As a result of the new federal health-care law, referred to as Obamacare, states had to decide whether to participate in a state or federal exchange. When making this decision, the State of Nebraska studied the issue in depth and we listened carefully to all sides of the issue. Like most Nebraskans I don’t agree with the law. However, my focus has been implementing the federal health-care law in the most efficient and cost-effective manner.

A fiscal analysis by the Department of Insurance and the Department of Health and Human Services calculated the cost of a state insurance exchange for FY 2013-2020 at $646 million; while the cost of a federal insurance exchange would be $176 million. The cost of a state exchange would be $470 million more expensive than a federal exchange.

Additionally, the federal government made it very clear that they would be totally in control of all major policy decisions regarding a state exchange. The bottom line was a state exchange was more expensive than a federal exchange and the federal government would essentially have operational control of a state exchange. Therefore, the State of Nebraska chose a federal exchange.

Another key issue is the optional Medicaid expansion. In FY 2013, Nebraska Medicaid covered more than 240,000 people at a total cost of more than $1.8 billion in federal and state funding. The cost of the current Medicaid program is growing faster than any other program in the state budget.

Obamacare creates both an individual mandate to have health insurance as well as establishment of health insurance exchanges.

Effective Jan. 1, 2014, states will be burdened with a significant increase in the number of Medicaid enrollees. This increase will come from individuals who are currently eligible, but have not applied

20 Physicians Bulletin November/December 2013

previously and from individuals switching from private insurance to Medicaid because of changes in the private health insurance market. The Medicaid benefit package is also richer than most private insurance plans and has no premiums or deductibles.

For the mandatory provisions of Obamacare, the Department of Health and Human Services estimates that there will be more than 48,000 Nebraskans who will be new enrollees in the Medicaid program through FY 2020. These new enrollees will increase the cost of the program to taxpayers by an additional $770 million.

This new state spending for Obamacare is money that should be going to state aid to education, special education, early childhood programs and higher education. Some members of the Nebraska Legislature and liberal advocacy groups want to expand Medicaid eligibility beyond the current requirements. The Department of Health and Human Services estimates that the cost of a Medicaid expansion through FY 2020 would be an additional $2.7 billion of federal and state funding. This is an unaffordable and unsustainable burden to place upon Nebraska’s taxpayers.

Another issue is the Medicaid Disproportionate Share Hospital (DSH) allocations to states. Hospital executives are concerned about reduced DSH payments from the federal government. Here are the facts. In 2011, the federal DSH allocation to Nebraska hospitals was $29.4 million, but Nebraska hospitals only earned $23.9 million of actual federal payments. Because Nebraska is a low usage DSH state, it is unlikely that Nebraska would exceed its entire federal allocation in the near future.

Finally, I would like to discuss rising health-care costs. The first priority for the federal government, state government, businesses and the health-care industry should be to control health-care costs.

As governor, I am working with state employees to make wellness a part of our everyday lives. The State of Nebraska offers an innovative wellness program and a health insurance package designed around wellness. In 2012, the State of Nebraska wellness program became the first and only state program to earn the coveted C. Everett Koop National Health Award. To receive this prestigious award, you have to demonstrate health improvements and cost savings. This award reflects how hard state employees are working to improve their health.

After just three years, the State of Nebraska has seen a $4.2 million reduction in claims. Our focus on wellness is resulting in a healthier work force. I would encourage the health-care industry and health-care professionals to join us in focusing on wellness to reduce health-care costs.

COVER feature

Sides on Expansion

M

EDICAL CARE IS APPROXIMATELY 50 percent

more expensive in the United States than other developed countries and American health care is ranked 26th in the world in terms of quality when measured by criteria including life expectancy and infant mortality.

While the United States has world-class sick care for insured patients, the effectiveness of our health-care system is reduced because of our percentage of uninsured and how we handle preventive care.

Already parts of the Affordable Care Act (ACA) have made a positive impact for patients because it prohibits life-term caps on insurance, allows children under the age of 26 to stay on their parents’ health insurance plans, requires insurance companies to cover preventive care and vaccinations without co-pays or deductibles. In addition, restaurant chains now have to publish the nutritional value of their food and insurance companies can’t deny people coverage because of pre-existing conditions. Not only that, but insurance companies are being held accountable for how much they spend on policyholders. So far this year, more than $1 billion dollars has been refunded back to the consumers.

The Congressional Budget Office predicts that over a 10-year period, the ACA will reduce the budget deficit by $109 billion.

These savings are realized through increased revenue from taxes on “Cadillac Plans” and on medical devices, as well as cost restraints to Medicare. Since Obamacare started, the acceleration of health care costs has slowed. From 2002 to 2010, premiums for employer health coverage increased by 8.2 percent per year. Since 2011, they rose only 5.6 percent per year.

We all know uninsured patients receive expensive, unreimbursed rescue medical care. They have increased medical bankruptcies, and increased morbidity and mortality. Right now, 217,000 Nebraskans are uninsured in this state. Under Medicaid Expansion, 55,000 of them would be eligible to receive Medicaid. Offering that would save 300 lives per year.* At this point, about half of the states have elected to expand Medicaid, including some with Republican governors who were fiercely opposed to “Obamacare.” They understand that it is to the economic benefit of their state because federal contributions would pay 100% for the first three years. After that, the percentage would decrease to 90% by 2020. These contributions through 2018, make Medicaid Expansion a net benefit to the state budget, create 10,000 ongoing jobs and $700 million in new economic activity per year.

Arkansas has been granted a waiver to use federal dollars to provide private insurance rather than Medicaid for health-care

Peter Silberstein, M.D.

expansion. Iowa, using a bipartisan coalition, has applied for a similar waiver. The Iowa hospitals have pledged to pay the first 5 percent of expansion costs if the federal government reneges on its planned reimbursement to the state. In the Iowa plan, some of the beneficiaries are required to contribute to their premium.

Nebraska teaching hospitals actually stand to lose money because the state isn’t expanding Medicaid. The formula for Disproportionate Share Hospital (DSH) is determined figuring that there will be Medicaid Expansion. Without it, the estimate is that Nebraska Medical Center and Children’s Hospital & Medical Center will lose $11 million due to decrease in DSH payments.

There are criticisms of the Affordable Care Act that are valid— technical problems with the federally-run exchange website, the need for many of the “healthy” uninsured to sign up for the exchanges and issues in regards to how large employers may manipulate their workforce in regards to part-time employment. Hopefully Congress and the Administration can work together to address those.

But for our state, it’s clear there are millions of dollars at stake.

Nebraska by adopting Health Care Expansion for the underinsured can improve both the physical health of patients as well as being a stimulus to the Nebraska economy. There is no debate that for the first years of Medicaid Expansion there is a benefit to the state budget because the entire cost is covered by the federal government. The ACA may be flexible in having Nebraska adopt a plan in which those new patients get private insurance rather than Medicaid. *LB577: Change provisions relating to the medical assistance program. Public Hearing February 28, 2013 at the Health & Human Services Committee of the Nebraska Legislature.

November/December 2013 Physicians Bulletin 21

feature

Bob Rauner, M.D.

A Call for Candidates

B

OB RAUNER, M.D., HAS two words for

fellow physicians who are thinking about running for public office: “Join me.”

Dale Mahlman, executive vice president of the Nebraska Medical Association, has another message for would-be candidates: “Call me.”

Mahlman said the Nebraska Legislature needs state senators with a background in medicine.

Health-care issues continue to confront the state, and legislators with knowledge of medicine are needed. He encouraged physicians who are considering a run for the legislature – or any other state office – to contact the NMA office, which can help would-be candidates do their homework before making a decision.

Dr. Rauner, a 44-year-old Lincoln physician, is running for the 28th legislative seat that is being vacated by State Sen. Bill Avery, who cannot seek re-election due to term limits. The registered Independent likely will face three opponents – two Democrats and one Republican – in the nonpartisan primary election.

He credits State Sen. Mike Gloor, former CEO of St. Francis Medical Center, who challenged physicians to run for office. Dr. Rauner recalled Gloor’s challenge, which came during his speech at a Nebraska Academy of Family Physicians Conference in 2009. “The Legislature needs more than just me representing health issues. I need one of you to join me.”

22 Physicians Bulletin November/December 2013

Dr. Rauner’s response: “Now, I am at a point where I can do that.”

Changes in his priorities, he said, prompted his decision and he is at a stage in his life where it’s feasible. “I am blessed with a wife who is a physician who can be the main bread winner.

I often say I married well. We are, ourselves, fiscally conservative and can survive on one salary (state senators earn $12,000 per year, plus some expenses).”

Also, his children are at ages (16, 14 and 12) where they are more independent, he said, “whether I like it or not.”

Dr. Rauner left his clinical practice in 2010.

He now runs his own nonprofit organization,

feature

Senator Joel Johnson, M.D.

Partnership for a Healthy Lincoln, which focuses on improving fitness and lowering obesity in Lincoln. He also serves as medical director for SERPA ACP, one of Nebraska’s two Accountable Care Organizations. He realized that serving a full patient load and serving in the Legislature would be virtually impossible. Joel Johnson, M.D., a former state senator, agreed. He suggested that physicians who work as freelancers might be best able to run for office.

Finally, Dr. Rauner said, he suffered a health scare several years ago. “I started looking at what’s important in life: making more money or making a difference.”

He was also involved at that time in the push to pass an indoor smoking ban in Lincoln and then statewide. The state legislation, whose sponsors included Dr. Johnson, passed in 2009.

“That tobacco bill has saved thousands of lives per year.” He said the success of that effort inspired him to get his master’s degree in public health from Johns Hopkins and get involved in the child obesity issue in Lincoln public schools.

“Look at the state budget. Three-fourths goes to health and education. We have former educators serving to represent education, but no physicians to represent health.” Dr. Johnson was the first physician to serve in decades.

Dr. Johnson, who served from 2002 to 2008, encouraged physicians to broaden their focus when campaigning for office. “To focus solely on medicine would be doing your constituents an injustice.”

Dr. Rauner shared some of his learnings from his first few months of campaigning: • “The strategy involved in running for office is fascinating.” Even simple things must be considered. For example, candidates have their names on their campaign logo printed in blue because it is perceived as a more trustworthy color.

• Door-to-door campaigning is interesting. “It’s not much different than going from room to room in the clinic. Most people are friendly.

Only one out of 100 is crabby.”

• Raising money isn’t as difficult as predicted. A consultant told him physicians were too tight to contribute to political campaigns. “Medical people do give – if it’s the right cause. It was nice to prove the campaign consultant wrong about physicians. They do step up on issues and candidates they care about.”

And finally, Dr. Rauner said he’s learned a little about dogs. “At least half the people in my district have them.”

November/December 2013 Physicians Bulletin 23

SOCIAL MEDIA in the Workplace Continued from page 12 << hour or more on social networking sites during the workday for personal use.”

CAN EMPLOYERS TAKE DISCIPLINARY ACTION BASED ON AN EMPLOYEE’S INAPPROPRIATE USE OF SOCIAL MEDIA?

It depends. The National Labor Relations Act (NLRA) protects “concerted activities for . . . mutual aid or protection” by most private-sector, non-supervisory employees. These protections apply in unionized and non-unionized workplaces.

Concerted employee activities have historically included employee discussions with their coworkers regarding things like improved pay, hours, safety, or workload. What is considered “unprotected activity?” Remarks that disparage the employer or its products, confidentiality breaches, and recklessly or maliciously false accusations.

So how does this relate to social media? The National Labor Relations Board (NLRB) (an independent federal agency that oversees the NLRA) has initiated several actions recently against employers who have taken disciplinary action against employees based on their social networking activities.

In a case involving a BMW car dealership, Karl Knauz Motors, Inc., an NLRB Complaint was filed after a Chicago area BMW salesperson was terminated for a Facebook post criticizing the quality of food and beverages at a dealership event. The salesperson complained that sales commissions would suffer as a result of the sub-par event, which was held to promote a new BMW model. He also posted pictures on Facebook and commented about how only hot dogs and bottled water were served. The salesperson’s first post stated I was happy to see that Knauz went “All Out” for the most important launch of a new BMW in years…the new 5 series. A car that will generate tens in millions of dollars in revenues for Knauz over the next few years. The small 8 oz bags of chips, and the $2.00 cookie plate from Sam’s Club, and the semi fresh apples and oranges were such a nice touch…but to top it all off…the Hot Dog Cart. Where our clients could attain a overcooked wiener and a stale bun…”

The salesperson also posted pictures of a Land Rover accident that occurred after another co-worker allowed a customer’s 13-year old son

to sit in the driver’s seat. The Facebook caption was “This is your car: This is your car on drugs.”

The salesperson wrote: This is what happens when a sales Person sitting in the front passenger seat (Former Sales Person, actually) allows a 13 year old boy to get behind the wheel of a 6000 lb. truck built and designed to pretty much drive over anything.

The kid drives over his father’s foot and into the pond in all about 4 seconds and destroys a $50,000 truck. OOOPS! Concerted activity or not? According to the NLRB, the employee’s Facebook posting regarding the party was a protected concerted activity because “it involved a discussion among employees about their terms and conditions of employment, and did not lose protection based on the nature of the comments.”

Did the administrative law judge (ALJ) agree?

Yes and no. The ALJ accepted the company’s position that it was the Land Rover posting that resulted in the termination decision and this was not protected activity. But the ALJ did agree that the first posting was protected activity.

The ALJ also found that some of the company’s

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24 Physicians Bulletin November/December 2013

Social Media handbook policies were unlawful including one that prohibited employees “from being disrespectful or from using language that damages the reputation of the Company”; and one requiring “outside inquiries concerning employees” to be directed to the human resources department. The ALJ held that if employees complied with these policies, they would not be able to discuss their working conditions with union representatives, lawyers, or NLRB agents, and that is their right under the NLRA. The takeaway? Employees can make comments online that may infuriate their employer, but if the comments constitute protected concerted activity, there may be very little the employer can do but tolerate such comments.

SOCIAL MEDIA POLICIES

In May of 2012, the NLRB issued its third Guidance Memo regarding social media policies.

In the May 2012 Memo, the NLRB reviewed seven employers’ social media policies and focused on provisions which the Acting General Counsel for the NLRB found to violate the NLRA. Only one of the seven policies met with NLRB approval.

According to the NLRB, when addressing confidential information in the workplace, employers should focus on trade secrets and private, confidential information. Prohibitions regarding the use of confidential information should not be drafted so broadly that the policy prohibits discussions regarding compensation or workplace safety (i.e. protected concerted activity.) A policy that prohibits the posting of content in social media that is “malicious, obscene, threatening or intimidating;” “harassing or bullying;” “meant to intentionally harm someone’s reputation” or “could contribute to a hostile work environment” on the basis of a protected class is appropriate.

However, a broader policy that prohibits online discussions that damage a person’s reputation may be considered overly broad under the NLRB’s current standards. A workplace social media policy should specify what is permitted, what is prohibited and what is required both inside and outside the workplace. Employees should be told to refrain from engaging in illegal conduct or violating social media site rules. Employees should also be reminded to protect their own privacy and to respect the privacy of others.

Employers should consider prohibiting the use of the employee’s company email address for personal communications. Managers should be discouraged from “friending” their subordinate employees.

The more we get together, the happier and healthier we’ll be.

At MMIC, we believe patients get the best care when doctors, staff and administrators are humming the same tune. So we put our energy into creating risk solutions that help everyone feel confident and supported. Solutions such as medical liability insurance, physician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care.

To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit MMICgroup.com.

November/December 2013 Physicians Bulletin 25

MOMS Foundation Annual Match Program

Each year the Metro Omaha Medical Society Foundation selects a local non-profit and asks members to join in supporting that cause, matching those donations up to a total of $5,000. This year’s Match Program will benefit the Omaha Street School.

The Omaha Street School, a local faith-based alternative high school, puts at-risk youth on the road to success focusing on dropout prevention through personalized education, a moral code, and tools for self-sufficiency through non-traditional approaches.

The 9th-12th grade high school students at OSS have typically not succeeded in traditional public or private schools, and many arrive with significant learning deficiencies. OSS offers low student to teacher ratios, individualized student learning plans and a focus on career pathways.

The OSS Future Focus program is designed to move clients, ages 17 and older, towards job readiness or continuing education. Programs include individualized GED tutoring and job skills certification opportunities.

To learn more about this program please read the article on the adjacent page.

2013 MOMS Foundation Grant Recipients Children’s Respite Care Center

Purchase a SleepSafe Bed to help children with special needs during overnight/weekend programs.

Child Saving Institute

Creation of a Healthy KIDS program emphasizing physical activity, nutrition education, staff development, family education and support.

Nebraska Children’s Home Society

Provide live music for residents of Hospice House to provide comfort in their final months.

Project Harmony

Purchase CPR training and equipment.

Completely Kids

Omaha Chamber Music Society

Metro maha Medical Society Foundation

Offer quarterly workshops to help parents, foster parents and professionals with specialized training to handle children with special health care needs.

Support bi-monthly training on child abuse and neglect for medical and non-medical professionals who work with children.

Project Pink’d

Fund spa baskets and gift jars with motivational messages for breast cancer patients. These items are distributed through physician offices to newly diagnosed patients.

To contribute to the MOMS Foundation Match Program or Grant Fund Call 402-393-1415 to make a donation by credit card or mail a check payable to the MOMS Foundation to: MOMS Foundation, 7906 Davenport St., Omaha, NE 68114 (Please reference either Match Program or Grant Fund)

Together we can touch lives and make a positive difference in our community.

feature

A Perfect Match: MOMS Foundation and Omaha Street School

O

MAHA STREET SCHOOL GRADUATES have this habit of stopping by.

Bri, a 2007 street school graduate, had made her way to the University of Nebraska-Lincoln with the hope of becoming a journalist.

Her instructors commented that she had talent. On her most recent visit, she brought along a clipping of her first story to run in UNL’s student newspaper, the Daily Nebraskan.

“The names are not real, but the stories are,” said Tami Saunders, director of donor relations at Omaha Street School. “It’s stories such as these that make me realize I love my job.”

The Omaha Street School is a nonprofit, faith-based alternative education program for at-risk teens in the Omaha area. Situated on the Turning Point Campus (formerly the Nebraska School for the Deaf) in north Omaha, OSS helps teenagers earn their high school degrees and young adults their GEDs. Its students often live in poverty and deal with such issues as illiteracy, gangs, substance abuse, unemployment, teen pregnancy and single-parent households. “These situations, whether chosen or not, get in the way of education and success – and can lead to despair,” Saunders said.

There’s Kalinda, who spent nearly two years at OSS. She was bright academically, but left school because of fighting. She received individualized attention to help her refocus her energies on a positive future. She returned to school, and graduated earlier this year. She now attends Iowa Western Community College. “She visits us regularly and attends family nights because we are part of her family,” Saunders said.

Then, there’s Derek, a spring 2013 OSS graduate. He is on his way to fulfilling his dream of joining the U.S. Air Force. He works at a family owned business, but is using the OSS FutureFocus program to help him

prepare for the military entrance examination. “We are excited that he is excited to serve our country and take the next step in his life,” Saunders said.

Not all the Omaha Street School success stories are so profound, Saunders said. “Sometimes it’s a success if a student makes it to school. But we are quick to celebrate victories – large and small.”

In the 2012-13 school year, OSS served 31 students and saw nine graduate. Its adult education program – called FutureFocus – served 37 students.

This program focused on GED tutoring, life skills and job readiness.

Omaha Street School is adding a new component to its arsenal of programs available to its students – thanks to support from the MOMS Foundation Match Program. Each year, the MOMS Foundation selects a nonprofit organization to support through its Match Program. MOMS members are encouraged to make a donation to the Match Program by Dec. 31. The MOMS Foundation will match those funds up to $5,000.

“As a high school that serves an at-risk population, most who live in poverty households, traditional health and wellness classes do not always address our students’ most basic health-related needs,” Saunders said.

OSS plans to use the funding from the MOMS Foundation to create curriculum to its afternoon schedule to focus on health, wellness and life skills – and is looking to MOMS members to provide the expertise.

“With our students, interactive, relevant instruction and materials are key,” Saunders said. “The more we can expose them to the world around them and a variety of people in the community, the more hope they have to live positive lives.”

For more information, visit www.omahamedical.com or call (402) 393-1415. If you are interested in volunteering time, contact Carol Wang at cwang@omahamedical.com.

November/December 2013 Physicians Bulletin 27

MOMS events SPEED DATING FOR YOUR SPECIALTY

1

Each fall since 2009, MOMS member physicians have volunteered their time to mentor area medical students at the MOMS Speed Dating for Your Specialty events. Events were held August 20 on the Creighton campus and September 10 on the UNMC campus with close to a hundred medical students and over 30 physicians participating 1. Dr. Judy Wolpert (right) participated in the event representing dermatology.

2. Dr. Lanette Guthmann (back right) gives several medical students an overview of practicing obstetrics and gynecology.

YOUNG PHYSICIANS GROUP KICK-OFF

The inaugural event of the MOMS Young Physicians Group was held October 8 at Charlestonâ&#x20AC;&#x2122;s at 75th & Dodge. Bringing together area physicians who are 40 years of age or under, or in their first five years out of training, the MOMS Young Physicians Group, led by Chair Dr. Jason Lambrecht, is a valuable network that is all about engaging young physicians, connecting with Omahaâ&#x20AC;&#x2122;s young professionals community, and working together to make a difference in the community..

3. Carol Wang, MOMS executive director, welcomes Dr. Travis Teetor.

4. Dale Mahlman, NMA vice president, and Dr. Brianne Kling discuss the need for young physicians to get involved.

2

3

28 Physicians Bulletin November/December 2013

4

MOMS coming events

Coming Events MOMS CPT CODING CHANGES & MEDICARE UPDATE SEMINAR DECEMBER 11 8:00 a.m. – NOON ITT TECHNICAL INSTITUTE, THEORY ROOMS 3 & 4 Join presenter Cynthia Swanson of Seim Johnson, LLP as she discusses the 329 newly added, revised and deleted codes associated with CPT®2014. She will also cover Medicare Physician Fee Schedule changes for 2014, and information on the Office of Inspector General’s 2014 Work Plan. Visit www.omahamedical. com to view the seminar brochure and print the registration form.

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November/December 2013 Physicians Bulletin 29

MEMBER news

Dr. Baxter part of study looking at abdominal aortic aneurysms

T

IMOTHY BAXTER, M.D., AND UNMC are conducting research for a

$12.2 million multi-center randomized placebo-controlled clinical trial of medical management of aortic aneurysm disease.

The management would be via a pill, which some scientists believe could significantly slow aneurysm growth said Dr. Baxter, professor of surgery The study is being conducted under the auspices of a grant from the National Institutes of Health, with UNMC serving as the clinical coordinating center.

The Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (NTA3CT) aims to enroll 250 patients with the collaboration of 15 top academic medical centers across the United States.

In addition to UNMC, the project’s pillar institutions include the University of Maryland Medical Center – for clinical trials management and design; University of Wisconsin School of Medicine and Public Health – for aortic imaging; and Washington University School of Medicine in St. Louis – for blood, lab and genetic testing.

Fifty percent of the trial’s enrollees will receive the antibiotic doxycycline, an inexpensive generic now widely used for acne and other conditions.

Dr. Baxter’s preliminary research in animal models shows the drug inhibits the enzymes which weaken aortic walls, thus causing aneurysms. If successful, it’s an inexpensive, noninvasive, proactive approach.

The surgery to repair aneurysms can come with a mortality rate of up to 3 percent – and a cost of about $20,000. More than 40,000 such procedures are done each year nationwide.

But, the study will show more than whether the pill works. It should also garner a host of invaluable information.

Aortic aneurysms affect 3 percent to 5 percent of the population, but are most common in men age 65 and older, often smokers with a family history.

“It’s considered a silent killer,” Dr. Baxter said, “because there are no symptoms until it ruptures. Most aneurysms we find by luck when imaging is done for other medical conditions.”

Dr. Baxter joined the UNMC faculty in 1990 as an assistant professor of surgery. He was elevated to associate professor in 1994 and to professor in 1999.

He earned his undergraduate degree from Colorado State University in 1978 and his medical degree from the University of Colorado in 1982. He did his research and surgery resident training at the University of Colorado and a vascular fellowship at Northwestern University.

30 Physicians Bulletin November/December 2013

Dr.Kosoko-Lasaki receives national recognition

S

ECRETARY OF HEALTH AND Human Services Kathleen Sebelius

has recognized the nomination of Creighton University’s Sade Kosoko-Lasaki, M.D., for her dedication to improving the health of the community. The recognition comes following Dr. Kosoko-Lasaki’s nomination as a White House Champion of Change for Public Health and Prevention.

The White House developed the Champions of Change program to highlight ordinary Americans who “are doing extraordinary things in their communities to out-innovate, out-educate and out-build the rest of the world.” As co-executive director for Creighton University’s Center for Promoting Health and Health Equities (CPHHE), Dr. Kosoko-Lasaki is actively involved in collaborating with the community to eliminate health disparities locally and internationally.

“Our emphasis is on health improvement of Omaha communities that have worse health related to social inequalities and inequities,” she said “We recognize that in order to foster health equality and promote health generally, health sciences centers such as CPHHE should become ‘centers without walls’ that embrace served communities as partners and collaborators.”

The top three issues facing the Omaha community, according to Dr. Kosoko-Lasaki, are obesity, cardiovascular disease and violence – which go hand-in-hand with Secretary Sebelius’ focus for public health.

“Too many communities continue to face high obesity, smoking and chronic disease rates, and I appreciate your tireless efforts around prevention and public health,” Sebelius wrote in a letter of recognition. “Your leadership is essential to moving our nation from a focus of sickness and disease to one that is based on wellness and prevention. Your efforts will have lasting effects on the health of Americans.”

Along with her leadership role with the CPHHE, Dr. Kosoko-Lasaki also serves as associate vice president for health sciences multicultural and community affairs as well as professor of surgery (ophthalmology) and preventive medicine & public health. An ophthalmologist with a public health degree, she is also passionate about training and educating individuals locally and throughout the world about blindness prevention, specifically vitamin A deficiency and glaucoma. She has initiated health fairs and screenings for glaucoma – the most common cause of blindness in African Americans and Hispanics – in Nebraska, Iowa, Kansas, Washington, D.C., the U.S. Virgin Islands and the Dominican Republic and has served as a consultant to UNICEF, USAID and Helen Keller International in Burkina Faso, Niger, Mauritania, Chad and the Philippines.

MEMBER news

Deb Perry, M.D

Dr. Sternberg Ellis recognized at alumni reunion

S

HEILA STERNBERG ELLIS, M.D., vice chair of

clinical affairs at the UNMC Department of Anesthesiology was among four health-care professionals honored for contributions to their respective professions during the UNMC Alumni Reunion in Omaha.

Dr. Ellis graduated from the UNMC College of Medicine in 1992 with high distinction. She completed her internship and residency at UNMC in the anesthesiology department, where she served as chief resident.

In 1996 after residency training, Dr. Ellis joined the UNMC anesthesiology faculty. She held various positions, including director of geriatric anesthesia and clinical director of anesthesiology service. In 2007, she was named vice chair of the department.

From 2008 to 2010, she served as interim chair.

She currently is vice chair of clinical affairs, director of the pre-anesthesia screening clinic, and director of liver transplant anesthesia. She also serves as chair of the credentials committee for The Nebraska Medical Center.

She was a member of the prestigious Executive Leadership in Academic Medicine program at Drexel University in Philadelphia from 2011-2012. The program of 100 emerging female medical leaders is dedicated to advancing women in medicine. Dr. Ellis also became part of a four-person leadership planning team at UNMC that developed and executed a year-long faculty development program.

She has served as president of the Nebraska Society of Anesthesiologists, participated as an oral board examiner for the American Board of Anesthesiology since 2004 and held a seat on the board of directors of the American Society of Anesthesiologists.

Tom Williams, M.D

Drs. Perry and Williams

T

recognized by pathologist group HE COLLEGE OF AMERICAN Pathologists (CAP) recognized Deborah Perry, M.D., and Thomas

Williams, M.D., with the CAP Excellence in Teaching Award at a special ceremony in Orlando, Fla., at CAP ’13 – The Pathologists’ Meeting.

The college established the award to recognize individuals who consistently provides outstanding contributions as faculty for one or more education activities resulting in exceptional development opportunities for pathologists. Dr. Perry received the award for her role as a facilitator for the nationally recognized Laboratory Medical Director Advanced Practical Pathology Program (AP3).

Dr. Perry said, “I am truly honored to have the opportunity to work with other medical laboratory directors on the fine points of laboratory management with the ultimate goal of delivering better patient care.”

Dr. Williams added: “It is humbling to receive this distinguished honor from the CAP and my peers in laboratory medicine. I am proud to be recognized with the CAP Excellence in Teaching Award for work that I enjoy doing every day on behalf of the specialty and patients.”

As a member of CAP since 1986, Dr. Perry is currently the chair of the CAP Point-of-Care Testing Committee and is an active member of the CAP Spokespersons Network. She also has served on the Hematology Resource Committee and the Publications Committee.

Dr. Perry is the medical director of Pathology at the Children’s Hospital and Medical Center and is a pathologist at Nebraska Methodist Hospital, both in Omaha.

She earned a bachelor’s of science degree in biology, graduating with high distinction, from Nebraska Wesleyan University in Lincoln. Dr. Perry went on to receive her medical degree graduating with distinction from the University of Nebraska Medical Center, where she also served as chief resident and completed a fellowship in hematopathology. The American Board of Pathology certifies Dr. Perry in anatomic and clinical pathology, as well as hematology and pediatric pathology.

Dr. Williams has chaired the CAP Publications Committee and the Quality Control Committee. He also has served numerous councils and committees, including the Council on Education, Council on Membership and Professional Development, the Chemistry Resource Committee, Quality Assurance Service, and the Surveys Committee. In addition, Dr. Williams served on the editorial board for CAP TODAY, the College’s official publication. He is a member of the STS Venture Committee and serves as a laboratory accreditation program inspector.

Dr. Williams is the chair of the department of pathology and medical director of the Pathology Center at Nebraska Methodist Hospital in Omaha, as well as laboratory director at the Methodist Physicians Clinic. He is also a clinical assistant professor of pathology at the University of Nebraska College of Medicine.

In addition to his involvement with the CAP, Dr. Williams was the president of the Nebraska Association of Pathologists. He is also a member of many other professional organizations, including the American Society of Clinical Pathologists and the National Academy of Clinical Biochemistry.

Dr. Williams earned his bachelor of science in chemistry from the University of Nebraska Lincoln. He went on to complete his medical degree at UNMC. While there, Dr. Williams also completed a rotating medicine internship before completing a residency in pathology at Nebraska Methodist Hospital.

November/December 2013 Physicians Bulletin 31

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32 Physicians Bulletin November/December 2013

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MEMBER news

Metro maha Medical Society STRATEGIC PARTNERS

NMA honors Dr. Zetterman

R

OWEN ZETTERMAN, DEAN EMERITUS of the Creighton University

School of Medicine was honored for his “Distinguished Service to Medicine” during the Nebraska Medical Association’s 45th Annual Session and House of Delegates in September.

Nominations for Distinguished Service to Medicine were submitted by physicians and county medical societies and recognize individuals who have contributed to the betterment of the health of Nebraskans.

Dr. Zetterman is an internist, gastroenterologist, and hepatologist and a professor of internal medicine at UNMC, where he is the director of Faculty Mentorship Programs. He is a former chief of staff for the Nebraska-Western Iowa VA Health Care System, and editor emeritus of the American Journal of Gastroenterology. Dr. Zetterman has served in leadership positions as president of the Metropolitan Omaha Medical Society, president of the Nebraska Medical Association, president of the American College of Gastroenterology, and chair of both the Board of Governors and of the Board of Regents of the American College of Physicians (ACP). He is currently a member of the Board of the Accreditation Council for Graduate Medical Education and an ACP delegate to the American Medical Association where he is a past-chair of the AMA Council on Legislation.

The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians.

Many of our member events and membership benefits are made possible by these partner organizations.

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IN memoriam WILLIAM BERTON, M.D. FEB. 8, 1924 – SEPT. 1, 2013

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For more information on our Strategic Partners, visit www.omahamedical.com November/December 2013 Physicians Bulletin 33

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34 Physicians Bulletin November/December 2013

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CAMPUS update UNMC, Creighton research challenges current views for genetic causes of familial breast cancer

It’s been almost 20 years since the landmark discovery of breast cancer (BRCA) genes 1 and 2, which first established that some breast cancer is inherited and can be passed down from generation to generation.

A finding published recently by researchers at the University of Nebraska Medical Center and Creighton University challenges current approaches in identifying breast cancer in families with a genetic link. The paper also might explain why, despite progress in the past two decades, identifying genetic connections for the majority of breast cancer that runs in families has been slow.

The study is published in the September/ October issue of The Breast Journal.

Currently, there are an estimated 30 to 50 gene mutations identified that affect about 30 to 40 percent of women with familial breast cancer -- with BRCA 1 and 2 being the most common.

“So many people get breast cancer but we cannot find the cause for most of it,” said

San Ming Wang, M.D., senior author of the article and associate professor in the UNMC Department of Genetics, Cell Biology and Anatomy. “Our study showed that many families have their own genetic factors that contribute to the disease. This finding goes against the existing theory, which has been that the same disease must have the same cause.

“But our data shows that the same disease can have different causes. People have been focused on finding a common mutation among different families. As many families have their own genetic causes, searching for a common cause will not work. This can explain why after almost 20 years we haven’t made significant progress.”

In the study, the research team sequenced all 20,000 or so genes in each of the eight members of a family, with five women affected by breast cancer in three generations. They discovered the family has the mutated gene KAT6B. The gene is known to be associated with many types of cancer but not before associated with breast cancer, Dr. Wang said.

He said they tested the same gene mutation in 40 other families with familial breast cancer but didn’t see mutations in those families. Since publishing the study, the team analyzed 30 more families with familial breast cancer consistent with the study results.

“Our data shows it’s very likely that many families have different mutations, which directly supports our concept of same disease, different causes,” Dr. Wang said.

Dr. Wang said advances in DNA technology and the DNA bank of Henry Lynch, M.D., of Creighton University, lent success to the project.

Dr. Lynch has one of the nation’s best collections of DNA from familial cancer patients, which is used by researchers all over the world.

“Our registry’s unique focus on family – relationships, connected cancer diagnoses and biological samples – lends itself to discoveries such as this,” said Dr. Lynch, professor and chair of the Creighton University Department of Preventative Medicine and Public Health and director of the Hereditary Cancer Center at Creighton University Medical Center. “This is nowhere near the end of our collaboration in this field. We hope to apply this concept and method to other families in our registry, as well as other types of cancer.”

The database also aided in Dr. Lynch’s discovery of the Hereditary Breast Ovarian Cancer syndrome, the Lynch syndrome and others.

Medical Society provide safe Halloween fun

afford costumes, to don a pair of scrubs and assist Dr. Creightonstein as he diagnosed a monster on the operating table.

Students involved with Phi Rho Sigma Medical Society regularly partner with the Heart Ministry Center to offer the Porto Urgent Care Clinic.

This free health clinic, located inside the Heart Ministry Center, offers preventative and urgent care health services every Wednesday to the center’s underserved populations.

Phi Rho Sigma Medical Society teamed with the Heart Ministry Center to host students at Sacred Heart School for a safe and free Halloween party. The medical student organization designed fun, healthy and educational activities for the 130 K-8 students, which included a Ghost Pony Ride, Spooky Book Store and a haunted store room.

Another popular activity, Monster Operation, allowed the students, many of whom could not

UNMC earns worldwide ranking The University of Nebraska Medical Center is ranked among the top 75 universities in the world in clinical medicine and pharmacy, according to rankings released this month by a leading Chinese university that has been ranking universities worldwide since 2003.

“The rankings validate that UNMC is well on its way to becoming a world-class institution,” said UNMC Chancellor Harold M. Maurer, M.D. “This has always been our goal, so it is reassuring to know that our presence worldwide is growing.”

The Academic Ranking of World Universities (ARWU) is published by the Center for World-Class Universities, Graduate School of Education of Shanghai Jiao Tong University in China.

UNMC is ranked with 25 other universities as No. 51-75 by ARWU. Only 31 U.S. universities are rated higher. Some of the other U.S. universities rated at the same No. 51-75 level are

the University of Arizona, University of Florida, University of Iowa, University of Illinois at Chicago, University of Rochester, and Washington University in St. Louis.

UNMC’s ranking is higher than several notable universities, including Case Western Reserve University (76-100), University of Cincinnati (76-100), New York University (76-100), University of Miami (76-100), and The Ohio State University (101-150).

“Obviously, we are in very good company,” said Brad Britigan, M.D., dean of the UNMC College of Medicine. “It speaks volumes for the quality work being done by our faculty and staff.”

November/December 2013 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

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Fax Application to: 402-393-3216

Mail Application to: Metro Omaha Medical Society 7906 Davenport Street Omaha, NE 68114

36 Physicians Bulletin November/December 2013

Apply Online: www.omahamedical.com

NEW MEMBER update

MEMBER benefits

Time to Renew Your Membership for 2014 We keep you informed.

Members receive the latest in local, regional and national health-care news through the MOMS eBulletin and NMA STAT as well as the Physicians Bulletin, Nebraska Medicine magazine and the NMA News.

We keep you connected.

Members have unique opportunities to network with their peers, local medical students and community leaders and can impact health care in the Omaha area through MOMS partnerships with local health-care related organizations.

We represent physicians and patients.

MOMS and NMA monitor state legislation and serve as the cumulative voice of Nebraska physicians to decision makers impacting Medicaid, Medicare, professional liability insurance, rural health and public health…just to name a few.

Lindsay Northam, M.D. Medical School: University of Nebraska School of Medicine

Medical School: State University of New York at Buffalo

Residency in Internal Medicine: Creighton University School of Medicine

Residency in Pediatrics: Naval Regional Medical Center – Portsmouth, Va.

Specialty: Internal Medicine

Other Post Graduate: Certified Physician Executive

Location: Methodist Physicians Clinic 192 Dodge Primary Care

Specialty: Pediatrics

Dr. Northam grew up in northeast Nebraska.

Her family owned a putt-putt golf course in Norfolk, Neb., called Nor-Sports. According to Dr. Northam, her many, many hours of practice have made her a mean putter on the golf course (especially if another golfer is standing above the hole, spinning his or her arms like a windmill.) The course is still open and these days she enjoys watching her nephews and nieces learn to play.

Other valuable member benefits: •

• • •

•

Access to the NMA Blue Cross Blue Shield health and dental plans COPIC premium reductions Access to Foster Group Wealth Management services Savings on AAA membership with no initiation fee for new members Access to TSYS Merchant Solutions member pricing to help your clinic save on credit card payment processing

If you would like more information on MOMS membership, call (402) 393-1415 or email Laura@omahamedical.com.

It’s that simple. It’s that important.

Stephen Lazoritz, M.D.

Location: Arbor Health Plan

After several years doing consulting work in the areas of medical communication and utilization management and working for the Department of Defense, Dr. Lazoritz recently returned to the Nebraska medical community as medical director of Arbor Health Plan. Arbor’s mission is to help the underserved of rural Nebraska get care, stay well and to build healthy communities. Dr. Lazoritz says he embraces these values, and is spending time learning about medical care in rural Nebraska. He is especially interested in improving access to care for woman and children in rural Nebraska.

Additionally, he is thrilled to be able to work as a volunteer faculty member at Creighton University, facilitating a small group of freshman students as they learn communication skills.

Dr. Lazoritz enjoys spending quality time with his wife and visits from their six children and five grandchildren. He enjoys writing and last February published his latest book “Case #1: The Mary Ellen Wilson Files.”

He also dabbles in cooking and says he is best known for being able to boil a mean pot of water.

NEW MEMBERS

Interested in becoming a MOMS Member?

Mohammad Hoque, MBBS Interventional Cardiology

Call 402-393-1415, apply online at www.OmahaMedical.com or complete the application on page 36.

November/December 2013 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 November/December 2013

Metropolitan Omaha Medical Society 7906 Davenport Street Omaha, NE 68114

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Heart Transplantation? Yes. Your 24-hour link to comprehensive cardiac diagnostics and treatments, physician-to-physician consults, referrals, admissions and transport service.

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