Issuu

50 Volume 55

4 Number 2

D O

O O S I E

Summer 2016

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

The Indiana Graduate Medical Education (GME) Board has continued to meet regularly. A request for proposals was sent out from the state of Indiana requesting bids from companies that would be able to assess the current GME status in Indiana, identify the medically underserved areas of the Mark S. Cantieri, D.O. state, assess the physician IOA President distribution within the state and barriers to education, review federal regulations for GME, determine costs and funding associated with GME, and help determine where potential growth for GME exists. The GME Board hired the national consulting firm Tripp Umbach of Pittsburgh, PA. They have met twice with the GME Board since being hired. Their final report is scheduled to be delivered September 16th. It will include a presentation of benefits, impacts, and their recommendations for expansion. Indianapolis had the honor and benefit of being the first city to host the Doctors that DO campaign outside of the original marketing area. Billboards, bus shelter ads and health club videos throughout the Indianapolis area shared the campaign message. Initial campaign results indicate that 20 million impressions were delivered in two months. Website traffic from Indianapolis increased 50% in one month and “Find Your DO” searches went up 20%. To see the campaign please take a moment and go to http://doctorsthatdo.org. Please also go to http://www.osteopathic.org/Pages/default.aspx for the American Osteopathic Association (AOA) and https://www.inosteo.org/default.aspx for the Indiana Osteopathic Association (IOA) and log in to make sure your contact information is current. Potential patients are looking for what we as health care givers provide. The AOA continues the transition to the single accreditation system with (continued on page 18)

PRESIDENT’S MESSAGE

ANNUAL MEETING OF MEMBERS

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 2, 2016, at 2:30 p.m., at the Sheraton Hotel at Keystone Crossing. 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. IN THIS THIS ISSUE IN ISSUE New Members…………………………………………….3 Members Concerns………………………………………3 WMD Update……………………………………………..4 Annual Winter Update…………………………………...5 Tips From Our Consultant………………………………8 AOA President Installed………………………………..17 AIOA News……………………………………………...18 Dean’s Update…………………………………………..20 Motyka Dannin Foundation……………………………21 Coming Events………………………………………….23 Practice Opportunities………………………………….24

Summer 2016 Winter 2015

HOOSIER D.O.

Page 2

Keeping the game fair...

...so you’re not fair game. Your Indiana medicine is getting hit from all angles. You need to stay focused and on point— confident in your coverage. Get help protecting your practice, with resources that make important decisions easier.

Proudly endorsed by

Healthcare Liability Insurance & Risk Resource Services ProAssurance Group is rated A+ (Superior) by A.M. Best.

Want to reduce risk? >> ProAssurance.com/Seminars

800.282.6242 • ProAssurance.com

Summer 2016

IOA WELCOMES NEW MEMBERS ACTIVE MEMBERS Scott T, Bormann, D.O. Robert L. Brunk, D.O. John M. Gonzaba, D.O. Johnathan R. Grant, D.O. Debra A. Gulyanics, D.O. Addison G. Haynes, D.O. Ward E. Harbin, D.O. Megan N. Heil, D.O. Townes R. Leigh, Jr., D.O. David P. Megremis, D.O. Linnea J. Nelson, D.O. Jennifer A. Pallone, D.O. Mary Jo Robinson, D.O. Sarah Schlie, D.O. John C. Tang, D.O. Stacie M. Wenk, D.O. Michelle A. Wysong Migliore, D.O. RESIDENT MEMBERS Danielle Cundiff, D.O. Deepal J. Dharia, D.O. Beau M. Links, D.O. Hee Kwon Yoon, D.O. INTERN MEMBERS Scott Agee, D.O. Molly E. Binkley, D.O. Ji Sun Hong, D.O. David C. Livingston, D.O. Lauren McKay, D.O. David Murphy, D.O. Matthew S. Nettleman, D.O. Joseph A. Perkins, Jr., D.O. Nicholas A. Seman, D.O. STUDENT MEMBERS Adam Alexander, MSII Tyler Beach, MSII Lauren Bruder, MSII Adam Cassella, MSII Brittani M. Corbisiero, MSIII Kelsey Cowden, MSII Shah Jahan Dodwad, MSII Katharyn Downs, MSII Aaron Golitko, MSIII Philip Graves, MSII Jesse F. Hartpence, MSIII Ashley C. Heyman, MSIII Grant Hicks, MSII Sarah E. Hockley, MSIII David M. Johnson, MSIII

HOOSIER D.O.

Page 3

Michael E. Joseph, MSIII Alicia B. Langhals, MSIII Paige Langhals, MSII Michael S. Lewis, MSIII Kevin McNulty, MSIII Katherine L. Neff, MSIII Kelly S. Prindle, MSIII Lauren M. Rose, MSIII Jessica Shoukry, MSIII Gregory C. Specht, MSIII Mitchel Steckbeck, MSII Calvin Streeter, MSII Nevin Vijayaraghavan, MSII Briana White, MSII Josselyn Wilimitisi, MSI John Wright, MSIII Kody Wyant, MSIII Michael A. Zipper, MSIII

MEMBER CONCERNS RECOVERING Allan M. Arkush, D.O., of Indianapolis, who is recuperating from health issues. Linnea J. Nelson, D.O., of Indianapolis, who is recuperating from surgery.

IN MEMORIAM The IOA has learned that Anne L. Kempf, D.O., of Albuquerque, NM (formerly of Washington, IN), died on March 11, 2016. Dr. Kempf was the great granddaughter of A.T. Still, D.O. and a 1973 graduate of A.T. Still University Kirksville College of Osteopathic Medicine (ATSUKCOM) in Kirksville, MO. Dr. Kempf was the daughter of Elizabeth and George Laughlin, D.O. She was united in marriage to Carrold J. Kempf, D.O. in 1971 in Grinnel, IA. Dr. Kempf was preceded in death by her parents. She is survived by her husband, Carrold; her brother, Patrick Laughlin, D.O. and wife, Sue; her sister, Susan Laughlin; her three sons, Nathan Kempf and wife, Renea, Joshua Kempf, D.O. and wife, Libby, and Aaron Kempf; one daughter, Rachel Gschwend and husband, Chris; and six grandchildren. Memorial contributions may be made to the Motyka Dannin Foundation.

Summer 2016

HOOSIER D.O.

Page 4

119TH ANNUAL SPRING UPDATE The following exhibitors, grantors, and in kind supporters made possible the excellent continuing medical education (CME) program offered during the IOAâ€™s 119th Annual Spring Update held Friday through Sunday, May 20 â€“ 22, 2016, at The French Lick Resort, in French Lick and West Baden. On Thursday, May 19, a highly successful preconference OMT workshop was offered. The CME Committee and the Board of Trustees of the Indiana Osteopathic Association (IOA) urges all members to let representatives of these companies know that you appreciate their support. EXHIBITORS AbbVie AstraZeneca Boehringer Ingelheim Boston Heart Diagnostics Center for Diagnostic Imaging Eli Lilly Flexible Footwear Indiana Professional Licensing Agency Janssen Legally Mine Marian University College of Osteopathic Medicine Motyka Dannin Osteopathic Educational Foundation Novo Nordisk ProAssurance Purdue Pharma Sanofi US Air Force GRANTORS Legally Mine Osteopathic Medical Foundation of Michiana IN KIND SUPPORTERS Boston Heart Diagnostics Genova Diagnostics Indiana Family and Social Services Administration Marian University College of Osteopathic Medicine Overdose Lifeline Plews Shadley Racher & Braun

WMD UPDATE

By: Colonel Charles A. Holt, D.O. !Hola! I'm going to use the scatter gun approach to giving you nuggets of trivia, so get ready. Chikungunya; sounds like a Chinese chicken delicacy, but is the mosquito-borne high fever/severe arthritis causing virus that appeared a few years ago on St. Martin in the Caribbean. OOPS! NEVER use/leave propane tanks inside a building because they can and will explode-remember the 1963 Indiana State Fairgrounds explosion that killed 74 and wounded 400? More recently, in Lubbock, TX, another explosion occurred at the University Medical Center, on 12/19/2013--8 persons injured d/t a fire and a tank explosion. Norovirus kills ~1,000/Y and causes >70,000 hospitalizations. Never think that you have heard it all...I remember that disgusting report, a few years ago, of the alcoholic/oxycontin/fentanyl addict hospital worker who infected at least 45 patients with HEP C, by using their syringes, first! Yuk! Yuk! And double Yuk! Anthrax is one sneaky bug. A Swiss study showed that its lethal toxins can hide in cell membranes; from not only our immune system, but blood tests, as well. What happened on 8/18/2014? Sec. of State Kerry announced that all of the Syrian chemical weapons of Bashar Assad had been destroyed on board the M V Cape May. What occurred on 9/18/2012? The TN Dept. of Health received the sentinel report linking the compounding pharmacy med methylprednisolone acetate injections to fungal infections...at least 64 died. What happened in NOV 2013? The military put out a medical alert about the dietary supplement CRAZE. It stated that it may contain an amphetamine-like component with possible severe health risks. Some people really do go crazy over supplements! Remember, some of AHRQ's most important critical surge capacity resources: IV tubing/O2 and tubing/ventilators/all-size ambu bags/critical care nurses and technicians to use these. What are three things that North Korea is famous for producing? Methamphetamine and its worldwide distribution/counterfeit money & brand-name cigarettes. Kim chee, anyone? Go to MESHcoalition.org, today, and sign up for their daily News Brief. The 24 July 2016 brief gave the titles of recent articles on topics ranging from Bexsero use at Princeton/MERS/training for disaster preparation and its aftermath/ZIKA/new Yellow Fever epidemic/bio-defense troubles. Adios.

Summer 2016

35TH ANNUAL WINTER UPDATE DOCTORS SAID LAST YEAR... “The practical stations provided for very good hands on experience.” “Enjoyed participating and learning.” “High quality.” “Outstanding use of three days.” “Good facility, good food, good moderators—really, everything great.” “All topics timely.” “An excellent program—every detail addressed—always appreciate.” “I thought this year was particularly informative.” “My first time here—good program!” PRECONFERENCE OMT WORKSHOP On Thursday, the Indiana Osteopathic Association (IOA) is offering an optional preconference OMT workshop for an additional fee. THIS YEAR’S PROGRAM We are pleased that Larry W. Anderson, D.O. FACOFP dist., president of the American College of Osteopathic Family Physicians (ACOFP) will be our guest at a luncheon on Friday and will report on behalf of the ACOFP Board of Governors. During a pain management symposium on Friday afternoon, the IOA will offer a unique opportunity for physicians to experience a pain management education with 3 hands on workshops. Registered spouses/guests and children are encouraged to join the Advocates to the IOA for dessert and socializing at The Cheescake Factory in the Fashion Mall on Friday afternoon. At a luncheon and silent auction on Saturday, Boyd R. Buser, D.O., president of the American Osteopathic Association (AOA) will be our guest and will recognize awards recipients and install our new trustees. Your support of the Advocates’ fundraising efforts at our CME program by buying raffle tickets and bidding on items in the silent auction is greatly appreciated. The money raised will go to the Motyka Dannin Osteopathic Educational Foundation to support the study of osteopathic medicine.

HOOSIER D.O.

Page 5

The IOA is hosting a holiday reception on Saturday evening. Plan to stop by for food, drinks, and an opportunity to celebrate with colleagues and friends. All spouses/guests and children are invited too. We also will be collecting new, unwrapped toys for distribution through Toys For Tots. ENTERTAINMENT December in Indianapolis offers numerous opportunities for family and grown-up fun. You can enjoy first rate theater, concerts, shopping and dining. A Christmas Carol. The spirits of Christmas bring new life to Ebenezer Scrooge in his journey from dark night of the soul to bright joyous morning. Celebrate the season with Indianapolis’s favorite holiday tradition. God bless us, everyone! Tickets on sale now. Go to www.irtlive.com or call (317) 635-5252 Monday through Friday, 11:00 am to 6:00 pm. Enjoy Indiana’s best holiday tradition, IPL Yuletide Celebration, as part of the SymFUNy Sunday family series. Ring in the holidays with Jack Everly, Conductor, and special guests as they bring to life the magic of tap dancing Santas, festive carols and larger-than-life puppetry alongside the ISO. Tickets on sale now. Go to www.indianapolissymphony.org or call (317) 639-4300 or (800) 366-8457 outside Central Indiana Monday through Friday from 10:00 am to 5:00 pm. Surround yourself with the magic and beauty of the holiday season as the Indianapolis Zoo hosts its annual holiday tradition, Christmas at the Zoo presented by Donatos and Teachers Credit Union. A visit to Christmas at the Zoo is unlike any other time of the year. As the sun sets over the White River State Park, enjoy the bright glow of holiday lights creating a magical nighttime experience. The Zoo opens at 12 noon daily and all the fun holiday activities are available from 5:00 pm to 9:00 pm. Holidays sparkle at The Children’s Museum of Indianapolis. Explore Jolly Days Winter Wonderland, visit with Santa Claus, and ride down the Yule Slide. The museum is open Tuesday through Sunday, from 10:00 am to 5:00 pm. The Eiteljorg Museum of American Indians and Western Art, the Indianapolis Art Museum, and the American Cabaret Theater are close too. The Fashion Mall connects to the hotel and is a great place for shopping. Many restaurants are within a short walk or drive from the hotel as well.

Summer 2016

HOOSIER D.O.

Page 6

TENTATIVE AGENDA

HOTEL ACCOMODATIONS

PRECONFERENCE OMT WORKSHOP THURSDAY, DECEMBER 1, 2016 8:00 am - 5:30 pm  MUCOM OMM Faculty Clinical Pearls Buffet This is an optional preconference OMT workshop for an additional fee. (Please indicate attendance on your registration form.) FRIDAY, DECEMBER 2, 2016 (Exhibits open 8:00 am - 3:30 pm) 7:00 am - 6:00 pm  Menopause and Perimenopause  Hypogonadism  Hormone Therapy  Science Based Medicine  Advanced Lipids Treatment of Genetic Lipid Disorders PAIN MANAGEMENT SYMPOSIUM  Practical Station  Practical Station  Practical Station 6:30 pm  Thrombotic Events This is a promotional event. CME credit will not be available for this session. In adherence with PhRMA guidelines, spouses or other guests are not permitted to attend company-sponsored events. (Please indicate attendance on your registration form.) SATURDAY, DECEMBER 3, 2016 7:00 am – 5:30 pm  Obstructive Sleep Apnea  Stroke  Anti-Coagulation  State Advocacy Priorities  Drop Foot  Moving the Needle  Pre-Exposure Prophylaxis Against HIV Infection  OMT Workshop: Difficult Clinic Conditions-Bring Your Difficult Cases 6:00 pm  Holiday Reception All spouses/guests and children are invited too. (Please indicate attendance on your registration form.) SUNDAY, DECEMBER 4, 2016 7:00 am - 12:15 pm  HIPAA and Electronic Communications  Striking an Ethical Balance In Public Health  Debridement Procedures and Wound Dressings  Coding and Billing Update (Topics and times subject to change.)

BOOK YOUR ROOM EARLY! The Sheraton’s address is 8787 Keystone Crossing Indianapolis, IN 46240. Make your reservation via the internet at https://www.starwoodmeeting.com/book/IOA35 or call (888) 627-7814. The room rate is $130.00 per night single, double, triple, or quadruple occupancy until 5:00 p.m. on October 31. Be sure to mention the IOA Annual Winter Update to receive this rate. Make your reservation now even if you’re not certain you will need a room. If you decide to cancel your reservation, please contact the IOA first. USE YOUR ELECTRONIC DEVICES! Participants may download powerpoint presentations provided to us by the week before our event on the IOA’s website during CME programs free of charge. Participants also may request flash drives loaded with powerpoint presentations provided to us by the week before our event free of charge. Download the YAPP app free of charge on your iPhone, iPad, or android and access the IOA’s 35th Annual Winter Update (WU) App instead of viewing a printed program. (Please indicate if you prefer a flash drive and if you prefer to download the WU App on your registration form.)

Summer 2016

HOOSIER D.O.

Page 7

REGISTRATION FORM __________________________________________________________________________________________________ Name (indicate first and last for name badges) Degree AOA Member Number __________________________________________________________________________________________________ Mailing Address (indicate office residence) City State Zip Code __________________________________________________________________________________________________ Telephone Number (indicate office residence cell) Medical College Year of Graduation __________________________________________________________________________________________________ E-Mail Address Specialty Certification

Non Member Member* Spouse/Guest Resident/Intern Non Member Resident/Intern Member Student Non Member Student Member

REGISTRATION FEES (circle appropriate fee) Before 11/4/16 After 11/4/16 $650 $700 $495 $545 $150 $200 $325 $375 $250 $300 $175 $225 $125 $175

* Member of IOA or respective state association. I would prefer a flash drive. .

I would prefer to download the WU App. I will participate in the optional preconference OMT workshop on Thursday, December 1. I have included an additional fee of $215 in my check. I understand that an additional fee of $215 will be charged as indicated below. I will participate in the promotional event on Friday, December 2. I will participate in the holiday reception on Saturday, December 3. I will bring a new, unwrapped toy for distribution through Toys For Tots. Check (made payable to IOA) enclosed. Charge to:

Visa

Mastercard

Discover

American Express

__________________________________________________________________________________________________ Card Number Expiration Date CVC Number Authorized Signature REGISTER ON-LINE FOR AN ADDITIONAL FEE: Go to www.inosteo.org. CANCELLATIONS & REFUNDS: The IOA must receive notice of cancellations by November 4, 2016, to grant full refunds. If originally paid by credit card, cancellations are subject to a 5% service fee. All cancellations received after November 4 are subject to a 15% service fee. After November 25, 2016, all cancellations are subject to a 25% service fee. MAIL REGISTRATION FORM WITH PAYMENT TO: Indiana Osteopathic Association 3200 Cold Spring Road Michael A. Evans Center for Health Sciences, Suite 107 Indianapolis, IN 46222-1997. QUESTIONS? Call (317) 926-3009. SPECIAL NEEDS? Contact the IOA before November 4, 2016, if possible.

Summer 2016

HOOSIER D.O.

Page 8

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

WPS Reverses Decision on Allergy Injections and “Incident To” Billing On January 18, 2016, WPS GHA published an article in eNews indicating …if the physician employing the person giving an allergy injection is not the physician treating the allergy, “incident to” requirements are not met and the service should not be billed to Medicare… The article explained that part of the requirement for “incident to” is that the billing physician (treating physician or a supervising physician/qualified health care professional of the same group practice) is treating the patient for the illness or injury. Under this interpretation of the “incident to” requirements, the only way a PCP (primary care provider) could bill for administering an allergy injection based on the allergist’s plan of care is if the physician or practitioner personally administered the injection. Knowing that for various reasons many patients evaluated by an allergist who prepares the serum specific to the patient, choose to have their PCP administer the injections, we requested WPS review and revise their interpretation. The following information will be published in a future eNews. Allergy injections may be provided by a local physician when the plan of care has been determined by another medical doctor (MD) or doctor of osteopathy (DO). The information discussing allergy injection is contained in 42 CFR 410.68. This section states that Medicare can allow for up to a 12-month supply of antigen when that is prepared by an MD/DO who has examined the patient and developed a plan of treatment including dosage levels; and the antigen is administered in accordance with that plan by an MD/DO or a properly instructed person under the supervision of an MD/DO. Therefore, when the billing physician is supervising ancillary staff in administering an antigen prepared by another MD/DO, the billing physician may submit a charge for the administration of the antigen. The writer apologizes for the error. This reversal will allow Medicare beneficiaries to continue to receive allergy injections administered by a physician other than the allergist. “Incident To” Reminders Many physicians and group practices continue to be confused by Medicare’s “Incident To” requirements. This phrase is more than simply billing the work performed by another person using the patient’s physician’s name and National Provider Identifier (NPI). We decided the remainder of this article should include some of the basic requirements for billing services “Incident To”. Remember, “Incident To” billing requirements are written for Medicare beneficiaries with original Medicare coverage. Medicare Advantage Plans and commercial insurers are able to choose how services performed by clinical staff and qualified health care professionals (Medicare refers to these latter individuals as “nonphysician practitioners”). CPT includes the following definitions in the Coding Tip included in the “Evaluation and Management Services Guidelines” A “physician or other qualified health care professional” is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his or her scope of practice and independently reports that professional service. These professionals are distinct from “clinical staff”.

Summer 2016

HOOSIER D.O.

Page 9

A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional, and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specific professional service, but does not individually report that professional service. Medicare considers the following individuals as non-physician practitioners (qualified health care professionals):              

Anesthesiology Assistant Audiologist Certified Nurse Midwife Certified Registered Nurse Anesthetist Clinical Nurse Specialist Clinical Social Worker Nurse Practitioner Occupational Therapist in Private Practice Physical Therapist in Private Practice Physician Assistant Psychologist, Clinical Psychologist billing independently Registered Dietitian Nutrition Professional

Physicians should also remember there are additional requirements applicable to billing shared visits where both the physician and the NPP provide services to the same patient during the same encounter, or in the case of hospital inpatient, on the same date of service. “Incident To” Services - Supervising Provider Billing Instructions http://www.wpsmedicare.com/j8macpartb/resources/provider_types/incident-services-supervising-provider-billinginstructions.shtml In the office, among other criteria, “incident to” services must be rendered by a qualified provider who is directly supervised. To meet supervision requirements for “incident to,” the billing provider does not have to be physically present in the treatment room while the service is being provided, but must be present in the immediate office suite, for the entire duration of the service, to render assistance if needed. If the billing physician is a solo practitioner, he/she must directly supervise the care. In a group practice, there may be situations when the provider responsible for the treatment plan is not the provider physically present in the office suite when the patient is seen in follow up. Thus, the supervising provider can be different from the ordering provider. At this time, the supervising physician qualifier for Item 17 of the CMS-1500 (02-12) is not required for “incident to” services. Qualifier DN DK DQ

Role Referring Provider Ordering Provider Supervising Provider

In the case of a service provided “incident to”, when the person who ordered the service is not supervising, enter the National Provider Identifier (NPI) of the “supervising provider” in the lower unshaded portion of Item 24J. To find additional instructions for completing the CMS-1500, please refer to CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 26.

HOOSIER D.O.

Summer 2016

Page 10

To find complete information on CMS “incident to” requirements, please refer to CMS Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15. Medicare Claims Processing Manual, Chapter 26, §10.4 - Items 14-33 - Provider of Service or Supplier Information https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf Item 17 - Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in item 17. All claims for Medicare covered services and items that are the result of a physician's order or referral shall include the ordering/referring physician's name. The following services/situations require the submission of the referring/ordering provider information: [Not All-Inclusive] 



When a service is “incident to” the service of a physician or non-physician practitioner, the name of the physician or non-physician practitioner who performs the initial service and orders the nonphysician service must appear in item 17. Effective for claims with dates of service on or after October 1, 2012, all claims for physical therapy, occupational therapy, or speech-language pathology services, including those furnished “incident to” a physician or non-physician practitioner, require that the name and NPI of the certifying physician or nonphysician practitioner of the therapy plan of care be entered as the referring physician in Items 17 and 17b

Item 17b – Enter the NPI of the referring, ordering, or supervising physician or nonphysician practitioner listed in item 17. All physicians and non-physician practitioners who order services or refer Medicare beneficiaries must report this data. Item 24J - Enter the rendering provider’s NPI number in the lower unshaded portion. 

In the case of a service provided “incident to” the service of a physician or non-physician practitioner, when the person who ordered the service is not supervising, enter the NPI of the supervisor in the lower unshaded portion.

WPS “Incident To” Services and Diagnosis http://www.wpsmedicare.com/j8macpartb/resources/provider_types/incident_srvs-dx.shtml The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Chapter 15, §§60, 60.1, and 60.2 discusses the “incident to” requirements. According to §60, “To be covered “incident to” the services of a physician or other practitioner, services and supplies must be:    

An integral, although incidental, part of the physician’s professional service (see §60.1) Commonly rendered without charge or included in the physician’s bill (see §60.1.A) Of a type that are commonly furnished in physician’s offices or clinic (see §60.1.A) Furnished by the physician or by auxiliary personnel under the physician’s direct supervision (see §60.1.B)”.

§60.2 states …there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician’s continuing

Summer 2016

HOOSIER D.O.

Page 11

active participation in and management of the course of treatment. In addition, the physician must be physically present in the same office suite and be immediately available to render assistance if that becomes necessary.” [Emphasis Added] For example, Dr. A is currently treating the patient for diabetes. The patient’s evaluation and management (E/M) encounter in the office today is with a Physician Assistant (PA) of the same group for an upper respiratory infection. Can the PA bill the service “incident to” Dr. A and bill under Dr. A’s provider number? In the situation described, the upper respiratory infection is not part of the treatment for diabetes and, therefore, is not an “integral, although incidental” part of Dr. A’s “professional service.” The PA should not bill “incident to” under Dr. A’s provider number, but should bill the appropriate level of new or established E/M service provided under his or her own provider number. The physician must have performed the initial service for the diagnosis or condition and must remain actively involved in the course of treatment. WPS Office Services (Q&As) http://www.wpsmedicare.com/j8macpartb/resources/provider_types/2009_0622_emfaqoffice.shtml Q2.

Are there any examples of when a physician may bill a 99211 without a face-to-face visit with a physician?

A2.

The documentation must support the use of the procedure code 99211 and the “incident to” requirements. 99211 cannot be billed for a telephone call, completing a form to document the results of tests, or if the physician is not in the office suite. Services provided by ancillary staff or a non-physician practitioner (NPP) may be billed by the physician when the “incident to” requirements are met. The Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-02, Chapter 15, §60, discusses these guidelines. The services must be:    

Q3.

Can we bill a 99211 under the name of the physician in the following situations?     

A3.

An integral, although incidental, part of the physician’s professional service (see §60.1); Commonly rendered without charge or included in the physician’s bill (see §60.1a); Of a type that are commonly furnished in physician’s offices or clinics (see §60.1a); Furnished by the physician or auxiliary personnel under the physician’s direct supervision (see §60.1B).

Physician is immediately available in the office suite RN checks blood pressure, pulse and weight RN reviews symptoms or complaints RN performs INR test RN follows dosing protocol as directed by the physician

The documentation must meet the history, exam, and medical decision making requirements for the procedure code. In the example given above, history is the review of symptoms and complaints, exam is the blood pressure, pulse, and weight check, and medical decision making is the possible dosage change. Before submitting a charge for 99211 in addition to the blood draw and INR test, a physician should verify the visit is for more than the INR. The Comprehensive Error Rate Testing (CERT) program recently identified errors when the documentation did not support the use of this code in addition to the test itself.

Newby Note: Remember the clinical staff’s work must be medically necessary and tied to the physician’s plan of care. Simply obtaining vital signs is not sufficient to support reporting 99211. Q5.

We schedule patients for injections, blood draws and other minor visits before the physician comes into the office. Can we bill for these services under the “incident to” guidelines?

Summer 2016 A5.

HOOSIER D.O.

Page 12

Medicare pays for services and supplies (including drugs and biologicals) furnished “incident to” a physician’s or other NPP’s services, which are commonly included in the physician’s bills, and for which payment is not made under a separate benefit category listed in §1861(s) of the Act. One of the requirements of “incident to” billing is that the physician must provide direct supervision - the physician must be in the office suite. For more information, see the CMS IOM Publication 100-02, Chapter 15, §60. Laboratory tests have their own benefit category as listed in §1861(s) of the act and as such are not subject to the “incident to” guidelines. Medicare considers a blood draw as part of the Clinical Laboratory services and as such is not subject to the “incident to” guidelines. You can find more information in the Medicare Learning Network (MLN) Matters Special Edition SE0441.

Q6.

The patient did not show up for the appointment. Can I bill a low-level office visit code to Medicare?

A6.

No. There was no service to the patient; therefore, there is no charge to Medicare. You can bill the patient for the services. CMS requires that office policies be administered the same for all patients.

WPS “Incident To”/Shared/Split Billing (Q&As) http://www.wpsmedicare.com/j8macpartb/resources/provider_types/2009_0803_incident.shtml Newby Note: Before billing services provided by a nonphysician provider (NPP) “incident to” by reporting the supervising physician’s NPI in Item 24j, for Medicare patients and other insurers using Medicare’s “incident to” guidelines, be sure the “incident to” requirements are met. These frequently asked questions are helpful when determining whether the NPP’s services can be billed by the supervision physician. Be aware that “incident to” billing is only available in the office setting. “Incident to” guidelines do not apply in any other setting, e.g., patient’s home or facility. “Incident to” billing is when a service is provided in an office setting by someone other than the physician. However, if the situation meets the guidelines, the physician may bill Medicare for the service. Shared/split billing is for services provided in any location when both the physician and a non-physician practitioner (NPP) provide, document, and sign the work they each performed. There must be a face-to-face encounter with both the physician and NPP. The physician can bill the service to Medicare. Why does this make a difference? Medicare allows 100% of the Medicare fee schedule amount for coverable services submitted by a physician. Medicare allows a percentage of the physician fee schedule amount when services are submitted under an NPP provider number. (The percentage is 85% for physician assistants, nurse practitioners, and clinical nurse specialists.) If the situation does not meet the guidelines, the NPP would bill the services. You can find more information in the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 10004, Chapter 12, §30.6.1.b, and 100-02, Chapter 15, §60. Q1.

Can a physician and an NPP perform the discharge visit as shared/split? If they can, who bills for the service? If they cannot, who bills for the service?

A1.

A physician and NPP may perform the discharge management services as shared/split. The CMS IOM Publication 100-04, Chapter 12, §30.6.9.2, discusses hospital discharge services. Each party must document the work they performed. The documentation must show a face-to-face encounter with the physician. If there is no face-to-face encounter with the physician, the NPP must bill the service using his/her National Provider Identifier (NPI).

Q3.

We are a physician clinic and our physician has left. We currently have two NPPs providing services. A physician in another office sponsors and supervises the NPPs. Can we bill the NPP services as “incident to” the physician in the other office?

Summer 2016

HOOSIER D.O.

Page

A3.

No. Services provided in the office must meet the “incident to” requirements, one of which is that the billing provider must be present in the office suite. In the situation you describe, bill the services under the NPI of the NPPs. You can find more information on the “incident to” requirements in the CMS IOM Publication 100-04, Chapter 12, Section 30.6.1, and 100-02, Chapter 15, §60.

Q4.

Is it necessary to have the physician sign the medical record when the NPP provides a service “incident to” the physician? Can just the NPP sign the note?

A4.

Medicare does not require the physician to sign the medical record when the NPP provides a service under the “incident to” guidelines. Physicians would need to look to state regulations and their own comfort level in determining whether they need to sign the note.

Q5.

Is it necessary to have the physician sign the medical record when the NPP and the physician provide a shared/split visit? Can the NPP document that the physician agrees?

A5.

Under a shared/split visit situation, both parties must document and sign the work they perform. A notation of “seen and agreed” or “agree with above” would not qualify the situation as a shared/split visit because these statements do not support a face-to-face contact with the physician. Only the NPP could bill for the services.

Q6.

If the physician is not in the office, but available by phone, can the NPP bill under the “incident to” guidelines?

A6.

No. If the physician is not in the office suite, the service does not qualify under the “incident to” guidelines. The NPP would bill for the service under his/her provider number.

Q7.

Both the physician and the NPP performed part of the Evaluation and Management (E/M) service for the patient. The doctor left the documentation of the visit to the NPP. Is this a shared/split visit?

A7.

No. To bill a shared/split visit, both the physician and the NPP must document the work they performed and sign their part of the medical record.

Q8.

What are you looking for to prove that the doctor had a face-to-face with the patient for share/split visits?

A8.

The doctor must document his/her work and sign the medical record.

Q9.

If a PA in orthopedics has the initial encounter with a patient, then the patient meets with the physician the next day and the physician develops a plan of care, can the PA then bill “incident to” for the encounters after the physician’s visit?

A9.

The initial encounter is billed under the NPP number. Any subsequent visits after the patient sees the physician may be billed under the physician’s provider number only if the situation meets the “incident to” requirements. See CMS IOM 100-02, Chapter 15, §60.

Q10.

Can we bill inpatient subsequent visits as a shared/split visit?

A10.

Yes. You can bill a shared/split visit only if the visit meets the documentation requirements for facility services. For a shared/split visit, both the MD/DO and the NPP must document and sign the portion of the visit they performed.

Q11.

Are nurses able to perform services “incident to” an NPP when the NPP is present in the office?

A11.

The “incident to” requirements apply to services “incident to” both the physician and the NPP. A nurse is able to provide a service “incident to” the NPP when the situation meets all requirements. If the nurse or auxiliary person performs E/M services, use code 99211.

Summer 2016 Q12.

HOOSIER D.O.

Page 14

In the office setting the NPP performs a portion of an E/M encounter and the physician completes the E/M service. If the “incident to” requirements are met, the physician reports the service. If the “incident to” requirements are not met, the service must be reported using the NPP’s NPI. In the above scenario, when “incident to” requirements are not met, can the physician bill for the service using only his/her documentation? If not, what is the reasoning. If the physician can bill, can he then use any documented PFSH or ROS if these were documented by the APN/PA? If they in fact perform a shared visit knowing a consult cannot be shared, can the physician then bill a consultation based on his documentation only?

A12.

A consultation cannot be performed as a shared/split service. The physician would submit a new or established patient visit as appropriate. In an office setting where the physician and NPP share/split the service, if the “incident to” requirements are not met, only the NPP can submit the charge. This is based on the CMS IOM Publication 100-04, Chapter 12, §30.6.1.

Q14.

If the service performed in the office meets the shared/split billing guidelines but does not meet the “incident to” requirements in the office, can we still bill under the MD/DO?

A14.

No. Shared/split visits in the office must meet the “incident to” requirements. The NPP must bill for the services under his/her own Medicare number.

Q15.

The physician reviews the documentation from the PA, but does not see the patient. Is this a shared/split visit? The PA documents the physician reviews and agrees. Does it make a difference if this is a new or established patient visit charge?

A15.

If the physician is not performing any of the E/M services, it is not a shared/split visit. If the service is performed in a facility setting, only the NPP may submit a charge for the service. If the service is performed in an office setting, the physician may submit a charge for the service if the “incident to” requirements are met. One requirement is that it is the physician who has established the plan of care. Therefore, if the patient is new, only the NPP may bill the service.

Q16.

Is there a restriction on the level of procedure codes allowed under the “incident to” or shared/split guidelines?

A16.

There is no restriction on the level of service as long as the situation meets the requirements and the person providing the services can legally perform the services.

Q17.

We schedule patients for injections, blood draws and other minor visits before the physician comes into the office. Can we bill for these services under the “incident to” guidelines?

A17.

Inpatient Split/Shared Evaluation And Management (E/M) Services http://www.wpsmedicare.com/j8macpartb/resources/provider_types/inpatientsplitem.shtml

Summer 2016

HOOSIER D.O.

Page 15

Current review of medical records indicates an increasing number of Initial and Subsequent Hospital, as well as Emergency Department services, being billed as split/shared visits between the billing physician and a Non-Physician Practitioner (NPP) from the same group practice. The purpose of this article is to provide guidance on the appropriate documentation of split/shared services. For a split/shared service to be reimbursed by Medicare Part B, the supporting medical records must satisfy the documentation requirements found in the Internet-Only Manual (IOM) references. An inpatient Split/Shared Evaluation and Management (E/M) service is defined by the Centers for Medicare & Medicaid Services (CMS) IOM Publication 100-04, Chapter 12, §30.6.1(B), as an E/M service, ...shared between a physician and an NPP from the same group practice and the physician provides any face-toface portion of the E/M encounter with the patient. Additionally, IOM Publication 100-04, Chapter 12, §30.6.13 (H) states that, A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, exam, or medical decision making key components of an E/M service.” Both the physician and the NPP must each personally perform part of the visit, and both the physician and the NPP must document the part(s) that he or she personally performed. When the supporting documentation does not demonstrate that the physician “performed a substantive portion of the E/M visit face-to-face with the same patient on the same date of service” as the portion of service performed by the NPP, a service billed under the physician’s Provider Transaction Access Number (PTAN) will be denied. It is of particular importance to remember that notes documented by the NPP for E/M services performed independently within a facility, and later reviewed and co-signed by the physician, depict neither a scribe situation nor an appropriate split/shared visit. Additionally, ““incident to”” guidelines do not apply to services in an inpatient setting. In this situation, the service should be billed under the NPP’s provider number, and would be reimbursed at the established rate for that provider. With the IOM requirements in mind, the following are examples of medical record documentation by the physician which would not be considered adequate to support a split/shared visit:       

“I have personally seen and examined the patient independently, reviewed the PA’s Hx, exam and MDM and agree with the assessment and plan as written” signed by the physician “Patient seen” signed by the physician “Seen and examined” signed by the physician “Seen and examined and agree with above (or agree with plan)” signed by the physician “As above” signed by the physician Documentation by the NPP stating “The patient was seen and examined by myself and Dr. X., who agrees with the plan” with a co-sign of the note by Dr. X No comment at all by the physician, or only a physician signature at the end of the note

In conclusion, please remember that for a split-shared visit, there must be documentation of the face-to-face portion of the E/M encounter between the patient and the physician. The medical record should also clearly identify the part(s) of the E/M service which were personally provided by the physician, and which were provided by the NPP. In the absence of such documentation, the service may only be billed under the NPP’s provider number per CMS IOM Publication 100-04, Chapter 12, §30.6.1 (B). This applies to the initial history and physical examination, the discharge summary, and subsequent hospital visits.

Summer 2016

HOOISER D.O.

Page 16

Mid-Level Providers, Nursing Facilities, and Evaluation and Management (E/M) Services http://wpsmedicare.com/j8macpartb/resources/provider_types/mid-level-providers-nursing-facilities-em-services.shtml WPS Medicare receives multiple questions on the E/M services mid-level providers can perform in nursing facilities. The determination of what E/M services a Mid-Level provider can perform depends on the type of facility. MidLevel providers include physician assistants (PA), nurse practitioners (NP), and clinical nurse specialists (CNS). In a Skilled Nursing Facility (SNF), the mid-level provider cannot perform the initial assessment. An NP or CNS not employed by the facility, working in collaboration with the physician, and meeting state license requirements may sign the required initial certification and re-certification verifying the patient requires daily skilled nursing care or rehabilitation services. A PA cannot complete this function. A mid-level can alternate the federally mandated visits with the physician when the collaboration, physician supervision, and state license requirements are met. A mid-level provider can perform medically necessary services prior to and after the physician’s initial assessment. Medically necessary services are those E/M necessary to diagnosis or treat an illness or injury or to improve the functioning of a malformed body member. In a Nursing Facility (NF), the mid-level, not employed by the facility, can perform the initial assessment when the collaboration, physician supervision, and state license requirements are met. A mid-level provider may perform any other federally mandated visits. A mid-level provider may perform medically necessary services prior to and after the initial assessment. A mid-level provider may complete the certification/recertification as necessary. Medicare does not reimburse shared/split services in a SNF or NF. A shared/split service is where both the MD/DO and the mid-level provide a portion of the service. The services are only billable under the mid-level provider number and coding is based on the services provided by the mid-level. Medicare would not reimburse shared/split services under the physician provider number in this situation. Medicare does not reimburse services provided as “incident to” the physician when provided in a SNF or NF. Services provided by the mid-level provider are billed only under the mid-level provider number and coding is based on the services provided by the mid-level. A physician may have a discrete part of the facility designated as his/her office. If the discrete part of the facility qualifies as an office setting, services provided in only that area by mid-level and ancillary staff meeting the entire “incident to” requirements may be billed under the MD/DO provider number. For more information, see the CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 12, §30.6.13 and The Center for Medicaid and State Operations/Survey and Certification Group The Center for Medicaid and State Operations/Survey and Certification Group S&C-04-08.

Summer 2016

AOA PRESIDENT INSTALLED On July 23, 2016, the American Osteopathic Association (AOA) inaugurated Boyd R. Buser, D.O., as the 2016 – 2017 president. An AOA board-certified physician in osteopathic manipulative medicine and family medicine, Dr. Buser serves as the vice president for health affairs and dean of the University of Pikeville Kentucky College of Osteopathic Medicine (UPKYCOM) in Pikeville, KY. In addition, he is a professor of osteopathic principles and practice, and professor of family medicine at UPKYCOM. Previously he served as the interim vice president and dean of the University of New England College of Osteopathic Medicine (UNECOM) in Biddeord, ME, as well as associate dean for clinical affairs. Dr. Buser has served the AOA in numerous capacities, including recently serving as the chair of the Department of Business Affairs and the Bureau of Osteopathic Graduate Medical Education Development. He also has chaired the Departments of Professional Affairs, Governmental Affairs and Educational Affairs. A fellow of the American College of Osteopathic Family Physicians, Dr. Buser is past president of the American Academy of Osteopathy (AAO). In addition, he is a past chair of the National Board of Osteopathic International Alliance. From 2011 – 2013, Dr. Buser served as co-chair of the Blue Ribbon Commission (BRC) for the Advancement of Osteopathic Medical Education. He also served as a member of the AMA’s Current Procedural Terminology (CPT) Editorial Panel from 2007 – 2015. Dr. Buser received the A.T. Still Medallion of Honor from the AAO in 2010. Additionally, he was a recipient of the Riland Medal for Public Service from the New York Institute of Technology College of Medicine (NYITCOM) in … in 2013 as well as the Santucci Award for outstanding contributions to the mission of the NBOME. In 2015 he received the Pioneer of Osteopathic Medicine Award from the UNECOM. Upon earning his osteopathic medical degree from the Des Moines University College of Osteopathic Medicine (DUMCOM), Dr. Buser completed his postdoctoral medical training at the former Cranston General Hospital in Cranston, RI. Dr, Buser’s colleagues say his expertise—in education and other fields, makes him an ideal candidate to lead the AOA into the future. While many of the profession’s leaders deserve credit for helping oversee the AOA’s transition to a single graduate medical education (GME) accreditation system, Dr. Buser has been “the longest continuous thread” throughout the endeavor, says Norman Vinn, D.O., the AOA’s 2013 -2014 president.

HOOSIER D.O.

Page 17

From the very beginning, Dr. Buser acted as a skilled negotiator and interpreter, leading discussions with the Accreditation Council for Graduate Medical Education and explaining the nuances of the transition to AOA stakeholders, he notes. “Dr. Buser is going to be president at nearly the midpoint of the transition process, when a whole new crop of challenges are going to emerge,” Dr. Vinn says. “He’s very well-suited to move us forward in a positive direction because he knows so much about the history and strategic basis of the single GME accreditation system.” Dr. Buser is interested in moving the needle on medical education in other areas, too. “On the BRC, Dr. Buser really stressed that any recommendations we made needed to be rooted in osteopathic principles and practices (OPP),” says Stephen Shannon, D.O., MPH, the president and CEO of the American Association of Colleges of Osteopathic Medicine. “He was really good at connecting the dots between innovating education and staying true to the traditions of the profession.” Back at UPKYCOM, Dr. Buser has updated the clinical curriculum as well as the physical facilities where students train. One area of prime focus has been OPP. “How DOs use their hands is one of the most distinct aspects of our profession, so it’s important for students to develop that sense of touch,” he says. Dr. Buser has long served as one of the profession’s strongest advocates for osteopathic manipulative medicine, pushing for increased training and a low student-to-trainer ratio in OMM labs at KYCOM. “We can gather so much information and impart so much empathy to our patients through touch,” he says. “It’s incredibly powerful.”

AOA HOUSE OF DELEGATES The osteopathic medical profession in Indiana was well represented at the AOA House of Delegates meeting in Chicago in July. The IOA delegation included Susan M. Moore Riesbeck, D.O., Chair, Lauren N. Brankle, D.O., Mark S. Cantieri, D.O., David L. Coil, D.O., Dan C. Galloway, D.O., Max E. Helman, D.O., Ben D. Huang, D.O., David C. Koronkiewicz, D.O., and Angela B. Wagner, D.O. Timothy McCall, MSI (Student Delegate), Henry Guan, MSI (Alternate Student Delegate), Adam Davis, MSI, and Madelyn Kahn, MSI also participated. The AOA’s House of Delegates meets annually to set organizational policies and elect new officers.

HOOSIER D.O.

Summer 2016

Page 18

AIOA NEWS

PRESIDENT’S MESSAGE (continued from page 1)

ACGME. The AOA has created the Call Campaign to assist GME programs in this transition. Please note that Osteopathic GME is not going away. We have designs to see it grow and include not only D.O.s but M.D.s as well. The Call Campaign has contacted 96% of the OGME programs that exist. There are 1,244 programs. 1,020 programs or 82% have applied or plan to apply for ACGME certification. Seventy-nine programs or 7% do not plan to apply. Six programs or 2% are undecided. There has been no contact with 4% or 52 programs. Sixtyfive programs or 5% are closed. The majority of these were closed because they had no trainees for the past three years. The AOA House of Delegates met at its annual meeting in July. . This was a tame affair compared to the prior year when the single accreditation issue dominated the discussion. Boyd R. Buser, D.O. assumed the position of AOA President and Mark A. Baker, D.O., of Texas, was chosen as President-Elect. The Advocates to the AOA expressed their concern that after the line item for contributing to them was deleted on the AOA membership dues notice their receipts had dropped precariously threatening their very existence. The AOA has responded by mailing the membership and requesting support for the Advocates. The Advocates have worked to increase awareness and treatment of the growing issue of student and physician depression and suicide. Your support of them will help in addressing this problem. The IOA plans to work with other physician groups to encourage introduction of legislation in the Indiana General Assembly that will request approval of the Interstate Medical Licensure Compact. This compact standardizes physician licensure requirements and simplifies the licensure process for physicians who need multi-state licensure. I will be attending the Indiana State Medical Association (ISMA) House of Delegates meeting in September and offering a resolution seeking support from the ISMA on this issue. If the resolution passes, our two groups can work together to see this bill through the Indiana General Assembly’s next session. I have also been busy with the creation of the AOA’s new three-year strategic plan, chairing the AOA’s Bureau of International Osteopathic Medicine, and chairing the Department of Education of the AOA. My thanks to my wife Becky for tolerating and supporting all of this.

Mark S. Cantieri, D.O. IOA President

The 35th Annual Winter Update, December 4 – 6, 2016, at the Sheraton Hotel at Keystone Crossing, in Indianapolis, is approaching quickly. Watch for notification and go to the IOA’s website at www.inosteo.,org to register online. It’s instant. It’s simple. The Advocates to the Indiana Osteopathic Association (AIOA) program will be great fun as usual. Please plan to join us for dessert following lunch on Friday afternoon and breakfast, a business meeting, and installation of officers on Saturday morning. We especially hope physicians and spouses/guests will join us for our silent auction during lunch on Saturday afternoon and during the holiday reception on Saturday evening. Your support of our fundraising efforts by buying raffle tickets and bidding on items in the silent auction is vital. The money raised will go to the Motyka Dannin Osteopathic Educational Foundation to support the study of osteopathic medicine. And don’t forget the items you wish to donate for our silent auction. These items should be unique and in good condition. They may be something you have made or bought, tickets to a sporting event or theater production, time at your own retreat, etc. The AIOA is selling advertising in the annual winter update program too. Details were e-mailed to you in late August about this and the auction. Lastly, please thoughtfully consider joining the AIOA. You may contact Debbie Coyle at the IOA office to receive an application or you may download an application at www.inosteo.org by clicking on Advocates to the IOA under the Related Organizations tab. Take care and I’ll see you in December.

Mike Coyle AIOA President

Summer 2016

HOOSIER D.O.

Page 19

SMARTPHONE APPS: A GROWING TREND IN MEDICINE By: Jenice M. Deming, JD; ProAssurance Service Center Director

A smartphone isn’t just a phone; it’s a miniature computer. We surf the web, email, play games, and use smartphones and other wireless devices as tools for work. This explosive growth in use has been aided by mobile applications (“apps”). Today physicians can monitor a patient’s vital signs, download patient schedules, access medical records, dictate office notes, and consult with other physicians without entering a clinical setting. One of the first medical apps in use was Epocrates, providing clinical information on thousands of prescription and over-the-counter drugs.1 In addition to reference apps like Epocrates, physicians are using specialty-specific, federal government, and semi-interactive apps (e.g., to review and monitor ECG histories). Greater Access, New Risks As with any new medical device, there are risks to consider. Mobile devices “are considered one of the most vulnerable areas for [privacy] breaches.”2 This is in part due to security assessments that failed to address the use of mobile devices.3 The Health Information Technology for Economic and Clinical Health (HITECH) Act requires notification whenever a breach of unsecured protected health information (PHI) occurs. 4 Additionally, the Department of Health and Human Services requires security of PHI on storage devices (hard drives), transmission media (cyberspace), and portable electronic media (e.g., smartphones).5 Reference guides, such as Epocrates, should not be a HIPAA risk. However, apps that transmit PHI could be intercepted by hackers or corrupted by a virus. Regardless of whether a physician’s mobile device is used to access, transmit, or store PHI, consider all HIPAA and HITECH requirements. HIPAA requires data security and proper destruction, and retention of PHI, when appropriate. What Can You Do?      

Review potential wireless apps to ensure security of PHI at all levels; Limit the type of app that can be used based upon the individual app’s level of security; Use encryption software that makes data unusable by intercepting parties; Develop a security policy addressing mobile devices and the types of apps that can be used, along with the appropriate use and destruction of PHI data; Develop an eDiscovery policy for retaining PHI in the event of litigation; seek assistance from your attorney or your medical professional liability carrier’s risk management staff; and Work closely with IT personnel to address all security issues.

Glenn, B. “Physicians’ top 5 most-used medical apps for smartphones and tablets.” June 13, 2013, http://medicaleconomics.modernmedicine.com/medical-economics/news/physicians-top-5-most-used-medical-appssmartphones-and-tablets (accessed August 27, 2013).

Dolan, P. “Large settlement for data breach sends message to lock up laptops and smartphones.” American Medical News, September 28, 2012, http://www.amednews.com/article/20120928/business/309289995/8/ (accessed August 27, 2013). 2

“Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules,” 78 Fed. Reg. 5568 (25 January 2013). 3, 4, 5

Summer 2016

HOOISER D.O.

Page 20

DEAN’S UPDATE

By: Donald J. Sefcik, D.O., MBA Vice President for Health Professions and Dean Marian University College of Osteopathic Medicine AROUND CAMPUS. On July 1, 2016, the Marian University College of Osteopathic Medicine (MUCOM) entered a new academic year that will culminate with the graduation of its inaugural class on May 7, 2017. The members of the Class of 2017 matriculated in August 2013 with Founding Dean Paul Evans, D.O. Currently, they are completing audition rotations across the state and throughout the nation preparing for the residency match process which will conclude in early 2017. On August 1, 2016, MUCOM welcomed the Class of 2020 during a three-day orientation. The first day of class for these osteopathic physicians-in-training was August 4th. They celebrated their official welcome to the profession during their White Coat Ceremony on Sunday, August 7th, at the Indiana Roof Ballroom. Gaston Dana, D.O., Vice President of the IOA, attended the ceremony and administered the Osteopathic Pledge of Commitment. The Class of 2018, now in their third year of training, has maintained MUCOM’s tradition of notable accomplishment on licensing examination performance by achieving a pass rate on the COMLEX Level 1 exam above the national average. Currently in their second month of rotations, feedback from our preceptors is that they are well-prepared and doing an outstanding job providing patient care beyond their level of training. Rounding out the full cohort of students at MUCOM, the Class of 2019 had its orientation on August 5, 2016 and began classes on Monday, August 8th. They are clearly glad to be back in class and ready to complete the second year of their pre-clerkship education. The Evans Center is once again vibrant now that summer break has concluded. ACCREDITATION. MUCOM just received notice of the likely team of inspectors for our final provisional accreditation visit from the AOA’s Commission on Osteopathic College Accreditation (COCA) currently scheduled for February 2017. It has been quite a journey to reach this milestone. Everyone-our Board of Trustees, President, Provost, affiliated training partners, all of our supporters, and MUCOM’s administration, faculty (both campus-based and adjunct), staff, and especially our students are to be complimented for everything they have done to bring MUCOM to this juncture in time. We anticipate FULL accreditation this spring as we graduate our first class. In just nine months, MUCOM will have alumni! COMMUNITY RELATIONS. MUCOM continues to be involved in the development of expanded

Graduate Medical Education (GME) training opportunities in Indiana. Mark Cantieri, D.O., president of the IOA, and I serve as Governor-appointed members of the GME Board (House Bill 1323). A report is expected to be completed by the group in November 2016. MUCOM is planning the establishment and development of satellite medical education training units at St. Vincent Hospital and the Community Health Network. Once established, the units will have both a physician and staff member on-site to work with our students and preceptors to advance medical education. Additionally, we are discussing the creation of inter-professional training units that will serve to prepare both our medical students and students in the Leighton School of Nursing in an innovative, collaborative, team-based manner. THANK YOU! On August 1, 2016, I started Day #1 of Month #6 as the Dean of MUCOM. To the members of the IOA Board of Trustees; Erin Weinert, Executive Director of the IOA; Debbie Coyle, IOA’s Manager of CME Programs and Office Manager; Steve Noone, Special Assistant to the Dean and retired Executive Director of the AAO; James Pike, D.O., Founding Chair of the Dean’s Advisory Board; David Williams, D.O., West Regional President of Community Health Network; and a cast of hundreds more, I offer much gratitude. It is clear to me that without your time, effort, wise counsel, and passion for osteopathic education, MUCOM would not have progressed as quickly and robustly as it has in such a short time. Thank you for all that you do and all that we will accomplish together in the months and years ahead of us! 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 improving the number of D.O. physicians in Indiana. We will be working with the goal of improving the health of the state and the region.

Summer 2016

HOOSIER D.O.

Page 21

Summer 2016

HOOSIER D.O.

Page 22

MOTYKA DANNIN FOUNDATION NEARS GOAL

APRIL 17 – 23 PROCLAIMED OSTEOPATHIC MEDICINE WEEK IN INDIANA

As a reminder, a large priority of the IOA in 2015 - 2016 was the restructuring of its foundation, the Motyka Dannin Osteopathic Educational Foundation (Motyka Dannin Foundation). With the reorganization, we set a goal of raising $100,000 by May of 2017, and offering our first $10,000 forgivable loan that same year. To date, we have raised $75,000 and are well on our way. To make a contribution, go to our website at www.inosteo.org and click on the Foundation tab to download the donation form or donate online. You also may call (317) 926-3009 or send an e-mail message to

Governor Mike Pence proclaimed April 17 – 23, 2016, as National Osteopathic Medicine (NOM) Week in Indiana. He joined Governors and Mayors across the United States in recognizing osteopathic medicine’s role in providing quality care to Americans. On Wednesday, April 20, the MUCOM Class of 2018/2019 Student Committee hosted a specialty meet and greet at Marian University in the Michael A. Evans Center for Health Sciences where the IOA office and the MUCOM are located. Students were able to meet specialists in areas of their interests, ask questions and begin to really think about where they belong. The event was a huge success. Everyone had a great time. Ideas for future events already are being discussed. NOM week brings the osteopathic medical profession together to focus on one common goal— increasing awareness of osteopathic medicine and doctors of osteopathic medicine (D.O.s) in our communities.

info@inosteo.org to donate stock shares.

The Motyla Dannin Foundation is a 501(c)(3) charitable organization. Please consider a contribution as one of your annual donations.

$100,000

Lose the limitations. $ 80,000

Keep your edge.

$ 70,000

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: 16-1238

Summer 2016

COMING EVENTS... Orofacial Development: Merging Osteopathy in the Cranial Field and Functional Dentistry September 16 – 18, 2016 Hilton Irvine Orange County Airport, Irvine, CA Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com OMED September 17 – 20, 2016 Anaheim, CA Sponsor: American Osteopathic Association Contact: AOA, (312) 202-8014 or www.osteopathic.org Clinical and Quality Care Essentials CME Conference November 9 – 12, 2016 The Condado Plaza Hilton Hotel, San Juan, Puerto Rico Sponsor: Rowan University School of Osteopathic Medicine Contact: ROWAN SOM, (856) 566-6358 or cme@rowan.edu Preconference OMT Workshop December 1, 2016 Sheraton Hotel at Keystone Crossing, Indianapolis, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org The IOA is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. The IOA designates this program for a maximum of 8 AOA category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity. Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending. 35th Annual Winter Update December 2 – 4, 2016 Sheraton Hotel at Keystone Crossing, Indianapolis, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org. The IOA is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. The IOA designates this program for a maximum of 8 AOA category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity. Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending. Annual Meeting and Scientific Symposium December 8 – 11, 2016 Hyatt Regency Coconut Point Resort and Spa, Bonita Springs, FL Sponsor: American Academy of Addiction Psychiatry Contact: AAAP, www.aaap.org Winter Introductory Course: Osteopathy in the Cranial Field February 11 – 15, 2017 Hyatt Regency Atlanta Perimeter at Villa Christina, Atlanta, GA Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com

HOOSIER D.O.

Page 23

MARK YOUR CALENDARS

NOW AND PLAN TO ATTEND THE IOA 35TH ANNUAL WINTER UPDATE DECEMBER 2 - 4, 2016 PRECONFERENCE OMT WORKSHOP DECEMBER 1, 2016 SHERATON HOTEL AT KEYSTONE CROSSING INDIANAPOLIS, IN

Summer 2016

HOOSIER D.O.

HOOSIER

Page 24

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

2016 OFFICERS Mark S. Cantieri, D.O. President Gaston Dana, D.O. Vice President Terry A. Iwasko, D.O. Secretary/Treasuer Adrian L. Carter, D.O. Immediate Past President TRUSTEES Brian H. Black, D.O. Mary Burden, D.O. Shah Jahan Dodwad, MSII Chris A. Lowery, D.O. Stephanie M. Overmars, D.O. Rachel A. Shockley, D.O. 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 Lauren N. Brankle, D.O. Max E. Helman, D.O. Ben D. Huang, D.O. EX-OFFICIO TRUSTEE Donald J. Sefcik, D.O. The Hoosier D.O. is published two times per year in the Winter and Summer 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 d.bryantbfp@mw.twcbc.com or contact Erin Wernert or Debbie Coyle, IOA, at (317) 926-3009.