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50 Volume 53

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4 Number 1

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Winter 2014

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

It literally has been a long cold winter, but spring’s promise of sun and warmth is just around the corner. When the first bud blooms the inaugural class of the Marian University College of Osteopathic Medicine (MUCOM) will be well on their way to completing its first year.

Angela B. Wagner, D.O. The MUCOM class of IOA President 2018 is also shaping up with a record number of applicants whose quality measures have exceeded the national average.

The inaugural class students have greatly appreciated the welcome they have received from the Indiana Osteopathic Association (IOA).

They have formed an IOA Class of 2017 Committee within their student body organizations. The Committee consists of 30 students who have expressed a special interest in getting to know what the IOA is about. The president of the Committee, Ridaa Ali, has attended our last two Board of Trustee meetings. She has shared the student perspective and experience with our Trustees, which has been very inspiring. The Committee has many great ideas of how to engage the student body with the IOA and to encourage their membership for years to come. I had the honor of attending the first meeting of the Committee and sharing the IOA’s rich history with them. The students have embraced our past and look to us in the present to help lead them into the future just as those physicians who came before us directly contributed to the IOA’s accomplishments, including the development of an osteopathic medical school in Indiana. If you have not yet done so, please take the time to read the historical timeline posted on the IOA’s website at www.inosteo.org by clicking on Short History of Osteopathic Medicine in Indiana under The IOA tab.

The IOA Board of Trustees is planning a retreat this spring to strengthen our (continued on page 11)

PRESIDENT’S MESSAGE

At its House of Delegates meeting in July, 2013, Mark S. Cantieri, D.O., of Mishawaka, was elected to the Board of Trustees of the American Osteopathic Association (AOA). Dr. Cantieri is a former Director of Medical Education and has served as vice chair of the AOA’s Commission Mark S. Cantieri, D.O. on Osteopathic College AOA Trustee Accreditation (COCA) and as chair of COCA’s Standards Review Committee. He is a past president of the American Academy of Osteopathy (AAO) and continues to serve as a member of its Board of Governors and its Bureau of Experts. Currently, Dr. Cantieri is second vice president of the IOA and is a (continued on page 11)

CANTIERI NAMED TRUSTEE

IN THIS THIS ISSUE IN ISSUE Member Concerns……………………………………..…3 32nd Annual Winter Update…………………………...….4 Tips From Our Consultant……………..………………..5 AIOA News..…………………………………..……..…11 Dean’s Update…………………………………………..12 WMD Update……………..…………………………….13 OMF Financial Assistance……………..………………14 Coming Events………………………………………….15 Practice Opportunities………………………………….16

Winter 2014

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IOA WELCOMES NEW MEMBERS The following physician was accepted as new members of the IOA at the Board of Trustees meeting on October 6, 2013: ACTIVE MEMBER Lisa R. Chun, D.O., NYITCOM (1991), Osteopathic Manipulative Medicine, Indianapolis ASSOCIATE MEMBER Donald J. Sefcik, D.O., MWUCCOM (1985), Family Medicine/Emergency Medicine, Okemos, MI

IN MEMORIAM The IOA has learned that Joanna E. Reusser, D.O., of Cincinnati, OH, died on February 22 as a result of complications from treatment of Hodgkin’s Lymphoma. She was born in Goshen to Thomas and Mayrea (Simpson) Reusser. They now live in Elkhart.

She graduated in 2002 from Elkhart Christian Academy.

She received a B.S. in biology from Indiana University South Bend in 2007. In 2011, she earned a Doctor of Osteopathic Medicine degree from Oklahoma State University College of Osteopathic Medicine in Tulsa, OK. Dr. Reusser was in her third year of residency specializing in physical medicine and rehabilitation at the University of Cincinnati College of Medicine in Cincinnati.

Life member of the IOA, George E. Midla, D.O., of South Bend, and father of Gary S. Midla, D.O. and Todd E. Midla, D.O., died on September 8, 2013. He was born in Marianna, PA, to the late Mike and Mary (Humenik) Midla. He married Joanne D. (Rankin) Midla in 1952 in Marianna. In 1957, following his graduation from Kirksville College of Osteopathic Medicine in Kirksville, MO, they moved to South Bend where he served the community for 40 years at Scottsdale South Family Clinic. Dr. Midla retired in 1996.

Memorial contributions may be made to the Motyka Dannin Foundation.

SINGLE GME ACCREDITATION SYSTEM After months of discussion, the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM), have agreed to a single accreditation system for graduate medical education (GME) programs in the United States.

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A single GME accreditation system will evaluate and provide accountability for the competency of physician residents consistently across all GME programs.

This ensures the quality and efficiency of postdoctoral education, while preserving the unique dimensions of the osteopathic medical profession and recognizing its contribution to health care in the U.S. Under the agreement: • From July 1, 2015, to June 30, 2020, AOA-accredited training programs will transition to ACGME recognition and accreditation.

• There will continue to be osteopathicfocused training programs under the ACGME accreditation system. Two osteopathic review committees will be developed to evaluate and set standards for the osteopathic aspects of training programs seeking osteopathic recognition.

• DOs and MDs would have access to all training programs. There will be prerequisite competencies and a recommended program of training for MD graduates who apply for entry into osteopathic-focused programs.

• AOA and AACOM will become ACGME member organizations, and each will have representation on ACGME’s board of directors.

The agreement provides the framework for the osteopathic and allopathic communities to prepare future generations of physicians with the highest quality graduate medical education and serve as a unified voice for graduate medical education resources to help mitigate the primary care physician shortage and better serve the public.

As stated in a joint press release, a single GME accreditation system ensures that all physicians have access to the primary and sub-specialty training they need for the patients they want to serve. For the osteopathic medical profession, the system recognizes the unique principles and practices of D.O.s and their contribution to the health and well-being of all Americans.

While there is still much to determine over the coming months as far as processes, visit www.osteopathic.org/acgme for more information.

MEMBER CONCERNS REMEMBER IN PRAYER Gary S. Midla, D.O., of Martinsville, and Todd E. Midla, D.O., of Indianapolis, on the death of their father, George Midla, D.O.

Winter 2014

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32ND ANNUAL WINTER UPDATE The Continuing Medical Education (CME) Committee once again built on previous success by assembling a well-received and well-attended program.

On Friday through Sunday, 229 physicians attended the 25 hour category 1-A CME program. On Thursday, the Indiana Academy of Osteopathy provided a highly successful optional pre-conference OMT workshop. 42 physicians attended this 8 hour category 1-A CME program.

Without exhibitors, grantors, and other in kind supporters, the CME Committee would not be able to offer the variety and quality of topics they do. The CME Committee and the Board of Trustees of the IOA encourage you to let representatives of these companies know that you appreciate their support.

EXHIBITORS Abbvie American Clinical Solutions American Express Astellas Bristol-Myers Squibb Community Health Network Eli Lilly EmCare Ferring Indiana Army National Guard Innovative Health Solutions Marian University College of Osteopathic Medicine MedExpress Merck MMIC Group Novartis Novo Nordisk PainDX Pfizer ProAssurance Purdue Pharma Sanofi-Aventis South Bend Medical Foundation Takeda Transdermal Therapeutics Valeritas

GRANTORS American Osteopathic Association CME Enterprise Creative Educational Concepts Indiana Chapter, American College of Osteopathic Family Physicians Osteopathic Medical Foundation of Michiana

IN KIND SUPPORTERS American Osteopathic Association Marian University College of Osteopathic Medicine Newby Consulting

SPECIAL RECOGNITION OF INDUSTRY SUPPORTER The IOA has recognized one company for outstanding support of the 32nd Annual Winter Update.

This company played a significant role in making this year’s program a success. This company is: Creative Educational Concepts The CME Committee and the Board of Trustees of the IOA recommend that you express special thanks to this company. Creative Educational Concepts’ help, along with that of other grantors, in kind supporters, and exhibitors allows our association to offer excellent CME programs yet keep the cost to you as practicing physicians as low as possible.

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

2014 MEDICARE FEE SCHEDULE In December President Obama signed the Pathway to SGR Reform Act of 2011. This law prevented the 20.1 percent reduction in the Medicare Physician Fee Schedule and replaced the reduction with a 0.5 percent positive update to the conversion factor. This change is only for services rendered January 1, 2014 through March 31, 2014.

If Congress does not act on the pending bills to replace the Sustainable Growth Rate (SGR) with a new mechanism to determine the Medicare Physician Fee Schedule, the original 20.1 percent reduction in the fee schedule will become effective April 1, 2014. The following fees show what will happen to the fees-for-services rendered on or after April 2, 2014.

CPT Code 99213 17000

20610 93000

Description

1st Qtr Effective 2014 4/1/2014 $69.32 $51.84

Office visit, established patient Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), $70.18 premalignant lesions (eg, actinic keratoses); first lesion Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, $57.15 subacromial bursa) Electrocardiogram, routine ECG with at least 12 $15.78 leads; with interpretation and report

$52.79

$42.75 $11.84

Continue to monitor the activities in Washington, D.C. It will be interesting to see what happens over the next couple of months!

PHYSICIAN QUALITY REPORTING SYSTEM Although the Physician Quality Reporting System (PQRS) continued to be a “voluntary” program, in 2013, if you did not participate in PQRS, your 2015 Medicare fee-for-service payment schedule will be reduced by 1.5 percent. To prevent this penalty, at a minimum, you must have reported at least one PQRS measure on at least one patient. This “gift” was only applicable for one (1) year. There are significant changes in PQRS reporting options for 2014.

Your practice must decide whether you will report PQRS using the Group Practice Reporting Option (GPRO) or if you will report individual measures. Next you need to decide whether your goal is to “successfully” report to qualify for the 0.5 percent incentive payment (lump sum payment in the fall of 2015) which will also prevent the 2016 payment penalty of 2 percent. You can choose to participate in PQRS to simply prevent the 2 percent payment penalty OR you can choose not to report PQRS and simply accept the 2 percent penalty in 2016 for all Medicare fee-for-service payments for services paid on the Medicare Physician Fee Schedule.

This article simply explains the different options and the choices of whether or not to participate. Which reporting option is best is up to you and your practice. Remember, this is a “voluntary” program!

Information about the GPRO reporting option can be found on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Group_Practice_Reporting_Option.html

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As it appears that most physicians continue to report as individuals as opposed to reporting as a group practice, we will focus on the options available to individual physicians and non-physician providers. So let’s review the basics of PQRS. Eligible and Able to Participate The following professionals are eligible to participate in PQRS: 1.

Medicare Physicians  Doctor of Medicine  Doctor of Osteopathy  Doctor of Podiatric Medicine  Doctor of Optometry  Doctor of Oral Surgery  Doctor of Dental Medicine  Doctor of Chiropractic

2.

Practitioners  Physician Assistant  Nurse Practitioner*  Clinical Nurse Specialist*  Certified Registered Nurse Anesthetist* (and Anesthesiologist Assistant)  Certified Nurse Midwife*  Clinical Social Worker  Clinical Psychologist  Registered Dietician  Nutrition Professional  Audiologists *Includes Advanced Practice Registered Nurse (APRN)

3.

Therapists  Physical Therapist  Occupational Therapist  Qualified Speech-Language Therapist

Note: Beginning in 2014, professionals who reassign benefits to a Critical Access Hospital (CAH) that bills professional services at a facility level, such as CAH Method II billing, can now participate (in all reporting methods except for claims-based). To do so, the CAH must include the individual provider NPI on their Institutional (FI) claims.

Eligible But Not Able to Participate Some professionals may be eligible to participate per their specialty, but due to billing method may not be able to participate: •

Professionals who do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider’s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services.

Services payable under fee schedules or methodologies other than the PFS are not included in PQRS (for example, services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals including method I critical access hospitals, rural health clinics, ambulance providers, and ambulatory surgery center facilities).

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2014 PQRS Options •

2 Measure Options  Individual Measures  Measures Group

•

4 Reporting Options  Claims Based  Registry  Qualified Registry  Qualified Clinical Data Registry  Direct EHR Vendor  EHR Data Submission Vendor 

•

Not all measures can be submitted with the four different reporting options. For example, there are some measures that can be reported using claims-based reporting, but cannot be reported using the direct EHR data submission vendor option.

2 Reporting Periods  12 months (1/1/2014 through 12/31/2014  Claims must be submitted no later than 2/28/2015  6 months (7/1/2014 through 12/31/2014)  Must be submitted no later than 2/28/2015  Measures Group - Registry Reporting Only

Significant Changes in 2014 There are new individual measures and new measures groups for 2014. You will also find some previous measures have been revised for 2014. In all probability you will need to revise how you have reported previous PQRS measures.

You will find that the 2014 measures address various aspects of care, such as: Prevention • Chronic- and acute-care management • Procedure-related care • Resource utilization • Care coordination •

You will also find that individual measures are assigned to one of six National Quality Strategy (NQS) Domains: • Patient Safety • Person and Caregiver-Centered Experience and Outcomes • Communication and Care Coordination • Effective Clinical Care • Community/Population Health • Efficiency and Cost Reduction The following examples have been selected to identify how a measure is assigned to a specific domain.

•

Patient Safety Documentation of Current Medications in the Medical Record: Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter.

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This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements  AND must contain the medications’ name, dosage, frequency, and route of administration 

•

Person and Caregiver-Centered Experience and Outcomes Urinary Incontinence: Plan of Care for Urinary Incontinence in Women aged 65 Years and Older: Percentage of female patients aged 65 years and older with a diagnosis of urinary incontinence with a documented plan of care for urinary incontinence at least once within 12 months

•

Communication and Care Coordination Closing the referral loop: Receipt of specialist report:  Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred

•

Effective Clinical Care Controlling High Blood Pressure: Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period

•

Community/Population Health Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: Percentage of patients 18 years and older who were screened for  Tobacco use one or more times within 24 months AND  Who received cessation counseling intervention if identified as a tobacco user

•

Efficiency and Cost Reduction Antibiotic Treatment for Adults with Acute Bronchitis: Avoidance of Inappropriate Use: Percentage of adults 18 through 64 years of age with a diagnosis of acute bronchitis who were not prescribed or dispensed an antibiotic prescription on or 3 days after the episode

Earn the Incentive AND Prevent the 2016 Payment Penalty If you choose to report individual measures to receive the payment incentive AND prevent the 2016 payment penalty, to the extent possible, you need to report: • • •

at least 9 quality measures (as opposed to 3 measures in 2013) that cover at least 3 different domains for at least 50 percent of the time the measures are applicable to the patients seen in 2014

Eligible professionals (EP) that report less than 9 measures or less than 3 domains, will be subject to MeasureApplicability Validation (MAV). The MAV process will determine whether the EP should have submitted additional measures or additional measures with additional domains to be considered incentive eligible or avoid the payment adjustment. For more information on the MAV process, see: http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/PQRS/AnalysisAndPayment.html You can also choose to report at least one measures group on a 20-patient sample. For more information, see Getting Started with 2014 Reporting of PQRS Measures Groups on the CMS website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html

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Report to Only Prevent the 2016 Payment Penalty If you want to avoid the 2.0 percent penalty applicable to your 2016 Medicare fee-for-service payments for services included on the Medicare Physician fee schedule, you will need to report: • • •

at least 3 quality measures covering 1 NQS domain for at least 50 percent of the time the measures are applicable to the patients seen in 2014

EPs that submit quality data for one or two PQRS measures for at least 50 percent of their patients or encounters eligible for each measure will be subject to MAV. How to Get Started Sounds overwhelming? CMS has excellent guides on how to begin to report and also explains the differences for reporting in 2014 compared with 2013. The “How To” guides are available on the CMS webiste at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html Need Help?

If you have questions or need assistance with PQRS reporting, contact the QualityNet Help Desk. The help desk is available Monday–Friday; 7:00 AM–7:00 PM CST • • •

Phone: 1-866-288-8912 TTY: 1-877-715-6222 Email: Qnetsupport@sdps.org

ICD-10: What is Your Action Plan?

The October 1, 2014, ICD-10 compliance date is fast approaching. By now, you should be employing identified preparation strategies. For detailed timelines and checklists for activities that all providers need to carry out to prepare for ICD-10, visit the CMS ICD-10 web page (http://www.cms.gov/Medicare/Coding/ICD10/index.html) now! You can also access an On-line Implementation Guide, (https://implementicd10.noblis.org/start/) designed especially for small and medium practices, large provider practices, small hospitals, and payers.

Please complete a brief survey (http://survey.constantcontact.com/survey/a07e8twefakhqqqm79v/start) to help WPS Medicare determine the readiness of our provider community for the implementation of ICD-10 codes.

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FIGHT RX ABUSE - PLEASE VISIT WWW.IN.GOV/INSPECT

Don’t turn a blind eye to prescription drug abuse

inspect@pla.in.gov

Get Registered Today!

Visit www.in.gov/inspect and click “Registration Information” for instructions

13 millions records collected annually Over 16,000 registered users Fulfilling over 6,000 reports daily 44% of eligible osteopathic physicians already registered INSPECT Program: 402 W. Washington Street, Room W072 Indianapolis Indiana 46204

Winter 2014

PRESIDENT’S MESSAGE (continued from page 1)

Mission and purpose and shape our strategy for the future as we continue to grow as an organization. You will have an opportunity to contribute by completing a short survey that will be included in your dues statement this spring.

Please take the time to share your thoughts, concerns, and ideas of how the IOA can better serve you now and in the future.

In closing, please join us May 2 – 4, 2014, for our 117th Annual Convention at the French Lick Springs Resort in French Lick and West Baden, Indiana. It is a beautiful place to enjoy the much anticipated spring weather and fantastic continuing medical education program.

Angela B. Wagner, D.O. IOA President

CANTIERI NAMED TRUSTEE (continued from page 1)

delegate from Indiana to the AOA House of Delegates. In 2009, he was recognized with the IOA’s highest honor and received the J.B. Kinsinger Plaque for outstanding service to the osteopathic profession and his community. He also served for 8 years as the president of the Osteopathic Medical Foundation of Michiana.

Dr. Cantieri is a graduate of Des Moines University College of Osteopathic Medicine (DMUCOM) in Des Moines, IA, where he served an osteopathic manipulative medicine teaching fellowship. He is board certified in osteopathic manipulative medicine (OMM).

Dr. Cantieri has done extensive teaching in OMM and prolotherapy, both nationally and internationally. He is an author and co-author of several publications. Dr. Cantieri also is a graduate of the AOA’s Health Policy Fellowship.

Thank you, Dr. Cantieri, for your superior representation of the D.O.s Indiana.

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AIOA NEWS It was good to see everyone at the 32nd Annual Winter Update in December. I am looking forward to spending more time with all of you at our 117th Annual Convention, May 2 – 4, 2014, at the French Lick Springs Resort, in French Lick and West Baden. Watch for a brochure in early March and be sure to register.

The Advocates to the IOA (AIOA) program will be great fun as usual. Please plan to join us for lunch and a historical tour 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. Indiana students in osteopathic medical school truly appreciate the forgivable loans they receive as a result of our fundraising activities at annual conventions. Your support by making cash contributions, buying raffle tickets, and bidding on auction items is vital.

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 convention program again too. Details were e-mailed in early March 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 download the application on the IOA’s website at www.inosteo.org by clicking on Advocates to the IOA under the Related Organizations tab.

Mike Coyle AIOA President

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DEAN’S UPDATE

By: Paul Evans, D.O., FAAFP, FACOFP Vice President and Dean Marian University College of Osteopathic Medicine We grateful to members of the Indiana Osteopathic Association (IOA) for their support of the first college of osteopathic medicine in Indiana. Our goal is to provide much-needed osteopathic physicians for Indiana.

The need for physicians increases each year with the expansion in geriatric populations and the higher expectations on those who provide medical care. Marian University hopes to play an important part in addressing these Indiana needs in the near future.

The interest in our new school has been even higher this year! The Marian University College of Osteopathic Medicine (MUCOM) has had over 3,600 applications to date. Last year, we had 3,352 total. We have already completed about 400 of about 650 planned interviews, with about 110 seat deposits received to date.

We have received a 17% increase in applications this year and the quality of applicants is improved from last year.

Our community physicians have been invaluable in helping us with interviews and on our admissions committee in assisting to select the MUCOM’s next class.

We are moving forward successfully in our first year of operations. The D.O. Class of 2017 has 161 students starting their second term of instruction. Fifty-four percent of the class is from Indiana. Our innovative curriculum is competency based, using clinical cases from the first year forward to integrate biomedical science principles with clinical concepts of evaluation and management of patients.

Courses are based on an organ systems organizational approach. Each system has an introductory clinician-presented “anchor lecture” of an index case, then faculty use lecture and small group study of basic science principles to explain what is happening in approaching patients. This is followed by another clinical lecture presenting the differential diagnosis, work-up (labs and imaging), and management strategies for the case, all with biomedical science learning that is linked to the “what” and the “why”. A clinical experience for our first year students is built into the curriculum. The result? Our students are being trained to think-like-a-doctor from day one. High levels of active engagement and team based learning are linked to increased levels of student participation at all levels. So far, students have been doing very well. Outcome based data is being gathered already to measure successes of the program as we progress.

The MUCOM’s clinical education network continues to grow for both clerkship rotations and for planning future graduate medical education slots.

Potential teaching beds for our hospital partners now exceeds 10,000. We have over 60 hospitals formally

affiliated across the state, with St. Vincent Health, Community Health Network, and Suburban Health as our primary clinical teaching sites in metro Indianapolis. Our clerkship network appears to be forming nicely, allowing for quality educational experiences for our students when they start their rotations in 2015.

Local physicians have given clinical lectures at the college with strong student enthusiasm for their contributions. With the IOA’s continuing help, we hope to build a strong foundation from which to provide exceptional osteopathic medical education experiences and expand the presence of our new medical school in Indiana in the years to come.

IOAPAC THANKS DONORS Thank you to the following IOA members who contributed in 2013 to the IOAPAC, the political action committee for the Indiana Osteopathic Association. Your participation in the political process is appreciated and aids the IOA in ensuring elected officials who support osteopathic physicians remain in the state legislature.

Rebecca Allmon, D.O. James Bertsch, D.O. Christina Cabott, D.O. Mark Cantieri, D.O. Adrian Carter, D.O. David Coil, D.O. David Koronkiewicz, D.O. Susan Moore Riesbeck, D.O. James Pike, D.O. Thomas Ringenberg, D.O. Marylyn Rosencranz, D.O. As a reminder when dues statements arrive in your mail you can add an IOAPAC contribution to your dues payment when you send it to the IOA. Your contribution, however, must be in the form of a separate check (made payable to IOAPAC) and is not tax deductible. The IOAPAC is a state political action committee and is able to receive gifts from non-members and individuals or businesses. Federal PACs, such as the Osteopathic Political Action Committee of the American Osteopathic Information Association, may only solicit members and receive personal checks.

Winter 2014

WMD UPDATE

By: Colonel Charles A. Holt, D.O. Al-salam alaykum from the Arabian Gulf. Met several military D.O.s, here, and doing some OMT on our wonderful service members faithfully serving their country. Al-Hamdulillah. There was certainly something very special in being in the Mideast during Thanksgiving/Hanukkah/Christmas--I pray that you were blest during these holidays. Inshallah.

Suffer the children...in just one month last year, MMWR stated that the NPDS had over 1,000 poison center reports of laundry detergent ingestions; 1/2 were pods and most all children were <5y/o. Their S&S were more often worse if ate a pod vs loose detergent. MESH, through its DSABs (daily situational awareness briefs) (MESHintel@meshcoalition.org) can keep you UTD on WMD/EM items, from which I get many of these info bites. The 22 OCT 2012 brief covered ARS (acute radiation syndrome)/KI treatment/IPPZ (ingestion pathway planning zones). IN has 11 counties that border nuclear power plants (2@ in MI & IL).

As always, www.in.gov/dhs and CDC websites are great resources to learn more (Don't wait until an emergency occurs, Inshallah, to read up!). Check out the NASN (National Ass. of School Nurses) and the CDC re food allergies--an increasing problem. Only 8 foods cause 90%! Children are being poisoned via their parents using outside pesticides to try and kill bed bugs--growing and deadly problem--check out the NPIC (National Pesticide Info Center).

Suffer the adults...the FDA continues to warn us about online pharmacies. The risks are numerous/legit ones are few/up to 25% of internet shoppers has used them! And it's not as if there weren't any pharmacies on opposite corners of nearly every block! Methadone facts: mainly for heroin addiction TX, but now for chronic pain too/2% of painkiller RXs/OD deaths doubled the past decade/1/3 of a RX OD deaths. Unread test results on hospital discharge--up to 1/2! Avoid end-of-stay tests and ALWAYS have test result tracking in place. MPR (Monthly Prescribing Reference) and other companies offer all kinds of internet sites and apps for endless medical care uses including meds/microbes/TXs/calculators/algorithms.

I and you should keep UTD on the CDC's NCW (novel coronavirus website). We Hoosiers get >6000 international passengers/Y in Indy, alone. The Arabian peninsula's new one kills up to 50%! CRE kills up to 40% and infects untold thousands in the US--your inf. control nurse is Numero Uno in where to start.

Employer/employee conflicts over mandatory immunization is a growing issue. Only 1/3 of HC workers

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get flu shots. You can now view hospital employee vaccination rates online. Ma'asalaamah.

1 JAN 2014 was the first anniversary of the CIBDP (Central Indian Bed Diversion Program) migrating to IndyTRAC. Check out their website for more info--it is NOT just about available beds but all kinds of EM (emergency management) info. 5Y after the 5th dose of DTAP--immunity to pertussis/whooping cough/100d cough--starts to wane. CDC and ISDH has online resources on this and innumerable health topics. An example of a central IN EM business is the Lighthouse Readiness Group as featured in a 23 DEC 2012 Indy Star article. Last year, the 1st mammalian cell derived flu vaccine was used in the US--Flucelvax.

Invasive organisms threatening our Great Lakes way of life include riverborne carp and 185 other nonnative species along with algae that caused botulism outbreaks wiping intold numbers of birds. The locks and ships going up it have brought Atlantic species in and the reversal of the Chicago River into the MS River, 100 years ago, has allowed mussels to go West, latch onto boats that are towed over the Rockies onto the West Coast-potentially crippling hydroelectric dam pipes, there. And by the way, Chicago has an antiquated sewage treatment system--want to know more? Milwaukee Journal Sentinel had a great article in the 23 DEC 2012 Indy Star, as well.

Man-made inadvertent WMD may kill us, yet.

Re-cap of some common ID (infectious diseases). WNV (West Nile Virus) is often carried by Culex mosquitoes and causes symptoms in 1/5 infections.

The MIR (minimum infection rate) in the insects is rising in Marion Co.. Legionnaires' dis. (which I personally survived) has been linked to decorative water walls in at least two hospitals.

A U of Maryland study showed flu patients wearing surgical masks reduces airborne droplet release.

IN had at least 40 flu deaths this past 2012/3 season.

Majority were adults with >=1 medical condition--most common were Heart Dis./DM/Lung Dis./Renal Dis./HTN/Cancer. #1 & 2 Complications: ARDS & pn..

Read about viruses' internal molecular clock that must operate perfectly in order for the virus to spread at www.bbc.co.uk/news/health and at www.news.cell.com/cellreports. Ma'asalaamah.

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OSTEOPATHIC MEDICAL FOUNDATION FINANCIAL ASSISTANCE In 2003, the Osteopathic Medical Foundation, Inc. (OMF) of Michiana established the OMF Forgivable Loan Program. This program provides financial assistance via forgivable loans of $10,000 per year to osteopathic medical students who are in the FIRST through FOURTH years of study at one of our nation’s osteopathic medical schools and who desire to return to the Michiana area to practice medicine. In exchange for practicing within a 60 miles radius of South Bend, 25% of their loan will be forgiven for each year they are in practice. Please note the following eligibility requirements: An applicant must: 1. be at least a half time student in an osteopathic medical school accredited by the AOA; 2. demonstrate an interest in returning to the northwestern Indiana or southwestern Michigan “area” (“area” is defined as being within a 60 mile radius of South Bend, Indiana. Indiana counties include Saint Joseph, Marshall, Elkhart, Kosciusko, Starke and LaPorte. Michigan counties include Berrien, Cass and Saint Joseph) to practice osteopathic medicine upon graduation; 3. demonstrate financial need; 4. be of good moral character; 5. demonstrate good motivation toward the practice of osteopathic medicine; and 6. be available for a personal interview, if requested, by the Osteopathic Medical Foundation.

In 2007, the OMF Resident Recruitment Grant Program was established to provide financial assistance to new physicians or small practices interested in recruiting a new physician to enter their practice. This program provides a one-time grant of $10,000 to a new physician to assist in the repayment of student loans. Please note the following eligibility requirements: 1. be a graduate of an osteopathic medical school accredited by the AOA; 2. start up or join a practice located in the northwestern Indiana or southwestern Michigan “area” (“area” is defined as being within a 60 mile radius of South Bend, Indiana. Indiana counties include Saint Joseph, Marshall, Elkhart, Kosciusko, Starke and LaPorte.

Michigan counties include Berrien, Cass and Saint Joseph).

3.

4.

remain in the Michiana area for two years, and serve one year on the OMF Board of Directors.

Visit the OMF’s website at www.omfmichiana.org to download an application for either of these programs. The deadline for submitting applications is May 15, 2014.

The Osteopathic Medical Foundation appreciates your help in perpetuating the practice of osteopathic medicine in the northwestern Indiana and southwestern Michigan area via financial contributions to the OMF and is grateful for our generosity.

Winter 2014

COMING EVENTS...

Annual Convention March 13 – 16, 2014 Marriott Downtown, Philadelphia, PA Sponsor: American College of Osteopathy Family Physicians Contact: ACOFP, (800) 323-0794 or www.acofp.org Annual Convocation March 15 – 23, 2014 The Broadmoor, Colorado Springs, CO Sponsor: American Academy of Osteopathy Contact: AAO, (317) 879-1881 or www.academyofosteopathy.org “Orthopedics, Posture and the Primary Respiratory Mechanism” April 11 – 13, 2014 Doubletree San Francisco Airport, San Francisco, CA Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com National Osteopathic Medicine Week April 13 – 19, 2014 Preconference OMT Workshop: “The Principles of Muscle Energy Diagnosis ” May 1, 2014 8 hours category 1-A credit anticipated, pending approval by AOA CCME French Lick Resort, French Lick and West Baden, IN Sponsor: Indiana Academy of Osteopathy Contact: IAO, (317) 926-3009 or (800) 942-0501 or www.inosteo.org 117 th Annual Convention May 2 – 4, 2014 25 hours category 1-A credit anticipated, pending approval by AOA CCME French Lick Resort, French Lick and West Baden, IN Sponsor: Indiana Osteopathic Association Contact: IOA, (317) 926-3009 or (800) 942-0501 or www.inosteo.org Internal Medicine Board Review June 7 – 11, 2014 Bonaventure Resort & Spa, Weston, FL Sponsor: Cleveland Clinic Florida Contact: Cleveland Clinic Florida, www.clevelandclinicfloridacme.org Introductory Course: “Osteopathy in the Cranial Field” June 14 – 18, 2014 40 hours category 1-A credit anticipated, pending approval by AOA CCME Sheraton City Centre, Indianapolis, IN Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com Annual Conference: “Beyond Sutherland’s Minnow—Anatomy, Perception and Treatment” June 19 – 22, 2014 Sheraton City Centre, Indianapolis, IN Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com The Cranial Base September 17 – 21, 2014 Renaissance Suites O’Hare, Chicago, IL Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com AOA Convention October 25 – 29, 2014 Washington State Convention Center, Seattle, WA Sponsor: American Osteopathic Association Contact: AOA, (312) 202-8014 or www.osteopathic.org

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The Midline Course November 7 – 9, 2014 Doubletree Hotel San Francisco Airport, San Francisco, CA Sponsor: The Cranial Academy Contact: The Cranial Academy, (317) 581-0411 or www.cranialacademy.com

MARK YOUR CALENDARS

NOW AND PLAN TO ATTEND THE IOA 117TH ANNUAL CONVENTION MAY 2 - 4, 2014 FRENCH LICK RESORT FRENCH LICK AND WEST BADEN, IN

Winter 2014

HOOSIER D.O.

HOOSIER 2012 - 2013 OFFICERS Angela B. Wagner, D.O. President Adrian L. Carter, D.O. First Vice President Mark S. Cantieri, D.O. Second Vice President Terry A. Iwasko, D.O. Secretary Patrick J. Woodman, D.O. Treasurer Chris A. Lowery, D.O. Immediate Past President TRUSTEES Brian H. Black, D.O. Mary Burden, D.O. Gaston Dana, D.O. Steven J. DeLee, D.O. Laura L. Helman, D.O. Stephanie M. Overmars, D.O. VICE PRESIDENTS DISTRICT CHAIRS Terry A. Iwasko, D.O., District I Steven J. DeLee, D.O., District II Zachry L. Waterson, D.O., District III Laura L. Helman, D.O., District IV Bruce C. Brink, Jr., D.O., District V Dan C. Galloway, D.O., District VI A.O.A. DELEGATES Mark S. Cantieri, D.O. David L. Coil, D.O. Dan C. Galloway, D.O. Max E. Helman, D.O. David C. Koronkiewicz, D.O. Susan M. Moore Riesbeck, D.O. A.O.A. ALTERNATE DELEGATES Thurman V. Alvey, III, D.O. Ben D. Huang, D.O. Angela B. Wagner, 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 or (800) 942-0501 www.inosteo.org

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

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 (800) 942-0501 or (317) 9263009.

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 (800) 942-0501 or (317) 926-3009.

NORTHERN INDIANA. Excellent opportunity for the physician wishing to practice integrative medicine. The practice was established over 15 years ago, has a large patient base, experienced and trained staff, and utilizes cutting-edge medicine to restore health. This position offers a competitive salary, malpractice, generous vacation, CME time and allowance, and a 4 ½ day work week. Located in a safe, family-oriented suburb with a low cost of living, numerous recreational opportunities and close access to Chicago and South Bend. Interested candidates please contact Lisa McDonald with Integrated Connections; lisa@integratedconnects.com or (970)988-2728.

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.

OPPORTUNITY IN INDIANAPOLIS. Community Westview Hospital’s Department of Emergency Medicine is seeking an emergency medicine board certified or eligible physician with good interpersonal skills to work in a lower volume but occasionally high acuity emergency department (ED) in Indianapolis. Volume is less than 10,000 but pay is extremely competitive with other Indianapolis EDs. Work in a collegial environment with other ED board certified or eligible physicians with an excellent hospitalist group and great specialty support as well as superb administrative support. There are some teaching opportunities with our family practice and podiatry residents as well as with medical students. For more details, please contact Ben Huang, D.O., MPH, FACOEP at benhuangdo@gmail.com or call/text (317) 698-1942.

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 in-house 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 B.brinkdo@insightbb.com or contact Erin Wernert or Debbie Coyle, IOA, at (800) 942-0501 or (317) 926-3009.