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Summer 2015

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

Hello again.

I hope all of you had a good Spring and are having a good Summer too. One of my favorite events in May is the Indy 500 and I always am anxious to find out who the winner of this historic race will be. This year I was in Florida on a beach listening to the race on the radio and enjoying the Adrian L. Carter, D.O. commentary as the drivers IOA President completed the race. I hope all of you were able to do something you enjoy on Memorial Day and to reflect on the significance of this important holiday.

As you may be aware, associations today face intense pressures that threaten their continued relevance.

As a result, many are taking a very close look at how they operate. The Indiana Osteopathic Association (IOA) has been doing so as well and several changes will be occurring beginning with our committee structure.

Standing committees will function under the supervision of the President. New standing committees will be Legislative, Membership, Bylaws and Manual of Procedures, Continuing Medical Education, and Fundraising and Development. A Finance and Investment Committee will consist of members of the Executive Committee. An Awards Committee will consist of the last three recipients of The Kinsinger Plaque. A Past Presidents Committee will consist of all active past presidents. Our new president will be working on committee appointments soon so If you are interested in becoming involved, I encourage you to contact the IOA office and let them know. More changes will be delineated in proposed revisions to our By-Laws to be considered at our Annual Meeting of Members in December 2015. We are hopeful these changes will motivate more osteopathic physicians to participate in the IOA in order to create a better organization and produce future leaders for osteopathic medicine in our state. (continued on page 12)

PRESIDENT’S MESSAGE

GENERAL ASSEMBLY UPDATE

Several issues that affect physicians and patients consumed the General Assembly’s energy this year. Bills that became law include: HB 1145 - CIVIL IMMUNITY FOR VOLUNTEER HEALTH WORKERS. Specifies criteria for civil immunity from liability for certain volunteer health care providers. Requires the professional licensing agency to establish and maintain: (1) a process for the approval of locations at which volunteer health care services may be provided; and (2) a health care volunteer registry. Provides that an approval of a location where the provision of health care services in which a provider may be immune from civil liability is valid for up to two years.

Requires a person who meets the criteria for immunity from civil liability to provide a record and results of laboratory and imaging based screenings and tests to the patient.

HB 1183 - PHYSICIAN ASSISTANTS. Allows a physician assistant who is delegated authority to prescribe a controlled substance after practicing for at least 1,800 hours. (Former law allowed (continued on page 8) IN THIS THIS ISSUE IN ISSUE Member Concerns……………………………………..…3 WMD Update……....………….…………..………….…..3 118th Annual Spring Update……………………………..4 Tips From Our Consultant……………..………………..5 AIOA News……………….……………………….…….12 Dean’s Update…………………………………………..13 Motyka Dannin Foundation……..…………………….14 Coming Events………………………………………….15 Practice Opportunities………………………………….16

Summer 2015 Winter 2015

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When you need it in Indiana.

Medical professional liability insurance specialists providing a single-source solution in Indiana ProAssurance.com Proudly endorsed by

Summer 2015

IN MEMORIAM The IOA has learned that D. Robert Mengel, D.O., of South Bend, died on November 22, 2012.

Memorial contributions may be made to the Motyka Dannin Foundation.

IOA WELCOMES NEW MEMBERS The following physicians were accepted as new members of the IOA at the Board of Trustees meeting on April 12, 2015: ACTIVE MEMBERS Micah J. Leestma, D.O., MWUCCOM (2011), Family Medicine Carl T. Ratliff, D.O., OUHCOM (2006), Psychiatry

APRIL 12 - 17 PROCLAIMED OSTEOPATHIC MEDICINE WEEK IN INDIANA Governor Michael R. Pence proclaimed April 12 18, 2015, 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 Tuesday, April 21, the MUCOM Class of 2017/2018 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.

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WMD UPDATE

By: Colonel Charles A. Holt, D.O. Hello, fellow Hoosiers.

I recently, from somewhere in the Persian/Arabian Gulf, served with the U.S. Army, where they say in Arabic, Al-asalam Alaykum. I am bringing you a roundup of emerging diseases/emergency response issues, etc. Starting 7,000 miles away, Middle East respiratory syndrome coronavirus (MERS-CoV) is a continuing threat. In China, a novel flu virus H7N9, has had up to a reported 24% fatality rate. Be sure to keep UTD on variant influenza A (H3N2v) and multi-drug resistant organisms (MRDOs) such as C. dif/M. tuberculosis/MRSA&CRE via the Indiana State Department of Health (ISDH) website.

Grain bins kill around 25 farmers/year despite it being a nearly totally preventable occupational hazard. As well, ammonium nitrate used as an explosive and fertilizer and caused the West, TX, blast in May, is made and stored all over the farm belt in undocumented facilities. Liquid meth is now the latest way to smuggle meth into the country--hard to detect when concealed in various bottles.

In June of 2013, two men were arrested in NY trying to assemble a portable lethal XRAY gun--I thought only Flash Gordon had those! Beware of overpass and bridge failures--1/10 are structurally deficient per the FHA. Need a new buzz? Don't try bath salts/spice or the latest, sizzurp (cough syrup+codeine+soda) and definitely don't try krokodil--a highly addictive and deadly Russian codeine derivative which can literally rot your flesh. The NEJM recently published a study showing it is possible to decrease bloodstream infections 44% by using "universal de-colonization". A "woo-hoo" from the WHO--no yellow fever vaccine booster is needed, for the time being.

Want to cut down on infection spread in your facility?-ban artificial nails--see the CDC. Also, recent Bangladesh sweat shop and Russian psychiatric hospital fires remind us to never forget to keep on top of fire safety. Got a touch of GE--you're not alone--almost 50M Americans get a food-borne illness/Y and ~130 thousand are admitted and ~ 3 thousand die. Ricin is back in the news with it being sent to various government leaders via letters. This year the Los Angeles Times had an article, carried in the Stars and Stripes, about the (now 3Y) Syrian Civil War and its effluent of death/destruction/disease. It has laid to waste schools/homes/clinics/hospitals/food/medicines/ utilities/immunizations and now polio is back with a vengeance, crippling children there for the first time in 14Y. When in the Persian/Arabian Gulf, over Thanksgivukkah and many other times, I reflected on all of the wonderful blessings we enjoy in America--take time to travel to a 3rd world country and you will be embarrassed by all of our 'stuff'. (continued on page 4)

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118TH ANNUAL SPRING UPDATE The following exhibitors, grantors, and in kind supporters made possible the excellent continuing medical education (CME) program offered during the IOA’s 118th Annual Spring Update held Friday through Sunday, June 5 – 7, 2015. On Thursday, June 4, 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 Athletico Physical Therapy Community Health Network Eli Lilly Genova Diagnostics Glenwood Systems Harbor Light Hospice Indiana Professional Licensing Agency Janssen Marian University College of Osteopathic Medicine Novo Nordisk Precision Compounding Pharmacy ProAssurance Purdue Pharma Sanofi-Aventis South Bend Medical Foundation Teva US Navy GRANTORS Forefront Collaborative Osteopathic Medical Foundation of Michiana IN KIND SUPPORTERS CardioDx Genova Diagnostics Hall Render Killian Heath & Lyman Indiana Family and Social Services Administration Marian University College of Osteopathic Medicine Newby Consulting Plews Shadley Racher & Braun Precision Compounding Pharmacy

WMD UPDATE

By: Colonel Charles A. Holt, D.O. (continued from page 3) Many of the 3rd World Foreign Nationals working around the world, including in the Mideast, do NOT do it for their meager pay, but mainly so they can live in a better place, and if possible, have their spouses and children live with them for the same reason.

Since pearl diving was big, in the Arabian Gulf, during the previous centuries, I will divest myself of some medical ones for your viewing pleasure. You have my permission to wear them or give them to someone you love. Recently, at an American food processing plant, there was a large chlorine gas leak when a worker accidentally poured into a 55-gallon drum of antimicrobial ACID, BLEACH! Over 150 workers went to the ER with asthma-like S&S. NIOSH under CDC found these key causes: untrained workers/drum in wrong place/illiterate in English--all signage was in English, only.

Go to http://1.usa.gov/uk29qs for the latest Emergency Response Guidebook. Recent reports by the CDC of the top 15 causes of death have good trends with homicides off the list and LESS deaths from the TOP 5: heart dis./cancer/chronic lower respiratory dis./stroke/accidents.

However, #6 Alzheimer's dis. surged as did the new #15 pneumonitis--d/t aspiration pn.--both d/t our aging population. My advice--don't have B-days!

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

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

As any physician or non-physician practitioner enrolled in Medicare knows, things can change overnight! This article includes some reminders and updates we believe are pertinent to osteopathic physicians.

Primary Care Incentive Payment Program (PCIP) §5501(a) of the Affordable Care Act authorized a quarterly incentive payment program to augment the Medicare payment for primary care services when furnished by primary care practitioners beginning January 1, 2011 and ending December 31, 2015. The incentive payment is available to primary care providers who have a Medicare specialty designation of family medicine, geriatric medicine, pediatric medicine, internal medicine, nurse practitioner, clinical nurse specialist, or physician assistant for CPT codes 99201-99215 and 99304-99350 if these codes account for at least 60 percent of the provider’s total allowed charges under the physician fee schedule in the qualifying calendar year.

In order to be eligible for the PCIP, physician assistants, clinical nurse specialists, and nurse practitioners must be billing for their services under their own National Provider Identifier (NPI) and not furnishing services incident to a physician’s service.

The Centers for Medicare & Medicaid Services (CMS) uses Medicare claims data from the calendar year that is 2 years prior to the PCIP incentive payment year to calculate the payment. Incentive payments are equal to 10 percent of the Medicare paid amount for primary care services. Incentive payments are made quarterly to individual physicians, non-physician practitioners, group practices and Method II critical access hospitals billing for practitioners.

CMS provides contractors with a list of the eligible primary care physicians and non-physician practitioners, based on their NPI, each year to use in calculating and issuing the quarterly incentive payment. 2015 PCIP is based on 2013 data and is the last year for the PCIP. WPS posted the list of the Indiana physicians/non-physician providers eligible for the 2015 PCIP at http://www.wpsmedicare.com/j8macpartb/fees/incentive-programs/pcip-program.shtml 2015 Medicare Physician Fee Schedule Instead of “ding, dong the witch is dead,” physicians are singing “ding, dong SGR is dead!”

On April 16, 2015, President Obama signed the “Medicare Access and CHIP Reauthorization Act of 2015,” which permanently repealed the Sustainable Growth Rate (SGR) payment formula. This law eliminates the 21.2 percent negative update to the 2015 fee schedule that was scheduled to take effect with dates of service on and after April 1, 2015.

The new law, known as “MACRA,” also makes significant changes to the way Medicare will pay physicians in the future. There will be a strong emphasis on quality, value, and physicians/providers taking more financial risk by continuing with the Physician Quality Reporting System and Value-Based Modifier. Most of these changes will not take effect until 2019. In the meantime, it is largely business as usual.

Medicare claims submitted for dates of service January 1, 2015 through June 30, 2015 will continue under the current fee schedule. Under MACRA services for dates of service July 1, 2015 through December 31, 2015 will receive a positive update of 0.5%. The law also provides for a positive 0.5% update each year for 2016, 2017 and 2018.

In an effort to minimize financial effects on providers, on April 1, CMS instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. Although the Medicare Administrative Contractors (MACs) were instructed to implement the rates in the legislation, a small volume of claims were processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess the claims paid at the reduced rate with the new payment rate.

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No action is necessary from providers who have already submitted claims for the impacted dates of service.

ICD-10 Effective October 1, 2015 October 1st will be here before you know it!

The transition to ICD-10 is required for all physicians, providers, suppliers, insurers and other entities subject to code sets required by the Health Insurance Portability Accountability Act (HIPAA). When we transition to this code set, in most cases, physicians/non-physician providers will need to document detailed diagnostic statements in medical records in order to determine the appropriate ICD-10 to report on the claim.

Because ICD-10 is expanded and has up to seven digits of specificity, physicians and other providers need to assess whether their current documentation will support ICD-10 by the compliance date of October 1, 2015.

CMS Timeline CMS will implement ICD-10 effective with dates of service on or after 10/1/2015.

WPS recommended the following implementation timeline. Are you ready?

•

By April 30, 2015  Seek resources from CMS and professional and membership organizations to help with the transition  Appoint an ICD-10 coordination manager or lead.  Raise awareness of ICD-10 requirements.  Make a list of staff members who need ICD-10 resources and training, such as billing and coding staff, clinicians, management, and IT staff.  Plan a comprehensive and realistic budget  Identify systems, procedures and technologies requiring upgrade  Request a timeline and cost estimate  Ask your vendors how they will support you in the transition to ICD-10

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By May 30, 2015  Perform formal training for all applicable staff. Educate your staff about upcoming changes and documentation requirements. Prioritize training needed if applicable  For example, train the coders who will need additional time to learn and practice ICD-10 coding changes  Identify the all CPT, HCPCS, and ICD-9 codes that impact your office  Prioritize the CPT, HCPCS, and ICD-9 lists based on the financial impact to your office.

Learning these first may help to keep a steady revenue to your office during the implementation process  Prepare practice claims for cross walking purposes  Begin cross walking the priority CPT, HCPCS, and ICD-9 codes to learn how to become familiar with the process

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By June 30, 2015  Upgrade systems, procedures and technologies.  Get ready for testing. ICD-10 codes must work in all aspects of your organization.  Medical practices need to start internal testing as soon as new systems and upgrades are installed  Conduct internal testing within your clinical practice  Resolve any issues or concerns  Request a testing plan to schedule from your vendor for external testing

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•

By July 30, 2015  Conduct external testing with payers and other external business partners. Test your systems to see if they can accept and process ICD-10 codes  Continue internal testing within your clinical practice as well  Continue ICD-10 cross walking activities on your priority CPT, HCPCS and ICD-9 codes  Conduct any additional training needed

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By August 30, 2015  Conduct internal testing within your clinical practice as well external testing with payers and other external business partners after you have completed the planning stages  Educate staff on resolutions and corrective actions  Implement corrective actions  Prepare a backup plan for any unresolved issues or training

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By Sept. 30, 2015:  Continue external testing and validation. Test your transactions and medical claims with your vendor  Resolve any issues  Educate staff on resolutions and corrective actions  Implement your backup plan for any unresolved issues or training

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October 1, 2015 - Implementation day!

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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GENERAL ASSEMBLY UPDATE (continued from page 1)

a physician assistant to be delegated to prescribe a controlled substance after practicing for one year after graduating from a physician assistant program and practicing for at least 1,800 hours.)

Removes the requirement that a supervising physician must delegate prescribing authority by the name of the drug or drug classification, the 30 day limitation on the amount of a controlled substance a physician assistant may prescribe, and provides that a pharmacist may not require the supervising agreement or a co-signature to fill a prescription written by a physician assistant. Removes the requirement that patient encounters must be reviewed within 72 hours and provides that a physician must review physician assistant charts within a reasonable time which is appropriate for the maintenance of quality medical care.

It reduces the number of physician assistant charts that a physician must review and requires 50% of patient records for a Schedule II prescription that a physician assistant, with less than a year of authority to prescribe Schedule II controlled substances, writes to be reviewed by the physician. Provides that a physician may supervise four physician assistants at the same time. Lastly, allows a physician assistant and certain advanced practice nurses to treat a patient with a Schedule III or Schedule IV controlled substance for weight reduction or to control obesity if certain conditions are met.

HB 1269 – MENTAL HEALTH MATTERS. Makes the Department of Correction (DOC) an inmate's authorized representative for applying for Medicaid for inmates who are potentially eligible for Medicaid and who incur medical care expenses that are not otherwise reimbursable. Makes the county where an offender is in the county jail an offender's authorized representative for applying for Medicaid for offenders held in county jails who are eligible for Medicaid and who incur medical care expenses that are not otherwise reimbursable. Provides that the DOC shall assist a committed offender in applying for Medicaid and securing treatment upon discharge from the DOC. Provides that a county or a health navigator shall assist an offender in applying for Medicaid and securing treatment upon discharge from a county jail.

Provides that a community mental health center may be used in assisting with DOC inmates and county jail offenders applying for Medicaid. Requires that after a person is arrested and taken into custody, a mental health or addiction professional shall assess the person and report the recommended treatment plan to the person and to the law enforcement agency that arrested the person if the person is determined to have a mental health issue or

substance abuse addiction. Requires the office of the secretary to prepare an annual report concerning presumptive eligibility. Requires the office to apply to the United States Department of Health and Human Services for the following Medicaid plan amendments or demonstration waivers for the provision of behavioral health homes within the Medicaid program. Allows a community mental health center to use the center's provider identification number to file any Medicaid claim, including primary care health service, if certain conditions are met. Prohibits the office from limiting the filing by a community mental health center of primary care health services and mental health services for a recipient if the services are covered services and necessary to ensure coordinated care for the recipient. Requires the division of mental health and addiction to develop a mental health first aid training program. Includes a mental health first aid training program in the: (1) continuing education programs promoted by the emergency medical services commission; (2) basic or in-service course of education and training for teaching professionals; and (3) requirements for an initial teaching license. Authorizes the division of mental health and addiction to award matching grants to a school corporation necessary for a school counselor to obtain a mental health counselor license.

Provides that the funding for the grants shall be provided by the Indiana secured school fund. Requires a school corporation to enter into a memorandum of understanding with a mental health care provider or a community mental health center to establish conditions or terms for referring students of the school corporation for services. Provides for coverage of telemedicine services under a policy of accident and sickness insurance and a health maintenance contract. Provides that subject to funding that a person who is arrested and taken into custody must be assessed by a qualified mental health provider.

HB 1323 – MEDICAL RESIDENCIES. Establishes the medical residency education fund for the purpose of expanding medical education in Indiana by funding new residency program slots at licensed hospitals.

Specifies uses of money from the medical residency education fund.

Establishes the graduate medical education board in order to: (1) provide funding for residents not funded by the federal Centers for Medicare and Medicaid Services; (2) provide technical assistance for entities that wish to establish a residency program; and (3) provide startup funding for entities that wish to establish a residency program.

SB 33 – ASCs AND WORKERS COMPENSATION. Adds an ambulatory outpatient surgical center to the definition of "medical service facility" under the worker’s compensation law. In 2013 the General Assembly passed legislation that cut worker’s compensation reimbursement to (continued on page 9)

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GENERAL ASSEMBLY UPDATE (continued from page 8)

hospitals by around 30%. ASCs were not included in that cut. SB 33 imposes a cut to ASCs that is in the range of 65%, or 200% of Medicare. Interested parties are seeking an amendment to the bill that would limit the cut to the same 30% that hospitals received two years ago, or 370% of Medicare.

SB 406 – OVERDOSE. Allows specified health care professionals with prescriptive authority to dispense, or write a prescription, or prepare a standing order for an overdose intervention drug (naloxone) without examining the individual to whom it may be administered if specified conditions are met. Allows for an individual who is a person at risk, a family member, friend, or other individual or entity in a position to assist another individual who, there is reason to believe, is at risk of experiencing an opioid-related overdose, to obtain and administer an overdose intervention drug if certain conditions are met.

Requires certain emergency personnel to report to the Indiana State Department of Health (ISDH) the number of times an overdose intervention medication is administered. Also provides for civil and criminal immunity SB 461 - HEALTH MATTERS. Ensures a whole host of things, but was amended in the House to include a needle exchange program after the emergency in Scott County. Summary of Legislation: 1) Allows EMTs to monitor glucose; 2) Provides exceptions to certain criminal laws concerning the possession and distribution of needles and syringes; 3) Specifies that hospital discharge information filed with the Indiana State Department of Health (ISDH) is confidential except under specified circumstances; 4) Further specifies the circumstances for the review of the death of a child by a local child fatality review team. It also allows a local child fatality review team to review the near fatality or serious injury of a child; and 5) Immunization provisions: a) Adds hepatitis A to the list of school children immunizations. b) Requires the ISDH, before November 30 of each year, to publish a two-year immunization calendar. c) Provides information to parents of Grade 6 students concerning the human papillomavirus (HPV) infection. (Former law provided this information only to parents of female Grade 6 students.).

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Requires the ISDH to provide the Department of Education with immunization materials and requires the materials to be distributed to students' parents and guardians. e) Requires a health care provider who administers an immunization to enter the information into the state immunization registry. f) Requires a school corporation to ensure that immunization information is complete in the state immunization registry not later than the first Friday in February.

Bills that were defeated include: SB 55 - MEDICAL REVIEW PANALS. Would have changed the threshold to avoid the medical review panel from $15,000 to $50,000. Prior to the amendment the bill moved the limit to $187,000. The IOA, Indiana State Medical Association and the Indiana Hospital Association were seeking a $20,000 threshold.

HB 1043 - CAP INCREASE. The first, HB 1043, authored by Representative Jerry Torr (R-Carmel), would have increased the cap from $1.25 million to $1.65 million. Additionally it would have raised the amount that a qualified provider is responsible for from $250,000 to $300,000. After the bill passed out of committee, Representative Torr decided not to call the bill for second reading, effectively killing the bill.

SB 536 – METHAMPHETAMINE. Many different bills dealing with methamphetamine were filed this year. Of the various bills that were filed, only one stayed alive. SB 536 passed in March, but went through a lot of changes throughout the first half of session. Senate Corrections and Criminal Code Committee member, Senator Brent Steele (R-Bedford), attempted to have made all purchases of pseudoephedrine and ephedrine prescription only. As a compromise, in its second committee hearing, the bill was amended by the author, Senator Mike Young (R-Indianapolis), to set up a sort of “goal” system in which, if the number of meth labs in the state do not decrease to 400 by the year 2020 then, at that time, pseudoephedrine and ephedrine would have become prescription only. The IOA supported the compromise.

That version of the bill passed out of committee 7-1 and then out of the Senate Appropriations committee, 7-6. On second reading on the Senate floor, the bill’s co-author, Senator Carlin Yoder (R-Middlebury), amended the bill to take it back to its original intent. This would have required Hoosiers with drug-related offenses to obtain a prescription before purchasing pseudoephedrine, or any cold and allergy related medicine. It also would have called for the state’s courts and police to update the electronic database pharmacies use to track sales of overthe-counter cold and allergy medication – NPLEX – which are precursors in the (continued on page 14)

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CYBERSECURITY—PROTECTING YOUR ELECTRONIC HEALTH RECORDS

By Jeremy A. Wale, JD, ProAssurance Risk Resource Advisor

With the increased use of technology comes increased risk of cyberattacks. Anything transmitted or stored electronically is at risk of being stolen by a hacker.

Many people don’t believe—or understand why—medical information is valuable or at risk. According to a compilation of data breach statistics, there were 783 security breaches in the United States in 2014. Of those, 42.5% were breaches of medical or healthcare information. This equated to over eight million individual records being accessed or stolen by cyberattacks.1 Large healthcare systems, hospital networks, and individual healthcare providers have all been attacked, but the size of the entity is no clear indication of the size of the breach. For example, one Blue Cross Blue Shield attack yielded only 300 records, while a large system in Tennessee yielded approximately 4.5 million records. Several individual physician practices were breached as well, yielding as many as 7,500 records from one practice.2 Why are medical records targeted?

Medical records seem to be targeted because they contain all of an individual’s personal information: finances, social security numbers, health information, and family information. This gives thieves more potential uses for the stolen information, including applying for credit cards, store accounts, or other lines of credit. They also can use the information to steal healthcare services. These are just a few reasons why a medical record can fetch up to $50 on the black market, while a credit card number may only earn $5.3 Another example of how valuable a medical record may be: a security firm CEO shared an example of a black market advertisement to sell ten Medicare numbers. “It costs 22 bitcoin—about $4,700 according to today’s exchange rate.”4 The transition to electronic health records has given criminal hackers more opportunities to steal medical records.

The chief information officer for a hospital system in Salt Lake City states his hospital system “fends off thousands of attempts to penetrate its network each week.”5 Another reason is ease of access. Some hospitals and healthcare providers are using systems that have not been updated in more than ten years.6 While hospital systems and healthcare providers rush to prepare for ICD-10 implementation and meaningful use, cybersecurity seems to be falling through the cracks. Many healthcare systems “do not encrypt data within their own networks.”7 Once a hacker penetrates whatever security the system does have, the unencrypted information is there for the taking.

Criminals also use stolen medical records to fraudulently bill healthcare insurance providers and Medicare/Medicaid. The victims may not discover the theft for several months—or even years. In some instances, victims have received debt collection requests for medical services they never received.

What can you do to safeguard electronic medical records?

When implementing or updating an EHR system, talk to your vendor about cybersecurity. Ask whether the stored information is encrypted. It also is a good idea to determine if or when the vendor will provide security updates for your EHR software. (continued on page 11)

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CYBERSECURITY—PROTECTING YOUR ELECTRONIC HEALTH RECORDS

By Jeremy A. Wale, JD, ProAssurance Risk Resource Advisor (continued from page 10)

Organizations may need to “invest more money and employee talent in shoring up the walls around their electronic data.”8 Cybersecurity is a highly specialized area that requires a certain expertise. Your EHR vendor may be able to provide some assistance in this area, but remember their expertise is creation and functionality. Hiring in-house cybersecurity experts or contracting with a cybersecurity firm specializing in this area may be the best options to protect your organization and your patients.

Several organizations, such as the Department of Homeland Security, the American Hospital Association, the Centers for Medicare & Medicaid Services, and the National Institute of Standards and Technology, offer guidance and resources on cybersecurity. Their web addresses are included in the endnotes of this article.9 These are just a few of the vast number of resources available to organizations regarding cyber-security.

1

Identity theft resource center breach report hits record high in 2014. Identity theft resource center Web site. http://www.idtheftcenter.org/images/breach/DataBreachReports_2014.pdf. December 31, 2014. Accessed May 8, 2015.

2 Identity theft resource center breach report hits record high in 2014. Identity theft resource center Web site. http://www.idtheftcenter.org/images/breach/DataBreachReports_2014.pdf. December 31, 2014. Accessed May 8, 2015.

3 Murphy T, Bailey B. Hackers mine for gold in medical records. The Boston Globe. February 6, 2015. Accessed April 28, 2015.

4 Shahani A. The black market for stolen health care data. NPR website. http://www.npr.org/blogs/alltechconsidered/2015/02/13/385901377/the-black-market-for-stolen-health-care-data. February 13, 2015.

Accessed April 28, 2015.

5 Humer C, Finkle J. Your medical record is worth more to hackers than your credit card. Reuters website. http://www.reuters.com/article/2014/09/24/us-cybersecurity-hospitals-idUSKCN0HJ21I20140924. September 24, 2014. Accessed April 28, 2015.

6 Humer C, Finkle J. Your medical record is worth more to hackers than your credit card. Reuters website. http://www.reuters.com/article/2014/09/24/us-cybersecurity-hospitals-idUSKCN0HJ21I20140924. September 24, 2014. Accessed April 28, 2015.

7 Shahani A. The black market for stolen health care data. NPR website. http://www.npr.org/blogs/alltechconsidered/2015/02/13/385901377/the-black-market-for-stolen-health-care-data. February 13, 2015.

Accessed April 28, 2015.

8 Radcliffe S. Patients beware: hackers are targeting your medical information. Healthline News website. http://www.healthline.com/health-news/hackers-are-targeting-your-medical-information-010715#1. January 7, 2015. Accessed April 28, 2015.

9 http://www.dhs.gov/topic/cybersecurity, http://www.aha.org/advocacy-issues/cybersecurity.shtml, http://www.nist.gov/cyberframework/index.cfm, http://www.cms.gov.

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AIOA NEWS

PRESIDENT’S MESSAGE (continued from page 1)

Next, I would like to provide you with an update on legislation that the IOA helped to support such as HIP 2.0 and funding medical residency education. It also helped to defeat changes to Indiana’s medical malpractice act that would have raised the cap from 1.25 million to 1.65 million for claims. I extend many thanks to our legislative representation including our lobbyists, Lou Belch and Angela Toth, and our Executive Director, Erin Wernert.

Lastly, please continue to support the Marian University College of Osteopathic Medicine (MUCOM) and our osteopathic medical students. The first year’s class has started their third year clerkships and needs your help as they thrive to become the best and brightest future osteopathic physicians in Indiana. It also has been an inspiration to see the amount of support the MUCOM has received from the private and public sectors. President Elsener, Dean Evans and the MUCOM students greatly appreciate this generosity as well. Please continue to thank our staff at the IOA for their efforts on our behalf as they spend hours preparing for our meetings and making sure we are informed of the happenings in our state. Your continued support of our organization is appreciated too.

God bless.

Adrian L. Carter, D.O. IOA President

The 34th Annual Winter Update, December 4 – 6, 2015, at the Sheraton Hotel at Keystone Crossing, is approaching quickly. Watch for notification in early September and be sure to register.

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 the president’s luncheon on Saturday afternoon. Your support of our fundraising efforts by buying raffle tickets, making cash contributions, and bidding on items in the silent auction is vital. The money raised will go to the Motyka Dannin Osteopathic Educational Foundation’s scholarship program.

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 winter update program too. Details were e-mailed to you in late August about this and the auction.

Lastly, please thoughtfully consider joining the Advocates to the Indiana Osteopathic Association (AIOA).

You may contact Debbie Coyle at the IOA office to receive an application or you also 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 2015

DEAN’S UPDATE

By: Paul Evans, D.O., FAAFP, FACOFP Vice President and Dean Marian University College of Osteopathic Medicine The Marian University College of Osteopathic Medicine (MUCOM) has oriented our third class, the D.O. Class of 2019. Orientation activities in the first week of August focused on introducing the faculty and staff, describing the responsibilities and obligations of starting a career as an osteopathic physician, preparing students for the course work and educational work of being a medical student, and learning the basic fundamentals of professionalism. The week ended with a start of classes on Thursday, August 6, and the White Coat ceremony was held at the Indiana Roof Ballroom on Sunday, August 9. Our students, faculty and parents are excited for this start of another 162 D.O. students in Indiana.

COMLEX USA LEVEL 1. Almost all D.O. Class of 2017 students (third years) have completed and passed this first part of the licensing exam. The MUCOM students participated in the Boards Boot Camp program in preparation. The program has directed readings, practice exam questions, “high-yield” study guides, and practice tests all designed to have students peak at the exact time of taking the exam. All scores are not in yet, but we are happy that so far the students are doing very well.

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 first month 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 great 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 etwork. This has been a wonderful achievement since they are transitioning into 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

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area among others. Our feedback about our students has been very positive! All is working well in these initial phases.

ACCREDITATION. Our COCA provisional accreditation steps are ongoing. We submitted a Progress Report on July 1 and will meet with the COCA on August 29. If all goes well we will continue the required steps toward full accreditation when we graduate our first class in May of 2017.

COMMUNITY RELATIONS. Organizational work now has 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 few 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 (IOA), 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 remains grateful for the support of the IOA physicians and staff. We truly appreciate the excellent teaching offers and the quality consultation assistance we have received. 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 existing physicians with the goal of improving the health of the state and the region.

Summer 2015

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REMEMBER THE

MOTYKA DANNIN FOUNDATION

As you make your charitable giving plans, think about how you can help Indiana students in colleges of osteopathic medicine.

Ask your tax advisor how you can reduce your taxes while giving to the Motyka Dannin Foundation.

ESTATE PLANNING , TOO We also remind you, when you write or revise your will, to remember the Motyka Dannin Foundation. After you have provided for your loved ones, church, alma mater, and favorite charities, perform one last generous act for the future of your profession.

Motyka Dannin Osteopathic Educational Foundation a 501(c)(3) charitable organization

MOTYKA DANNIN FOUNDATION CONTRIBUTORS IOA (in memory of D. Robert Mengel, D.O. and Paul E. Page, D.O.) On behalf of the future osteopathic physicians who will be helped by your generosity, thank you for your gifts to the Motyka Dannin Osteopathic Educational Foundation, Inc. (Motyka Dannin Foundation).

For additional information regarding the Motyka Dannin Foundation, contact Erin Wernert, Executive Director, at the IOA office. Contributions can be sent to the Motyka Dannin Foundation, 3200 Cold Spring Road, Michael A. Evans Center for Health Sciences, Suite 107, Indianapolis, IN 46222.

SCIENCE FAIR AWARDS The IOA again sponsored the Hoosier Science and Engineering Fair, Indiana’s science fair. This year two prizes in the category of human health, biology, or life sciences were awarded.

First prize, and a check for $100, was won by Alyssa Plumlee, Francis Joseph Reitz High School, Evansville, IN. The project title was “3D Printing for Osteoporosis.”

Second prize, and a check for $50, was won by Brock Bragg, Sprunica Elementary School, Nineveh, IN. The project title was “Bending Bones with Caffeine.”

GENERAL ASSEMBLY UPDATE (continued from page 9)

production of meth. Under the bill, anyone convicted of felony drug crimes would have needed a prescription before they could purchase pseudoephedrine or ephedrine.

The bill passed 47-3 on third reading, but died in the House.

SB 439 - SUBUTEX AND SUBOXONE. Would have limited Medicaid reimbursement for Subutex and Suboxone or a similar trade name or generic of the drug when the drug was prescribed for the treatment of pain management to only if the drug was prescribed by a physician who would have met certain requirements.

Would have allowed for the office of Medicaid policy and planning to require prior authorization for these drugs when being prescribed for substance abuse treatment as determined by the board or when being prescribed for more than six months. Would have required the division of mental health and addiction to adopt rules concerning: (1) opioid treatment by an opioid treatment provider; (2) take home opioid treatment medications; (3) clinical standards for tapering of a patient, relapse, and overdose prevention; and (4) specified standards and protocols for an opioid treatment provider. Would have required an opioid treatment provider to periodically and randomly test a patient for specified drugs during treatment. This bill passed the Senate in late February, but died in the House.

Summer 2015

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COMING EVENTS...

The Next Step: Advancing Your Skills in Osteopathy in the Cranial Field September 25 – 27, 2015 Arlington Hilton Hotel, Ballston, VA 22 hours category 1-A credit anticipated, pending approval by AOA CCME Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Healing From Traumatic Brain Injury: Advanced Studies November 13 - 15, 2015 NYCOM, Old Westbury, New York 17.75 hours category 1-A credit anticipated, pending approval by AOA CCME Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com AOA 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 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 Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or www.inosteo.org

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MARK YOUR CALENDARS NOW AND PLAN TO ATTEND THE IOA 34TH ANNUAL WINTERUPDATE DECEMBER 4 - 6, 2015 PRECONFERENCE OMT WORKSHOP DECEMBER 3, 2015 SHERATON HOTEL AT KEYSTONE CROSSING INDIANAPOLIS, IN

Summer 2015

HOOSIER D.O.

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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, Riverview Health and Witham Health Services. Contact Suburban Health Organization, (317) 295-5279 or send an e-mail 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.