5100261 ioa fall hoosier do

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Fall 2015

Published by The Indiana Association of Osteopathic Physicians and Surgeons, Inc.

Hello. I hope this letter finds you well during this Fall season.

This will be my last letter to you as president of the Indiana Osteopathic Association (IOA). I have enjoyed participating in all of the activities required of me as president and have become much more aware of what is happening Adrian L. Carter, D.O. within our organization at IOA President the state and national level. I had the privilege of attending another House of Delegates meeting of the American Osteopathic Association (AOA) in July and was able to see what our organization supports. It was nice to see the AOA rejecting more forced federal mandates for expansion of Medicaid and allowing states to come up with their own solutions to insuring those who are without insurance such as we have in Indiana with HIP 2.0. I’m thankful for a governor and general assembly who worked diligently with the Obama administration to pass a state run system that makes sense for the citizens of Indiana.

Another thing I appreciated seeing was the parliamentary process working in a large venue of physicians with different ideology. Because of my participation I had a voice in what the AOA is doing even if I don’t agree with everything it is doing. I also was able to attend the Indiana State Medical Association’s House of Delegates (HOD) meeting in July as a delegate for District I and a representative of the IOA. I enjoyed caucusing with my district to decide which issues we would and would not support and participating in the process of passing resolutions. These resolutions will be delivered with recommendations to our state legislature. I still would like the IOA to get a voting seat at the ISMA’s HOD as I think our voice would be better represented within the community of physician organizations in Indiana. By the way, we can be very proud of the osteopathic medical students at the Marian University (continued on page 8)

PRESIDENT’S MESSAGE

BECHER INSTALLED AS PRESIDENT

John W. Becher, D.O., a board certified osteopathic emergency medicine physician from Newtown Square, PA, is the 119th president of the American Osteopathic Association (AOA).

“The dynamic times we're living in have brought extraordinary change to health care in just the past few years. Osteopathic medicine is one of the fastest-growing segments of health care professionals in the United States and the demand for our philosophy and approach to care has never been greater,” Dr. Becher says. “As physicians, we treat the whole person, not just illness and injuries. I welcome the opportunity to add our perspective to the national health care conversation.”

Dr. Becher serves as chairman of the department of emergency medicine at the Philadelphia College of Osteopathic Medicine, in Philadelphia, PA, from where he also graduated in 1970. He is director of osteopathic medical education at AtlantiCare Regional Medical Center in Atlantic City, NJ, and an adjunct professor of emergency medicine at Thomas Jefferson University in Philadelphia as well.

A member of the Federation of State Medical Boards’ Maintenance of Licensure Committee, Dr. Becher has trained over 150 emergency (continued on page 10) IN THIS THIS ISSUE IN ISSUE Amendment of Bylaws…………….…………………..…3 Tips From Our Consultant……………..………………..4 AIOA News……………….……………………….……...8 Dean’s Update……………………………………………9 WMD Update……....………….…………..………...….10 Coming Events………………………………………….11 Practice Opportunities………………………………….12

Fall 2015 Winter 2015

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Fall 2015

IOA WELCOMES NEW MEMBERS The following physicians were accepted as new members of the IOA at the Board of Trustees meeting on August 23, 2015: ACTIVE MEMBERS Lauren N. Brankle, D.O., MWUCCOM (2011), Pediatrics Ann L. Habenicht, D.O., MWUCCOM (1982), Family Medicine/Osteopathic Manipulative Medicine

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HOUSE OF DELEGATES The osteopathic profession in Indiana was well represented at the AOA House of Delegates meeting in Chicago in July. The IOA delegation included Thurman V. Alvey, III, D.O., Mark S. Cantieri, D.O., Adrian L. Carter, D.O., David L. Coil, D.O., Dan C. Galloway, D.O., Ben D. Huang, D.O., and Susan M. Moore Riesbeck, D.O. The AOA’s House of Delegates meets annually to set organizational policies and elect new officers.

AMENDMENT OF BYLAWS In accordance with Article XVI, Amendments, of the Indiana Association of Osteopathic Physicians and Surgeons, Inc. By-Laws, written notice is hereby given of the Annual Meeting of Members on Friday, December 4, at 2:30 p.m., at the Sheraton Hotel at Keystone Crossing, in Indianapolis.

Proposed revisions to the By-Laws will be considered at this meeting and may be viewed or downloaded on the IOA’s website at www.inosteo.org by clicking on Proposed Revisions to the By-Laws under the IOA tab.

MARIAN UNIVERSITY Indianapolis

ELEMENTS OF EXCELLENCE

E Gala 2

®

celebrating

11.13.15

Marian University’s Dedication to Science, Technology, Engineering, Health Sciences, and Mathematics (STEHM)

presented by

JW Marriott Indianapolis Reception at 6:30 p.m. | Dinner at 7:30 p.m.

Black tie optional Emcee, Angela Buchman Meteorologist at NBC Affiliate WTHR-TV in Indianapolis

HONOREES INCLUDE: Sarah and John C. Lechleiter, Ph.D. Franciscan Values Award Raul Zavaleta John A. Purdie Innovator of the Year Award Bill Eckman ’74 Founders’ Award for Distinguished Service to Marian University Dennis Donahue ’62 Donald A. Fleming Award for Distinguished Professional Achievement

Visit www.marian.edu/gala to: Purchase a table or individual tickets.

Review discounted hotel rates at the JW Marriott Indianapolis.

Explore donor opportunities.

All proceeds from the gala go to support scholarships or designated area.

HOOSIER D.O.

Fall 2015

Page 4

TIPS FROM OUR CONSULTANT By: Joy Newby, LPN, CPC, PCS Newby Consulting

ICD-10 Effective October 1, 2015 Starting on October 1, Medicare claims with a date of service on or after October 1, 2015 will only be accepted if they contain a valid ICD-10 code. The Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes.

There has been some misunderstanding about a recent announcement by the Centers for Medicare & Medicaid Services (CMS) discussing the temporary flexibility in the claims auditing and quality reporting during ICD-10 implementation. 



For 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family. However, a valid ICD-10 code will be required on all claims starting on October I, 2015.

For all quality reporting completed for program year 2015, Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use (MU) penalties during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes. Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes.

This announcement does not mean there is a delay in the implementation of ICD-10. What it does mean is that CMS is willing to continue to process claims that include unspecified codes from the correct family of codes.

“Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters. One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

Thus, even though a “family of codes” is a three-character category, the physician must report a valid code. For example, the “family of codes” for cellulitis and acute lymphangitis is L03 Cellulitis and acute lymphangitis. The temporary reprieve from having to report to the greatest extent known at the time of service means for dates of service 10/1/2015 through 9/30/2016, a physician could report L03.90 cellulitis unspecified in lieu of reporting a more specific code: L03.011 L03.012 L03.031 L03.032 L03.111 L03.112 L03.113 L03.114 L03.115 L03.116

Cellulitis of right finger Cellulitis of left finger Cellulitis of right toe Cellulitis of left toe Cellulitis of right axilla Cellulitis of left axilla Cellulitis of right upper limb Cellulitis of left upper limb Cellulitis of right lower limb Cellulitis of left lower limb

Fall 2015 L03.211

L03.221 L03.311 L03.312 L03.313 L03.314 L03.315 L03.316 L03.317 L03.811 L03.818

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Cellulitis of face Cellulitis of ear (H60.1-) Cellulitis of eyelid (H00.0-) Cellulitis of head (L03.81) Cellulitis of lacrimal apparatus (H04.3) Cellulitis of lip (K13.0) Cellulitis of mouth (K12.2) Cellulitis of nose (internal) (J34.0) Cellulitis of orbit (H05.0) Cellulitis of scalp (L03.81) Cellulitis of neck Cellulitis of abdominal wall Cellulitis of back [any part except buttock] Cellulitis of chest wall Cellulitis of groin Cellulitis of perineum Cellulitis of umbilicus Cellulitis of buttock Cellulitis of head [any part, except face] Cellulitis of other sites

In contrast, the claim must still include the ICD-10 code that is supported by the documentation. For example, if the physician documents “lymphangitis” and does not specify it as acute, the coder should not select L03.91 which is the unspecified code for acute lymphangitis. The correct code for lymphangitis NOS (not otherwise specified) is I89.1 While this temporary reprieve from using the ICD-10 code that represents the greatest extent known at the time of the encounter is tempting, physicians should consider whether it is wise to simply report unlisted codes for the first year of implementation. At some point, greater specificity will be required. NCI recommends that to the extent possible, physicians should use the more specific codes beginning with dates of service on or after October 1, 2015, so additional changes will not be necessary in the future.

CMS has made it very clear that there is no guarantee other payers will allow the use of unspecified codes (especially for primary diagnoses – reason for the encounter – which should be the first diagnostic statement in the assessment section of the progress note and listed as the first diagnosis on the claim). Physicians should verify with their major commercial payers to determine whether the unspecified codes from the same family of codes will be accepted on claims that include ICD-10 codes.

Requests for Documentation Related to Orders Physicians have been seeing an increase in requests for documentation of medical necessity when ordering durable medical equipment, prosthetics, and supplies (DMEPOS), laboratory and radiology services before the entity will complete the order. Although CMS does not require ordering physician/nonphysician providers to include the documentation with the order, some suppliers have taken the position that without the information, they will not complete the order.

When NCI began receiving complaints about the increased work related to an order, we contacted the Jurisdiction B DME Medicare Administrative Contractor. The D-MAC’s representative explained that the supplier has the right to request the information with the order.

The majority of the requests appear to be coming from these suppliers because in Fiscal Year 2014, the Comprehensive Error Rate Testing (CERT) contractor reported a 53.1 percent improper payment rate for DME suppliers.

The vast majority of the improper payments were due to the supplier not providing sufficient documentation to support the medical necessity for the DMEPOS items.

Examples of services leading to the improper payment rate related to insufficient documentation for specific services include, but are not limited to, the following:

Fall 2015

HOOSIER D.O.

DMEPOS Services Oxygen Supplies/Equipment Glucose Monitor CPAP Enteral Nutrition Nebulizers & Related Drugs Hospital Beds/Accessories

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Insufficient Documentation 94.3% 85.0% 94.1% 98.6% 96.2% 96.2%

As this information is typically located in the physician/nonphysician provider’s documentation in the patients’ medical record, some suppliers have been requesting the documentation be submitted with the order. By having the information to begin with, the supplier can review the information to determine whether there is sufficient documentation to support the medical necessity especially when the item is subject to a Local Coverage Decision. Some suppliers are reviewing the information while others are simply filing the information in event the supplier is audited by any Medicare contractor.

According to §5.2 Chapter 5 of the Medicare Program Integrity Manual For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient documentation of the patient’s medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). The information should include the patient’s diagnosis and other pertinent information including, but not limited to, duration of the patient’s condition, clinical course (worsening or improvement), prognosis, nature and extent of functional limitations, other therapeutic interventions and results, past experience with related items, etc.

If an item requires a Certificate of Medical Necessity (CMN), it is recommended that a copy of the completed CMN be kept in the patient’s record. However, neither a physician’s order nor a CMN nor a supplier prepared statement nor a physician attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating physician. There must be clinical information in the patient’s medical record that supports the medical necessity for the item and substantiates the answers on the CMN (if applicable) or information on a supplier prepared statement or physician attestation (if applicable).

The patient’s medical record is not limited to the physician’s office records. It may include hospital, nursing home, or home health agency (HHA) records and records from other professionals including, but not limited to, nurses, physical or occupational therapists, prosthetists, and orthotists.

The documentation in the patient’s medical record does not have to be routinely sent to the supplier or to the DMERC or DMERC PSC. However, the DMERC or DMERC PSC may request this information in selected cases. If the DMERC or DMERC PSC does not receive the information when requested or if the information in the patient’s medical record does not adequately support the medical necessity for the item, then on assigned claims the supplier is liable for the dollar amount involved unless a properly executed advance beneficiary notice (ABN) of possible denial has been obtained.

While not all of the insufficient documentation errors can be attributed to lack of physician documentation, the problem does appear to account for a significant portion. These problems stem from the physician providing insufficient documentation that does not meet the requirements to support the order and the medical necessity for the service (which could include evidence of a required face-to-face evaluation) and/or physicians failing to provide any documentation.

WPS POSTS INFORMATION ON ORDERING OXYGEN As a member of the WPS (J-8 Part A/B Medicare Administrative Contractor for Indiana) Provider Outreach and Advisory Committee, we received the following information to be included in this article.

Physicians! Are You Ordering Oxygen For Your Patient?

Your medical record documentation determines whether your patient can receive the oxygen equipment and supplies you have prescribed and the amount of the patient’s out of pocket expenses.

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Your medical record documentation must show that other alternative treatments (e.g., medical and physical therapy directed at secretions, bronchospasm and infection) have been tried or considered and deemed clinically ineffective. The documentation must show the patient was seen within 30 days prior to the start of oxygen therapy. The medical record must show the medical condition necessitating the home use of oxygen therapy.

The medical record and/or prescription would indicate the oxygen flow rate (e.g., 2 liters per minute), the estimation of the frequency (10 minutes per hour), duration of use (12 hours per day) and duration of need (6 months).

You must specify the type of oxygen delivery system to be used (i.e. portable/stationary concentrator, compressed gas portable/stationary, liquid portable/stationary.)

Medicare can make payment for home oxygen supplies and equipment when the patient’s medical record shows the patient has significant hypoxemia and meets medical documentation, test results, and health conditions as specified in §240.2, Chapter 1, Part 4 of the Medicare National Coverage Determinations Manual http://www.cms.gov/Regulationsand-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part4.pdf You must complete and sign Form CMS-484 (Certificate of Medical Necessity (CMN): Oxygen.) https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms484.pdf. However, the CMN itself is not considered part of the medical record. All information included in the CMN must be supported by the contemporaneous medical record. You can find instructions on completing this form in the Chapter 5 of the Medicare Program Integrity Manual at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c05.pdf The Comprehensive Error Rate Testing (CERT) contractor has identified multiple errors in the claims received for oxygen equipment and supplies. These errors include missing physician clinical records showing the patient’s condition and the continued need for oxygen, missing signed and dated order from the physician when changing the oxygen liter flow rate, missing copy of the oxygen saturation testing, and missing treating physician’s re-evaluation for recertification CMN. Help your patients and the Medicare program by verifying you have the medical record documentation to support the order and supply of oxygen for your patients. This allows Medicare to pay claims appropriately.

EXCEPTIONAL CARE, SIMPLY DELIVERED At Community Westview Hospital we focus on the overall health of our patients. Our osteopathic philosophy of care means we treat the whole person and look for ways to prevent disease rather than just diagnose it.

Moving toward a health and wellness focus, Community Westview and the Healthplex are becoming more integrated and partnering together to help our patients maintain a healthy lifestyle. We believe that fitness and education combined with traditional medicine will continue to serve our patients well.

If you would like to learn more about how we can serve your patients and your practice, please follow our growth at eCommunity.com/Westview or call 800.777.7775.

A Facility of Community Hospital East

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AIOA NEWS

PRESIDENT’S MESSAGE (continued from page 1)

College of Osteopathic Medicine (MUCOM) who are participating in opportunities provided by the ISMA. Leadership within the ISMA is taking notice of the osteopathic medical students and appreciates their participation.

I would like to thank you for giving me the opportunity to serve as president and represent the IOA in the different assemblies which affect us as physicians and the future of our practices. I’m looking forward to Mark S. Cantieri, D.O., taking over as president. Dr. Cantieri has been involved in the IOA, the AOA, the American Academy of Osteopathy and many other physician organizations. I admire his leadership and am encouraged PRODUCTION about what he will bring to the IOA. As aTMP reminder, the IOA is seeking all members who are interested in(4c) serving 3.75 x 4.75 on the IOA Board of Trustees as well asrd/al/al/al/mr on committees. I hope more of you become involved in the IOA as you are an asset to our organization.

Again, please find a way to contribute to the MUCOM and the students in some way. This will help promote a legacy for future osteopathic physicians in Indiana and future leaders in the IOA. I also would like to thank the students for their membership. On behalf of our organization, I applaud your commitment to the osteopathic medical profession and look forward to hearing more positive feedback about you from others in the medical community.

Lastly, thanks to our staff, Erin Wernert and Debbie Coyle, for their support during my presidency.

They are wonderful and dedicated people to have representing us at the IOA. God bless.

By now you should have received notification of the IOA’s 34th Annual Winter Update to be held December 4 – 6, 2015 at the Sheraton Hotel at Keystone Crossing in Indianapolis. Go to the IOA’s website at www.inosteo.org and register online now. It’s instant. It’s simple.

You should have received details for advertising in the program and securing items for the silent auction too.

Please support the Advocates to the Indiana Osteopathic Association (AIOA) in our fundraising efforts. All proceeds raised benefit the study of osteopathic medicine.

For those of you who are not members, I again would like to invite you to join the AIOA and help support and promote the osteopathic profession. To receive an application, please contact Debbie Coyle at the IOA office or you may download anBOS045249B application at the 5 IOA’s website 2015 by clicking on Advocates to the IOA under the PBERGSTR Related Organizations tab.

Indiana

Mike Coyle AIOA President

Lose the limitations.

Keep your edge.

Adrian L. Carter, D.O. IOA President

We have an opening for a Full-Time Physician to provide Primary Care in our worksite health center on the campus of Purdue University in West Lafayette, IN! At Premise Health, you will be able to practice medicine as you were trained, with a focus on clinical excellence and evidence-based medicine. You will be able to spend time with patients to understand their needs, develop treatment plans and educate them on maintaining health and wellness.

We’re on a mission – a mission to change how workplace healthcare is seen and experienced. Join the Premise Health team and you’ll be able to take full advantage of our remarkable approach and our outstanding development opportunities. We can offer you everything you need to build a rewarding career and keep your edge.

To Learn more, contact Jeff Ligon at 615-468-6233 or jeff.ligon@premisehealth.com, or visit online: https://www.premisehealthjobs.com Job ID: 15-1719

Fall 2015

DEAN’S UPDATE

By: Paul Evans, D.O., FAAFP, FACOFP Vice President and Dean Marian University College of Osteopathic Medicine The Marian Uuniversity College of Osteopathic Medicine (MUCOM) is settling in our third class, the D.O. Class of 2019. They have taken their first anatomy tests (remember those days?) and are enculturating into how to succeed in medical education. The quality of the new class is even higher than the two preceding classes and remains above the national first year matriculate averages for GPA and MCAT scores. 57% are males. 76% are 20 24. We have 84 different undergraduate institutions represented with 23 from Indiana. The experiences of our students are impressive including running 39 ultramarathon races, a trustee at a college, a national champion cyclist, a private pilot, and four with military backgrounds. International students hail from Canada, Cameroon, India, South Korea, Zimbabwe, and Vietnam.

18% have graduate degrees. Our class has matched the national average for students from backgrounds typically underrepresented in medicine.

COMLEX USA LEVEL 1. The D.O. Class of 2017 students (third years) have completed and almost all have passed this first part of the licensing exam. All scores are not in yet, but we are happy that so far the students are doing very well. Our pass rate is above the national average for all osteopathic schools, a good endorsement for our innovative curriculum.

THIRD YEAR CLERKSHIPS. Clerkships started successfully in July 2015. Students were trained to successfully work in the hospital environment with attending physicians and the medical team. Specific medical information, case presentation skills, team skills, and medical procedure basics are part of this course work.

Simulation and standardized patients as well as task training was done before they started their hospital experiences in July. They learned about how hospitals work, navigating the continuum of care from admission to discharge with after care and follow up. We are very pleased that our three months has gone smoothly. Our clinical dean, Charles E. Henley, D.O., has done a great job in setting up this complex program with the help of our clerkship coordinators. St. Vincent Health, under the capable leadership of Dr. Mary Abernathy, VP of Medical Education and Research, had ninety third year students successfully begin in their system. Her team did a wonderful job in organizing physicians, rotation details, and the myriad other items needed to ensure success. Dr. Kathy Zoppi, VP for Medical Education at Community Health Network, has helped schedule our students in clinical rotations in their network. This has been a remarkable achievement since they are transitioning into

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more of a teaching hospital culture (new) and are undergoing the challenges that this brings. We also have a smaller number of students in Terre Haute, Richmond, and the South Bend area among others. Our feedback about our students has been very positive! All is working well in these initial phases.

ACCREDITATION. We will have a site visit from the AOA’s Commission on Osteopathic College Accreditation in February 2016. If all goes well we will continue in the required steps toward full accreditation when we graduate our first class in May of 2017.

COMMUNITY RELATIONS. Work has now started for a GME (Graduate Medical Education) Expansion Board with support through the Indiana state legislature. The goal is to expand Graduate Medical Education by 500 slots statewide for all medical students in Indiana over the next ten years. The bill was sponsored

by Representative Tim Brown, M.D., a family physician who is chair of the House Ways and Means Committee.

There was strong support of this program by many health related groups to include the Indiana Hospital Association, Indiana State Medical Association, Indiana Osteopathic Association, Indiana Academy of Family Physicians, Indiana Area Health Education Centers, Rural Health Association, Primary Care Association, many physician specialty groups and of course the IU School of Medicine.

There are still organizational tasks to accomplish this year.

The GME Expansion Board will form this fall and once the policies and procedures are determined, we will start to select support for new residency slots, expanding existing programs, and looking at an emphasis on primary care and specialty shortage slots for the state.

THANK YOU! Marian truly appreciates the support of the IOA physicians and staff. We are especially grateful for the excellent teaching offers and the quality consultation assistance we have received.

We are delighted to work with and learn with our osteopathic colleagues at the IOA’s annual winter update in Indianapolis in December. And yes, we are still seeking community physicians to teach our bright and eager medical students! We hope our graduates will be a very positive addition to increasing the number of osteopathic physicians in Indiana and improving the health of the state and the region.

Fall 2015

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BECHER INSTALLED AS PRESIDENT (continued from page 1)

medicine physicians as a residency director.

During his career, Dr. Becher held leadership roles within the AOA, including as a member of the editorial board of The Journal of the American Osteopathic Association, and is past president of the Pennsylvania Osteopathic Medical Association.

Dr. Becher’s goals for his presidency include: • Increasing awareness of osteopathic medicine. The AOA’s upcoming brand awareness campaign will elevate the profession’s profile, but Dr. Becher urges D.O.s to make a point of explaining osteopathic medicine to patients as well, which he said he does about 10 times every day.

• Pursuing funding to support research pilot projects documenting the impact of osteopathic medicine.

• Creating new osteopathic-focused residency programs.

• Boosting advocacy efforts at the state and federal level.

• Maintaining fiscal responsibility.

Dr. Becher also urges his colleagues to get involved outside the osteopathic medical profession, whether through community leadership or engaging in public policy. If half of all D.O.s and osteopathic medical students spent a few minutes a week informing people who aren’t familiar with the profession, he calculated, more than 2.5 million people could be reached this year.

“This kind of grassroots engagement is critical,” he says. “What we can do for the osteopathic profession is to stand up and tell the world why we are proud to be osteopathic physicians.”

WMD UPDATE

By: Colonel Charles A. Holt, D.O. Pearls for Fall: Syria, the constant harbinger of bad news, is one of a growing number of countries with polio outbreaks over the past few years; these include Nigeria, Pakistan and Afghanistan. There are so many children in our schools with food allergies that more and more states have given legal protection to schools allowing them to stock and dispense epinephrine without a RX. Extreme weather disasters since 1980 cost the US over $1Trillion! Never forget T.B.; the four big drugs used for TX: isoniazid, rifampin, ethambutol and pyrazinamide.

Apps are being developed to sort out the key info on social media during disasters. Cell phones/digital cameras/smart phones & laptops with cameras are real game changers.

Cooking caused fires are #1 in home/hospital/hospice/nursing home fires. Unattended stove tops are the #1 culprit. Indochina is seeing development of resistance to the drug artemisinin. This single drug has helped cut malaria deaths by 1/4 over the past 10 years; keeping the toll under 1M/Y. More disaster F/U. Remember Hurricane Sandy?

It has been reported that the city of New York's emergency plans were in violation of ADA in many ways.

Sandy was a trifecta of weather/full moon/storm surge that, in 2012, cut off electricity to 8M and killed at least 64. Read about W. Craig Fugate, chief of FEMA, and his Waffle House disaster scale. Hospitals need to stockpile 25 common items for Surge Capacity preparation--see AHRQ for more info. Enjoy the changing leaves, but beware of children playing in piles of them in the streets and driveways.

American Osteopathic Association 2013 – 2015 CME Cycle Will End December 31, 2015 Be Certain To Fulfill Your CME Requirements

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COMING EVENTS...

Annual Convention October 17 – 24, 2015 Orange County Convention Center, Orlando, FL Sponsor: American Osteopathic Association Contact: AOA, (312) 202-8014 or www.osteopathic.org Preconference OMT Workshop: A Comprehensive Approach to SI Joint Pain and Sacral Somatic Dysfunction December 3, 2015 8 hours category 1-A credit anticipated, pending approval by AOA CCME Sheraton Hotel at Keystone Crossing, Indianapolis, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org 34th Annual Winter Update December 4 - 6, 2015 25 hours category 1-A credit anticipated, pending approval by AOA CCME Sheraton Hotel at Keystone Crossing, Indianapolis, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org Healing From Traumatic Brain Injury: Advanced Studies November 13 - 15, 2015 17.75 hours category 1-A credit anticipated, pending approval by AOA CCME New York College of Osteopathic Medicine, Old Westbury, NY Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Introductory Course: Osteopathy in the Cranial Field February 13-17, 2016 40 hours category 1-A credit anticipated, pending approval by AOA CCME Albuquerque, NM Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Changing Lives: Osteopathy’s Gift to Children February 19 – 21, 2016 20.50 hours category 1-A credit anticipated, pending approval by AOA CCME Albuquerque, NM Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Annual Convocation March 16 – 20, 2016 Rosen Shingle Creek Resort, Orlando, FL Sponsor: American Academy of Osteopathy Contact: AAO, (317) 879-1881 or www.academyofosteopathy.org Annual Convention April 6 - 9, 2016, Puerto Rico Caribe Hilton, Sheraton, and Convention Center, San Juan, Puerto Rico Sponsor: American College of Osteopathic Family Physicians Contact: ACOFP, (800) 323-9794 or www.acofp.org Preconference OMT Workshop May 19, 2016 8 hours category 1-A credit anticipated, pending approval by AOA CCME French Lick Resort, French Lick and West Baden, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org 119th Annual Spring Update May 20 – 22, 2016 25 hours category 1-A credit anticipated, pending approval by AOA CCME French Lick Resort, French Lick and West Baden, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org

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Fall 2015

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PRACTICE OPPORTUNITIES AVAILABLE IN INDIANA IOA Serves as an Informal Clearinghouse for physicians seeking practice locations.

2014 - 2015 OFFICERS Adrian L. Carter, D.O. President Mark S. Cantieri, D.O. First Vice President Gaston Dana, D.O. Second Vice President Terry A. Iwasko, D.O. Secretary Patrick J. Woodman, D.O. Treasurer Angela B. Wagner, D.O. Immediate Past President TRUSTEES Brian H. Black, D.O. Mary Burden, D.O. Steven J. DeLee, D.O. Chris A. Lowery, D.O. Stephanie M. Overmars, D.O. Rachel A. Shockley, D.O. DISTRICT VICE PRESIDENTS Brian H. Black, D.O., District I Vacant, District II Vacant, District III Vacant, District IV Bruce C. Brink, Jr., D.O., District V Dan C. Galloway, D.O., District VI A.O.A. DELEGATES Thurman V. Alvey, III, D.O. Mark S. Cantieri, D.O. David L. Coil, D.O. Dan C. Galloway, D.O. David C. Koronkiewicz, D.O. Susan M. Moore Riesbeck, D.O. Angela B. Wagner, D.O. A.O.A. ALTERNATE DELEGATES Adrian L. Carter, D.O. Max E. Helman, D.O. Ben D. Huang, D.O. The Hoosier D.O. is published four times per year in the Winter, Spring, Summer, and Fall by the Indiana Association of Osteopathic Physicians and Surgeons, Inc. dba Indiana Osteopathic Association.

Editor: Deborah E. Coyle, CPS IOA Staff: Erin L. Wernert, Executive Director Deborah E. Coyle, Manager of CME Programs and Office Manager The IOA Office is located at: 3200 Cold Spring Road Evans Center, Suite 107 Indianapolis, IN 46222 (317) 926-3009 www.inosteo.org

FREELANDVILLE INDIANA. The small rural community of Freelandville misses its retired physician and is hoping a new one will come to town. If interested in a solo practice, contact Erin Wernert or Debbie Coyle, IOA, at (317) 926-3009.

INDIANAPOLIS PHYSICIAN AVAILABLE FOR FAMILY PRACTICE, OCCUPATIONAL MEDICINE, OR URGENT CARE. Certified in family practice in 1999. For additional information, contact Erin Wernert or Debbie Coyle, IOA, at (317) 926-3009.

NORTHERN INDIANA. Mishawaka Osteopathic Clinic has an immediate opening for a physician to come into the practice. We have a well-established and large patient base. Our experienced, loyal, and well-trained staff attracts many new patients. Currently, we have one full time and one part time D.O., an R.N., multiple medical assistants, fully staffed front office and medical records. Our Clinic has 11 exam rooms, including an office surgery/procedure room, PAP room, conference/lunch room and a large comfortable waiting room. We are a fast paced and patient friendly practice caring for families since 1969. Come join our team of patient care professionals who feel that “our patients matter.” For more information, please contact Mary Behrle, RN Staff Coordinator at (574) 323-3812 or e-mail inquiries along with your CV to mocnurse@yahoo.com.

PREMIER INDIANAPOLIS AREA FAMILY MEDICINE OPPORTUNITES AVAILABLE. Our practices are growing, and you can be busy right away. You’ll enjoy a collaborative environment with administration and your fellow physicians. Experience the benefits of practicing in a small town environment without sacrificing any big city amenities. Our hospitals offer: supportive cultures, competitive salaries, comprehensive benefits, rapidly growing communities, full and part time options, skilled support staff at each practice and accessible specialty and subspecialty medicine. Hospital owners: Hancock Regional Hospital, Hendricks Regional Health, Henry County Hospital, Johnson Memorial Hospital, Major Hospital, Margaret Mary Health, Riverview Health and Witham Health Services. Contact Suburban Health Organization, (317) 295-5279 or send an email message to laurenc@suburbanhealth.com.

SOUTHERN INDIANA. Brink’s Family Practice in Princeton has an immediate opening for a physician to come into the practice. The practice has a well-established patient base with experienced, well-trained staff and an inhouse lab. The practice is located in a growing community that still possesses small town friendliness and has access to large city amenities. For more information, please e-mail inquiries along with your CV to c.hurtbfp@mw.twcbc.com or contact Erin Wernert or Debbie Coyle, IOA, at (317) 926-3009.