AOMA Digest Fall 2014

Volume 29, No. 3

The Journal of the

Arizona Osteopathic

Medical Association

Fall 2014

INSIDE ■ AOMA 2014-2015 Board of Trustees

■ 2015 Clinical Case Competition and Poster Forum

■ Practice Management Articles

34th Annual AOMA Fall SeminarNovember 15 & 16, 2014

AOMA Digest Fall 20141

2014-2015 Board of TrusteesPresident

Adam Nally, D.O.

President Elect

Kristin Nelson, D.O.

Immediate Past President

Craig Phelps, D.O., FAOASM

Vice President

Jonathon Kirsch, D.O.

Secretary/Treasurer

Shannon Scott, D.O.

Executive Director/Editor

Pete Wertheim

Trustees

Craig Cassidy, D.O.

Donald Curran, D.O.

Angela DeRosa, D.O., MBA, CPE

William Devine, D.O.

David England, D.O.

Michelle Eyler, D.O.

Charles Finch, D.O.

Patrick Hogan, D.O.

Christopher Labban, D.O.

Julie Morrison, D.O.

Laurel Mueller, D.O., MBA

Kathleen Naegele, D.O., MBA, MIS, MPH

George Parides, D.O.

Wendell Phillips, D.O.

Bunnie Richie, D.O.

Resident Trustee

Mansoor Jatoi, D.O.

Student Trustees

Ryan Martin, AZCOM

Joshua Nead, SOMA

Speaker of the House of Delegates

Jeffrey Morgan, D.O., MA, FACOI

Vice Speaker of the House

Scott Welle, D.O.

AOMA STAFF LISTINGDirector of Education & Managing Editor

Janet Weigel

Member Services Manager

Sharon Daggett

Executive Assistant

Teresa Roland

Opinions expressed in the AOMA Digest are those of authors and do not necessarily reflect viewpoints

of the editors or official policy of the AOMA, or the institutions with which the authors are affiliated

unless explicitly specified. AOMA Digest does not hold itself responsible for statements made by any

contributor. We reserve the right to edit articles on the basis of content or length.

Although all advertising is expected to conform to ethical medical standards, acceptance does not

imply endorsement by this magazine. The appearance of advertising in the AOMA Digest is not an

AOMA guarantee or endorsement of the product, service or claims made for the product or service

by the advertiser.

Copyright 2014

Cover Photo: Sun Kachina © Joe Zeller

Contents Volume 29 No. 3

FA LL 2014COLUMNS2 President's Message

4 Executive Director's Message

5 What We Have Done For You Lately

6 2014-2015 Board of Trustees

8 Just Do It!

FEATURES10 Disability Insurance Basics: How to Choose a Policy

13 Meaningful Use and the Basics of Medical Care

14 Arizona: We Are One of the Top Ten in the Nation

17 Distracted Physicianing

19 Preventing CAUTI

20 Health Services Advisory Group – QIN-QIO

21 The Epidemic That You Can Cure

22 AOMA Business Partners

24 Welcome New AOMA Members

OSTEOPATHIC COMMUNITY NEWS26 2015 Clinical Case Competition and Poster Forum

28 Tucson Osteopathic Medical Foundation

30 Arizona Society of the American College of Osteopathic Family Physicians

32 A.T. Still University School of Osteopathic Medicine in Arizona

35 Midwestern University Arizona College of Osteopathic Medicine

39 Advertisers Index

40 Calendar of Events

AOMA Digest Fall 2014 2

President’s Message

As some of you may know, in an attempt to simplify our lives, my

wife and I moved our family out to a small farm on the west

edge of the Valley. Through this attempt to simplify some of

the complexities of our lives, the underlying theme of “Back to the

Basics” has been glaringly prevalent both at home and at the office.

A return to the basics was also one of the goals I identified this year

as part of my AOMA presidency. In a world of increasing mobility,

continuous access to all things high speed including internet, fast

food, fast cars, high speed travel, electronic charting, text messaging,

the barrage of social media, a 24-hour news and information cycle,

virtual video games, and many other corrupting influences, keeping

pace with the basics of life becomes more and more difficult.

I have learned over the last year that it is the performance of

those basics that actually makes life simpler. I am reminded of the

biography of Abraham Lincoln. The Lincoln family moved from

Kentucky to Indiana in 1816 and lived initially in a rough, rustic,

temporary shelter for a home. In the spring of 1817, following

Abraham’s 8th birthday, the family had to build a permanent home.

The author, John Lock Scripps wrote of this experience in 1860:

“The erection of a house and the felling of the forest was the first

work to be done. Abraham was young to engage in such labor, but

was large of his age, stalwart, and willing to work. An axe was at

once placed in his hands, and from that time until he attained his

twenty-third year, when not employed in labor on the farm, he was

almost constantly wielding that most useful implement.”

Throughout his life, Lincoln showed great skill and tremendous

strength with the use of the axe. Just before his assassination in 1865,

as President of the United States and at the age of 56, Lincoln was

found at a military field hospital shaking hands with hundreds of

wounded soldiers. His biography states the following:

“At one point in his visit he

observed an axe, which he picked

up and examined, and made some

pleasant remark about his having once

been considered a good chopper. He was

invited to try his hand upon a log of

wood lying near, from which he made

the chips fly in primitive style.”

It is written that he later

held the axe at arm’s length for

a full minute, demonstrating his

tremendous strength. A few of the

soldiers tried to duplicate the feat

and found that they could not.

In light of the years of experience, skill, and strength that

Abraham Lincoln possessed while using a very simple but effective

tool, he demonstrated his keen understanding of a basic principle

when he was quoted saying, “If I had eight hours to chop down a tree,

I’d spend six sharpening my axe.” A basic principle essential to the

effective woodsman is maintaining a sharp axe. Lincoln understood

this principle well enough to feel that 3/4th’s of his time should be

devoted to it. General Colin Powel stated that “If you are going to

achieve excellence in big things, you develop the habit in little matters

[the basics]. Excellence is not an exception, it is a prevailing attitude.”

Joshua Becker, in his book Inside-Out Simplicity, defines the

basics as actions or activities that bring “…clarity, purpose and

intentionality. It is marked by the intentional promotion of the things

we most value and the removal of everything that distracts us from it. It

is a life lived in unity…[and is] freedom from the passion to possess.”

Returning to the basics in medicine, in family, or life really

entails five simple steps. Where are you in the spectrum of these

steps in your practice, in your home, or in your relationships?

First – Define your values. What do you want to accomplish

in your practice? What do you want to accomplish in your life

in general? Is there something specific you want your family to

accomplish? From the perspective of the osteopathic tenets, what

do you value physically, mentally, and spiritually in the aspects of

your life? Your values are part of the body unit. It is essential to

understand and master basic values so that the self-regulating, self-

healing, and health maintenance abilities of the body can function.

If structure and function are truly interrelated, then values form a

foundation upon which the body structure must operate. If we are

untrue to or dissociated from our values, we inhibit the unity and

true potential of mind, body, and spirit. Write those values down

somewhere that you will see them frequently and make them a

daily part of your activities. Rank them in order of importance.

Adam S. Nally, D.O.2014–2015 AOMA President

Back to Basics


Second – You don’t actually have to be like everybody

else (and they don’t have to be like you.) Becoming proficient in

“the basics” may be notably different than proficiency in “the basics”

for someone else. Spending fifteen minutes regularly each morning

reading about diseases and treatments that interest you may be just

as important to you as a 20-minute walk six days per week is to

your colleague.

Third – Live intentionally. It is essential to stay focused on

living out your values and functioning from a foundation built upon

solid basics. Let these basics and values founded around the body,

mind, and spirit guide your decision each day instead of letting the

day dictate its cares to you and how you respond. The renewal you

get from spending that 30 minutes this evening to ride horseback

with your family may give you that added focus tomorrow morning

when you finish up your charting. Aristotle said, “We are what we

repeatedly do. Excellence, then, is not an act but a habit.” Living

from a foundation of solid basics is habitual.

Fourth – Live in the present. Don’t get carried away with

sentimentality about the past. And, don’t fear the future. Focus

on your values, stay on track, and be thankful. A thankful heart is

the parent of all other virtues. Psychologist Dr. Robert Emmons,

professor at UC Davis, documented scientific proof that people

who practice gratitude through activities such as acknowledgment

or keeping a gratitude journal are more loving, forgiving, and

optimistic about the future. They reported fewer illnesses and

generally felt better about their lives [Emmons RA, Thanks! How

Practicing Gratitude Can Make You Happier (Boston: Houghton

Mifflin, 2007), 2].

Fifth – Be content. Being grounded in mastery of the basics

brings a peace of mind and soul. It allows you to be content with

what you have and having a grasp on the big picture. It allows you

to reject the “next best thing” consumerism and materialism that

drives one to be constantly searching and never finding. Said Mark

Twain, “I have never let my schooling interfere with my education.”

Our education is really our mastery of the basics in whatever arena

that may be.

Mastering the basics is not easy, it is not immediate, and it can,

at times, be painful or monotonous. But in the words of the ancient

samurai, “Tomorrow’s battle is won during today’s practice.” As you

attend your next lectures, read your next journal articles, perform

your next procedure, and interact with patients, colleagues, and

family, may you have the ability to improve your focus and master

the basics in all you do.


Executive Director’s Message

As autumn begins and we get “Back to Basics” at the 34th

Annual AOMA Fall Seminar, this is an opportune time to

take a step back and remember what is most important as we

finish up 2014.

In this new age of healthcare, change is constant, and it is easy

to become frustrated and sometimes feel inadequate dealing with

the barrage of new information and programs we feel pressured to

learn.

While working for a health plan just prior to the passage of

the Affordable Care Act (ACA) in 2010, to get to my office each

morning I had to navigate through a vast array of cubicles with

hundreds of employees reviewing and preauthorizing provider

claims.

As I listened to the chorus of claims managers seldom

speaking in the affirmative, at the time it made me cynical about

the healthcare system. I understood why these claims operations

existed, but all of the codes and processes felt far removed from the

physician office where patients were being treated.

Then the ACA was passed and I wondered what the future

would look like and if the number of those preauthorization

employees would increase or decrease. Would the physician patient

relationship change in the future?

The healthcare system before the ACA passed was an

established, complex, and difficult system for many people to

navigate and understand. The nature of the legislative process lead

to the ACA being mostly an expansion and retrofit of the existing

complex system and not a redesign.

The reality is that a redesign of the system to achieve

simplification was not politically possible. The prevailing interests

succeeded in moving accommodation ahead of simplification.

In 1989, Phoenix voters soundly defeated a ValTrans proposal

for a 30-year sales tax to develop an elevated light rail system

situated two stories above traffic. Had ValTrans passed in 1989,

today there would be more than 130 miles of light rail at a cost of

$8.5 billion. A light rail sales tax was eventually passed by voters

in 2008 and subsequently 20 miles of light rail have been built at a

cost of $1.4 billion.

If light rail had been part of the city’s original plan, it would be

widespread – perhaps hundreds

of miles throughout Maricopa

County. If it had been approved

25 years ago, it would certainly be

much further along today and carry

a much lower cost.

The Phoenix light rail, much

like the ACA, has been expensive

and disruptive to the individuals

and businesses in the established

infrastructure. Along the light rail

path some businesses have closed,

new ones opened, and the public

is still debating and trying to

understand if this new option is a good one for them.

One would assume that someday the light rail in Phoenix and

the ACA in the United States will become ordinary. While long

ago no one could predict that both light rail and healthcare reform

would happen, the timing of each of them was unfortunate and

progress may take decades instead of years.

We should all try to remember the basics as we become

immersed in the many new and repurposed programs through the

ACA, such as bundled payments and shared savings, pioneer grants,

meaningful use, ICD-10, accountable care organizations, CAHPS

Hospital Surveys, comparative effectiveness research, etc.

The basics of a good physician patient relationship have and

always will remain the same. Smartphone apps have not replaced

the need to have a physician speak directly to a patient. Impersonal

healthcare advice obtained through the internet will never replace

the compassionate and personal care provided to patients by

physicians.

It is difficult to predict what the future of healthcare will be

decades from now. And while there will be business owners along

the new light rail who will fail, the ones most likely to succeed will

remember the basics of understanding their customers’ needs and

providing great personal service to them, as will physicians who

continue to focus on their patients’ needs. It is the one reliable

constant and the formula for success.

The Cornerstone for Success Starts with the Basics

Pete WertheimAOMA Executive Director


What We Have Done For You Lately

Advocacy/ Legislative Af fairs • Worked with the Arizona Board of Osteopathic Examiners to

develop legislation for 2015 to overhaul D.O. licensing statutes; many

of the proposed changes are technical in nature, but a few will provide

more flexibility to licensees

• Met with representatives from organizations that submitted sunrise

applications to the Arizona Legislature; AOMA positions will

be taken to support, oppose, or take no position on each of the

applications; further details to come, positions not finalized at time of

publication

• Arizona Industrial Commission of Arizona (ICA) - testified and

submitted a letter of opposition to portions of the ICA Director’s

Committee Proposed Evidence-Based Guidelines Medicine

Treatment Guidelines for Chronic Pain Patients; attended follow up

meetings, working with AOMA pain specialists, and monitoring the

progress of this committee

• Met with the American College of Physicians – AZ Chapter,

Arizona Academy of Family Physicians, Arizona Academy of

Pediatrics, Arizona Alliance of Community Health Centers, Arizona

Hospital and Healthcare Association, Arizona Medical Association,

Arizona Nurses Association, Banner Health, Maricopa Medical

Society, University of Arizona Health Network, and other groups to

share 2015 legislative agendas and election activities

American Osteopathic Association (AOA) House of Delegates • AOMA sent 12 delegates, one alternate delegate, two student

delegates, and two student alternate delegates to the AOA House of

Delegates meeting in Chicago

• Delegates actively participated in the resolution process, including the

resolution for ACGME Single Accreditation System

• Arizona’s student delegates filled three of the 14 student ex-officio

positions on the committees of reference, the highest number of any

state

Continuing Medical Education • Sponsored 7.0 hours of Category 1-A CME credit for New Concepts

in OMM

• Sponsored 41.5 hours of Category 1-A CME credit for Cranial

OMM

• Sponsored 4.0 hours of Category 1-A CME credit for Opioids: The

Epidemic That You Can Cure

• Online CME now available via the AOMA Website www.az-osteo.

org/OnlineCME

Osteopathic Charities • Redesigned Arizona Osteopathic Charities webpage

• Added online donation option

• Launched 2015 Birdies for Charities campaign

• Added charitable events to the AOMA calendar of events

Member Services • Expanded office hours. The AOMA office is now open from 8 a.m.

to 5 p.m.

• The D.O. Dashboard expanded to a monthly electronic newsletter

featuring upgraded content

• AOMA Facebook page has been redesigned and bolstered

• Met with Health Services Advisory Group to discuss their new

Quality Innovation Network Improvement Organization grant and a

partnership to assist D.O.s with electronic health record utilization to

address critical, National Quality Strategy goals

• Introduction of AOMA membership benefits to Tucson D.O.s at

the Tucson Osteopathic Medical Foundation “Connect the Dots”

gathering

• Proposed overhaul of AOMA Manual Procedures completed and

ready for Fall Seminar approval

• Upgraded AOMA phone system for more user-friendly options

Political Action Committee • Added online donation option

• Posted Gold PAC contributors on the webpage

• 2014 AOMA distributed $5,800 to 22 candidates who won their

primary elections

• Actively participated in eight fundraisers for legislative candidates

Public Health • Represented AOMA at the Arizona Department of Health Services

Vaccine Financing & Availability Advisory Committee and at The

Arizona Partnership for Immunization (TAPI) Steering committee

meeting

Public Relations • Met with Arizona Republic reporters to offer AOMA as a resource

for information and interviews

• Met with St. Luke’s Health Initiatives president and chief executive

officer and healthcare communications professionals to develop a

health innovation story bank for the media to use for positive media

stories about advances in healthcare

Students – the future of the osteopathic profession • Introduction and AOMA orientation to incoming students at the

A.T. Still University School of Osteopathic Medicine and Kirksville

College of Osteopathic Medicine

• Developing AOMA Student Legislative Affairs Committees

For more information about any of these updates, please contact

AOMA at 602-266-6699 or email [email protected]

What We Have Done For You LatelyThis regular feature of the AOMA Digest provides members with a recent update of the Association’s activities. We are representing the

profession as a healthcare stakeholder and are the voice of osteopathic medicine in Arizona. This update covers the three month period

from July 1, 2014 to September 30, 2014.


2014-2015 Board of Trustees

Adam S. Nally, D.O. President

Shannon Scott, D.O. Secretary/Treasurer

Angela DeRosa, D.O., MBA, CPE Member at Large

Kristin Nelson, D.O. President Elect

Pete Wertheim Executive Director

William H. Devine, D.O. District 1

Craig M. Phelps, D.O., FAOASM Immediate Past President

Craig Cassidy, D.O. Specialists

David P. England, D.O. District 5

Jonathon Kirsch, D.O. Vice President

Donald J. Curran, D.O. District 7

Charles A. Finch, D.O. District 3


OFFICERS

TRUSTEES



Jeffrey W. Morgan, D.O., MA, FACOI Speaker of the House of Delegates

Julie A. Morrison, D.O. District 6

Laurel Mueller, D.O., MBA Member at Large

Kathleen Naegele, D.O., MBA, MIS, MPH

New Physicians Representative

Patrick Hogan, D.O. Member at Large

Mansoor Jatoi, D.O. Resident Trustee

Christopher J. Labban, D.O. District 4

Ryan Martin AZCOM Student Trustee

Joshua Nead SOMA Student Trustee

George Parides, D.O. Member at Large

Wendell Phillips, D.O. Member at Large

Bunnie Richie, D.O. Member at Large

Scott Welle, D.O. Vice Speaker of the House of Delegates

NOT PICTURED:

Michelle E. Eyler, D.O.–Member at Large


Just D.O. It

How does a multi-lingual investment banker go from Wall

Street to practicing osteopathic medicine on the Hopi

Reservation? If you are Dr. Laurel Mueller, the journey has

been full of challenges, opportunities, and adventures.

Her story begins in La Porte, Indiana, a Midwestern rural,

once-thriving community near Lake Michigan. The daughter of a

physician and a nurse, her home was one in which talk and thought

about medicine was ever present. All the while, Dr. Mueller was

storing up her interest in becoming a doctor; yet she wasn’t sure if

she could ever compete with THE Dr. Mueller, her father.

The family was very sports-minded. At the local high school, Dr.

Mueller ran track and swam. She was the first girl to insist upon

equality and swim on the boys’ swim team, lettering in the sport.

Dr. Mueller soon found she had a power to learn and apply

foreign languages, beginning with German at age 12. During high

school, she embarked on a pivotal student exchange experience

through AFS International Programs.

Ultimately, Dr. Mueller graduated from Vassar

College with a bachelor’s degree in Italian

Language and Literature. Other languages she

commands are French, Russian, Japanese, and

Spanish. She is currently learning Burmese, a

necessary skill in her participation with on-the-

ground humanitarian efforts in Myanmar for

the last 2 years.

Foreign language proficiency also opened

doors to new adventures, including a year of

study at the University of Bologna in Italy and

a scholarship to study Russian in the former

Soviet Union. While also studying history

and international political science at Vassar,

Dr. Mueller worked for the U. S. Senator from

Indiana, Richard Lugar, as a foreign-language

interpreter.

After college, the Carter years and the

era of Glasnost ensued. High interest rates

and inflation led to economic recession and

tightened the job market. Dr. Mueller moved to

Philadelphia, Pennsylvania, and took a position

as a swim coach. Connections made through

the team led to a job at an investment banking

firm and soon thereafter, the pursuit of her

MBA at the Wharton Business School. She

then occupied and thrived in the world of Wall

Street and international finance. It was the late

1980’s and early 1990’s—the days of the “Wolf

In Any Language

Young Kayan women wearing neck rings pose with Dr. Mueller.

Laurel Mueller, D.O. serves rice to monks during a visit to Myanmar.


Features

Editor’s note: Just D.O. It! is a continuing feature in the AOMA Digest. Each column highlights an AOMA member and his or her contributions to the osteopathic profession.

of Wall Street” and junk bonds; the savings and loan crisis and

Charles Keating.

It was a lucrative time, but Dr. Mueller felt unfulfilled. Following

the death of her brother, she reassessed her priorities. With the

encouragement of friends who were already in medical practice,

Dr. Mueller enrolled in pre-med classes at Hunter College in New

York City. When she was not admitted to medical school, she was

drawn to osteopathic medicine as it gave her—someone with a non-

traditional background—a chance to be a different kind of doctor.

Dr. Mueller then matriculated at New York College of

Osteopathic Medicine. She attests, “Medical school was tough. I

barely graduated. I never would have made it through without help

from so many people—students, teachers, friends.”

After an internship at Jamaica Hospital in Queens, New

York, Dr. Mueller found the perfect residency at St. Elizabeth

Medical Center in Utica, New York, working at a refugee center.

Her medical training and aptitude for foreign language were put

to the test. This experience guided her to accept an assignment

with Indian Health Services on the Hopi reservation in northern

Arizona. She was one of the first D.O.s to practice on the

reservation. She spent three years practicing everything from

obstetrics and pediatrics to geriatrics and palliative medicine. She

has learned the Hopi language to strengthen her interpersonal skills

and “bed-side manner” among Native American populations.

Dr. Mueller loves osteopathic medicine. “I can be in the

middle of nowhere—no supplies, no drugs, no office—and I can

still help someone with their pain. The power of my hands. The

power of touch.”

Dr. Mueller has also critically needed the power of touch herself.

A near-fatal fall from Bell Rock in Sedona left her with a closed-

brain injury, broken hand, and crushed ankle. The ordeal confined

her to a wheelchair for four months. She continued to see patients

while recovering from the accident. “I really understand bone pain.

My accident made me a better doctor.”

In 2012, Dr. Mueller became a Clinical Assistant Professor of

Family Medicine at the Arizona College of Osteopathic Medicine

at Midwestern University in Glendale. During her time at the

College, she facilitated the transformation of the Health Outreach

through Medicine and Education (H.O.M.E.), from an extra-

curricular club activity started by a group of community-minded

medical students to a multi-specialty, interdisciplinary program

that serves the homeless of Phoenix and provides them with

basic medical care and health education. The program has been

enormously successful and continues to this day, with more than

500 students participating each year.

Dr. Mueller’s love of Sedona and her passion for clinical

medicine steered her to a new practice at the Yavapai County

Community Health Center in Cottonwood. This latest commission

brings assorted challenges with the patient population: no English;

wariness of authority; trust issues; and abuse. Her Spanish has

improved dramatically.

Human trafficking is a serious issue in the County. She is

working with Sheila Polk, Yavapai County District Attorney, to

combat the problem. The concern is not limited to Yavapai County.

“Keep your radar up!” says Dr. Mueller and she encourages all

physicians to increase their awareness of the telltale signs of human

trafficking:

• Suspicious injuries and accidents—bruises, broken bones,

burns, scars

• Furtive behavior—lack of eye contact, conflicting stories,

• Prostitution and sexually-transmitted diseases

• Kidnapping

• Runaway teens

• Abuse—verbal, physical, and mental

The journey for Dr. Laurel Mueller continues. In November,

she will be travelling to Myanmar (formerly Burma) to work in a

free clinic. The non-governmental organization that is sponsoring

the trip also performs surgery on patients with cleft palates and

cleft lips.

“I want to live my life with no regrets,” says Dr. Mueller.

“Shoulda, coulda, woulda is not in my vocabulary.”

Now, how do you say that in Russian?


Features

At some point in his or her career, almost every osteopathic

physician will consider purchasing a disability insurance

policy to protect his or her income in case of injury or

sickness. Perhaps you’re just finishing school and want to insure

your investment in your education, or maybe you’re an established

practice owner looking for additional protection. Either way,

selecting the disability insurance policy that is right for you can be a

daunting task. Disability insurance policies are not one-size-fits-all,

nor are all policies created equal. The terms of your policy can have

drastic consequences, and it’s important to understand a policy’s

provisions before you purchase it. As a law firm focusing on helping

doctors with disability insurance claims, we’re often asked which

policies are best. Though we can’t endorse any particular insurance

company, we’re happy to provide a few basic guidelines to help

osteopaths choose the most appropriate coverage.

1. Protect Your Own Occupation

The definition of “Totally Disabled” (or “Disabled” in some

policies) is the most important definition in a policy. Whether or

not you qualify for benefits will depend on whether you are Totally

Disabled according to the policy’s definition. Doctors should always

consider policies that define Total Disability in terms of the doctor’s

own occupation. Here is an example, taken from an actual policy, of

the definition of “Totally Disabled” that you want in your policy:

Total Disability or Totally Disabled

Total Disability or Totally Disabled means that, solely due

to Injury or Sickness, You are not able to perform the material and

substantial duties of Your Occupation.

You will be Totally Disabled even if You are Gainfully Employed

in another occupation so long as, solely due to Injury or Sickness, You

are not able to work in Your Occupation.

This definition is beneficial to you for two significant reasons.

First, it does not require that you be unable to perform any

occupation, it only requires that you be unable to perform your

occupation. For example, if you are a surgeon and you develop a

hand tremor that prevents you from safely operating on patients,

you would still be considered Totally Disabled, even if you were able

to treat patients in a non-surgical role. Under this policy definition,

you would be able to collect your benefits and work in a different

occupation at the same time.

Second, it does not require you

to be unable to perform all the

duties of your occupation in order to

receive disability benefits; you’ll be

considered Totally Disabled if you’re

unable to perform the material and

substantial duties of your occupation.

In the example above, you would

still be Totally Disabled even if you

could perform some incidental duties

of your surgical position, such as

supervising office staff or signing off

on patient charts.

Just as not all disability insurance policies are equal, not all

“own occupation” coverage is the same. Even if your agent assures

you that you’re buying an “own occupation” policy, you should still

review the policy in its entirety. Although many definitions of

“Totally Disabled” will look similar to the above example, insurance

companies sometimes introduce subtle variations which benefit

the insurer at your expense. For instance, beware of policies that

define Totally Disabled as “unable to perform all duties of Your

Occupation.” This language appears to be an “own occupation”

definition because it includes the words “Your Occupation,” but

it requires that you not be able to perform any duties of your

occupation before you may collect benefits.

As another example, some policies define Totally Disabled as

“unable to perform all duties of Your Occupation and not working

in another occupation.” Again, this language appears to be the

beneficial “own occupation” definition, but it will not provide you

benefits if you work in any other job – even if that job has nothing

to do with your prior occupation.

2. Avoid Specific Definitions of “Physician’s Care”

Another thing to watch out for in the definition of “Total

Disability” is the “Physician’s Care” or “Appropriate Care”

requirement. Although our example policy above did not include

such a requirement, definitions of “totally disabled” often require

that you be under the care of a physician for the condition causing

Disability Insurance Basics: How to Choose a Policy

Karla B. Thompson, Esq.

Comitz | Beethe

Disability Insurance Basics cont. page 12


Features

your disability. For example, one policy provides:

“Total Disability” means that because of Injury or Sickness:

a. You are unable to perform the important duties of Your

Occupation; and

b. You are receiving Physician’s Care.

How the policy defines “Physician’s Care” could greatly impact

whether you meet the policy’s definition of “Totally Disabled.” For

instance, if the policy states that “Physician’s Care” requires you to

see an M.D. or D.O., you may not be entitled to benefits if you are

only treating with a chiropractor or with a Ph.D.-level psychologist.

Some more restrictive policies also require you to receive the

care of a physician “which, under prevailing medical standards, is

appropriate for the condition causing the disability.” This provides

the insurance company with an opportunity to decide what care

is “appropriate” for you. For instance, some insurance companies

will deny a policyholder’s claim because he or she has declined

to undergo surgery, even though he or she is receiving other,

non-surgical treatment. The insurer will argue that surgery is the

most “appropriate” care, and so anything else does not meet the

policy’s requirements. The best policy for you is a policy that does

not separately define “Physician’s Care” or “Appropriate Care.”

This allows you to determine the care you receive, without being

concerned about the policy’s requirements.

3. Watch Out for Mental Disorder Limitations

You should also avoid policies that place special requirements or

limitations on mental health disorders. These may be in the form of

strenuous “Appropriate Care” requirements such as this one:

If the condition causing the Disability is a Mental Disorder, the

appropriate care must be approved by Us. We may require a written

plan of care from Your Physician.

These may also be in the form of limitations on the maximum

duration of benefits. For example, your policy might limit benefits

for mental disorders to two years of payments. In contrast, benefits

for physical disabilities typically pay until age 65, or for life.

If the policy specifically addresses mental disorders, be sure that

it includes them as covered illnesses. Avoid policies that deny, limit,

or otherwise place extra burdens on benefits for disabilities caused

by mental disorders.

4. Purchase a Cost of Living Adjustment Rider

To get the best long-term protection for your income, consider

purchasing a Cost of Living Adjustment, or COLA, rider. Riders

are additional policy provisions and/or coverages that may be added

to a policy at an additional cost. The COLA rider provides for your

disability benefit to increase by a certain percentage each year to

accommodate your increased cost of living due to inflation.

This rider is very important in long-term disability policies. For

example, imagine that you became permanently disabled at age 40.

A typical long-term disability policy will provide benefits at least

until you turn 65. Over that period of 25 years, your cost of living

will increase significantly. Without a COLA rider, your benefit

amount will remain constant over those years, making it very likely

that your benefits will no longer sufficiently cover your expenses in

your later years. A COLA rider will protect you from this.

5. Consider a Waiver of Premium Rider

Another beneficial rider is the “waiver of premium” rider.

This allows you to forgo paying the policy premium while

you are disabled, easing the financial burden disability creates.

Unfortunately, the waiver typically does not apply until after you

have been disabled for a prescribed amount of time, such as ninety

days. Nevertheless, even with a ninety-day waiting period, this rider

provides a valuable benefit, as the policy premium will be one less

expense you must cover.

These basic suggestions are just the starting point for making

smart decisions about your disability insurance coverage. Even if

you already have a policy, make sure that you take the time to read

it, paying special attention to the definitions. If the policies you

are considering or already own do not provide the benefits laid out

here, ask your insurance agent if you can add them in a rider. Your

ability to collect the benefits you need starts with the provisions of

the policy you select.

* Karla B. Thompson, Esq. is an attorney practicing in the Health

and Disability Insurance Practice Section at Comitz | Beethe,

6720 North Scottsdale Road, Suite 150, Scottsdale, Arizona

85253, (480) 998-7800. She has extensive experience in disability

insurance coverage and bad faith litigation, primarily representing

medical and dental professionals in reversing denials of their

disability claims. For more information about disability insurance

issues, please visit our website at www.disabilitycounsel.net.

DISCLAIMERThe information in this article has been prepared for informational purposes only and does

not constitute legal advice. Anyone reading this article should not act on any information

contained therein without seeking professional counsel from an attorney. The author and

publisher shall not be responsible for any damages resulting from any error, inaccuracy or

omission contained in this publication.

Disability Insurance Basics cont. from page 10


Features

“Back to Basics” is a phrase commonly used in education as a

remedy for poor performance or a lack of understanding. In

the business and professional world, it is more often a reaction to

complexity and the need to pare down less important activity and

focus on the essentials of a core business or purpose.

We live and work in an increasingly complex information age. Today

in health care, computers and software are a source of complexity but

also are essential tools not just for billing and operations, but for how

patient information and care are managed. Some 82% of Arizona

physicians today use some form of an electronic record (EHR) to help

manage patient information and care, and the driving force behind

the rapid adoption of EHRs has been the Medicare and Medicaid

EHR Incentive Programs that include a set of requirements to meet

Meaningful Use. While Meaningful Use might, at times, seem like

an additional chore and a departure from the “basics” of practicing

medicine, in fact, the opposite is true.

Meaningful Use and the Basics of a Successful Medical PracticeMeaningful Use digitizes the basic information that providers

have always captured about their patients

Meaningful Use covers basic elements of information that providers

have long captured or used through a basic process of providing care.

Demographics, a problem list, a medication list, allergies, a smoking

history, and vitals have always been basic to modern medical practice,

and these elements are a standard part of history-taking curriculum

in medical schools. The only difference is that with Meaningful Use,

captured information needs to be digitized and structured so that

information can be more readily and securely shared within the practice

and with other providers outside the practice.

By driving efficiency and practice “transformation,” EHR

adoption and Meaningful Use increase the percent of time a

provider can spend on basic patient care

While Meaningful Use does require that captured patient

information be digitized, with most EHRs, this information previously

collected by providers can now be captured and entered by staff.

Providers still must oversee the process to verify the accuracy of the

data, but EHR adoption allows providers to delegate many clerical

and administrative tasks that they once performed. And this is just the

beginning of a practice transformation that typically involves a review

of the practice’s workflow so that the segments of a patient encounter

can be managed by various staff members, with the EHR becoming the

center of the practice where patient information is captured and shared.

A number of other Meaningful Use requirements such as e-prescribing

and medication reconciliation drive additional efficiency in the practice.

The result is improved efficiency and increased productivity, especially

for the provider who is able to dedicate a greater portion of his or her

workday to direct patient care.

EHR adoption and Meaningful Use encourage automated

processes as well as reminders and alerts that improve basic patient

care

Meaningful Use encourages providers to enter critical information

for reference later, and most EHRs allow providers to set and

customize alerts and reminders to ensure that a provider has all the

right information available for a patient

encounter. For example, most drug-drug

and drug-allergy interactions were once

taught and memorized by providers.

Now, as a result of meeting Meaningful

Use requirements, providers and/or

their staff can access an automated and

regularly updated database of potential

interactions with cross-reference

options. In addition, at the time of

patient visits or chart reviews, providers

and their staff can be reminded about

screenings, immunizations, and other

interventions that are due or indicated.

The result is a much more productive

patient encounter, a basic goal of

medical practice.

Making EHR Adoption and Meaningful Use “Meaningful”While EHR Adoption and Meaningful Use can and does improve

the “basics” of medical care, it is important that providers use these

tools in a ”meaningful” way.

Meaningful Use is more than a checklist

Meaningful Use is a guide and a tool for improving patient care.

It’s not intended to be just a checklist. For example, say a provider

finds that a patient smokes. The provider can be done with a simple

notation, but using that information in a meaningful way takes a

few more steps. That would involve getting a patient enrolled in a

smoking cessation program and providing various treatment options.

Encountering a patient problem and addressing it is a basic practice

that goes beyond a mere checklist.

An EHR and Meaningful Use should not slow down or hinder

good patient care

A common complaint about some EHRs and Meaningful Use

is that the technology slows down the practice of medicine. EHR

technology can and will improve patient care, but if it doesn’t, the

problem likely lies with the practice’s workflow, or possibly with the

EHR vendor or the implementation process. If EHR adoption and

Meaningful Use are slowing the practice down, that means that there

is more work to be done with workflow redesign or with the EHR

vendor and implementation process or perhaps both.

EHR technology should not get in the way of direct patient

engagement

EHR adoption has meant the appearance of computers or laptops

in care settings. This new technology can create a divide between

the traditional provider-patient relationship. But, just as it is good

courtesy and common sense to avoid checking a smart phone when

going to dinner with someone, it is good basic patient care to be

sure that the computer or laptop does not detract from the basic

provider-patient encounter and relationship.

If you or your practice have a question about Meaningful Use,

EHR adoption, or health information exchange, please contact

Arizona Health-e Connection at (602) 688-7200 or [email protected].

Melissa A. Kotrys, MPH

CEO Arizona Health-e

Connection

Health Information

Network of Arizona

Meaningful Use and the Basics of Medical Care


Features

Arizona—We Are One of the Top 10 in the Nation!

By Joan Pearson, President

Catalina Medical Recruiters, Inc.

Making the top ten usually is a good thing and states are

proud of the distinction. However, in this particular

case, there is no reason to be proud. Phoenix, Arizona

was named one of the Top 10 cities in the nation experiencing a

physician shortage. We have known for a long time that Arizona

is a wonderful place to live. Why is it difficult to recruit well-

trained, quality physicians to our communities? How do you make

certain the candidate you make an offer to will accept the contract

and join your organization?

You’ve interviewed and identified a great candidate who you

think will be an asset to your practice. You made a contract offer

and are surprised to learn that he or she has declined your offer.

This can happen for a variety of reasons. Here are the top 10

reasons candidates may turn down an offer:

Compensation of fered was too low or dif fered from what was discussed.

Solution: Never discuss or present a salary or income potential

that cannot be achieved. Make your compensation plan as

attractive and competitive as possible within the means of the

practice potential. If you are uncertain, investigate available

compensation surveys or other possible data. It is also wise to

discuss the candidate’s expectations before making an offer to

avoid this problem.

Contract or employment of fer was too slow in coming.

Solution: The best time to review your contract and or

employment agreement is before you begin your search. The

recruitment environment is competitive and candidates usually

interview with several potential employers, making it likely

they are holding offers in hand at the time of their visit. Many

candidates will not wait if your offer is too slow in coming. If

your contract is not ready, consider offering a candidate a letter of

intent to let them know the formal offer is in process. Better yet,

be ready before you bring the candidate out for a visit.

Practice did not seem busy enough; no solid evidence of growth potential.

Solution: Ensure that your medical

staff plan supports the addition of

the specialty or position based

on solid data and fully share

this information in detail

with the candidate. If

the business or growth

simply isn’t there you

should not be recruiting.

Adding a physician or

provider simply to expand the

call schedule will be costly and

counterproductive in the long run if

there is not enough business to support the decision.

Practice buy-in was too high or length to partnership was too long.

Solution: Competition in the recruitment marketplace

mandates that your offer for partnership match the market

conditions in your area. Do your homework to see what your

competition is offering to their new hires. Partnership is generally

offered after one or two years, anything longer is unusual. Buy-

in also needs to be reasonable, explainable, and structured or

financed over a few years. Remember, this needs to be a win-win

for both the new hire and the existing partners. Keep in mind that

partnership agreements that were crafted years ago may no longer

reflect current market conditions.

Candidate got a better of fer or another location was a better fit.

Solution: Learn in advance what it will take to attract

the candidate to your practice. If the other location is truly a

better fit, learn what makes it so. If nothing can be changed to

10TOP


Features

accommodate the need, probe to see if an alternative may sway

the decision, e.g., a stipend during final training year, signing

bonus, possibly earlier partnership, or some creative solution

to meet or exceed the other offer. Caution—do not get into a

bidding war. But if you believe the candidate genuinely prefers

your location and practice, explore what you can do to make it

happen.

Candidate received and accepted a counter of fer to stay.

Solution: Call your candidate to learn if the decision is truly

final. The best strategy for this situation is not to let it happen!

Discuss this option with the candidate during the recruitment

process. Learn what the motivating factors are in his/her decision

making process and try to anticipate those. If the decision is final,

remember to conduct an “exit” interview. Find out what you could

have done differently and learn from the experience.

Candidate could not proceed because house wouldn’t sell.

Solution: Much can depend on how serious your interest is in

hiring the candidate and how intense the need. If it is possible,

delay the planned start date for a few months. Align yourself

with a creative realtor who can assist the candidate in setting

the house up for lease or rent, hopefully with an option to buy.

See if a local bank might be able to offer a relatively short-term

low-interest loan to accommodate the candidate’s needs until the

property sells. Look into the possibility of renting a house in your

community and help underwrite that cost until the candidate’s

house sells. Be creative.

Candidate did not feel welcomed by or comfortable with the group or hospital physicians or management/administration.

Solution: Consider assigning a peer liaison to act as a host

before, during, and after the site visit. If your candidate is coming

with his/her significant other, be sure to find out about their

interests, professional plans, and family needs. The courtesy you

show will be noted and appreciated. Similarly, ensure all group

physicians and executive administration knows the background

and interests of the visiting candidate and spouse so they can

communicate on a friendly basis that shows genuine interest.

Don’t leave this to chance—brief all who they will be meeting and

share what is important to know about them.

The practice/community did not seem like the right “fit” to the physician/candidate.

Solution: If a candidate tells you this it could be a blanket

excuse for any number of other problems or concerns. Probe

to learn what the candidate specifically means by this and be

prepared to research and offer additional information that might

change the candidate’s mind. Extend an invitation to make a

second site visit if you believe it may be beneficial. However, if

the candidate expresses a general malaise about everything and

offers up no specific objections or reasons they feel this way, they

probably truly are not interested and it is best to move on.

Location, location, location. The spouse/family disliked the community/did not fit their needs.

Solution: Again, the best time to address community concerns

is at the very beginning of the recruitment process. Skillful

interviewing and good listening skills will help screen out

candidates who will not be comfortable in your community. Know

what they need and whether you have it! Good screening in the

beginning of the search process will help eliminate bringing the

wrong candidates to interview and visit. Conducting good, in-

depth telephone interviews will save money, time, and frustration

later in the process.

Wouldn’t any physician love to relocate to sunny Arizona

with our growing diverse population, the Phoenix Symphony,

300+ golf courses, professional sports teams, and over 350 days of

sunshine? Be prepared and have your recruitment process in place

before you start interviewing candidates. You may be surprised

how soon your new associate will be seeing patients!

To request a Candidate Interview Form, please contact joan@

catalinarecruiters.com.


Features

There is a growing concern in healthcare safety which has

been referred to as “distracted physicianing.” The problem is

that while computers, smart phones, and other devices can

enhance communication among medical professionals, improve

accuracy of medical records, and help avoid errors, the devices can

divert clinicians’ eyes and minds from the patient. Hospitals and

physicians’ offices, hoping to curb medical error, have invested

heavily to put computers, smart phones, and other devices into

the hands of medical staff for instant access to patient data, drug

information, and case studies.

Like many cures, this solution has come with an unintended side

effect: physicians and nurses can be focused on the screen and not the

patient, even during moments of critical care. And they are not always

doing work; examples include a neurosurgeon making personal calls

during an operation, a nurse checking airfares during surgery, and a

poll showing that half of the technicians running bypass machines had

admitted to texting during a procedure. One study,

published in Perfusion, found that 55% of perfusionists

said they had texted, e-mailed, or otherwise used their

phone while running heart-lung machines during heart

bypass surgery.

“My gut feeling is lives are in danger,” said Dr.

Peter Papadakos, who recently published an article

on “electronic distraction” in Anesthesiology News.

“We’re not educating people about the problem,

and it’s getting worse.” Physicians and healthcare

professionals have always faced interruptions from

beepers and phones, and multitasking is simply a fact

of life for many medical jobs. What has changed is

that they face increasing pressure to interact with

their devices.

In response, some hospitals have begun limiting

the use of devices in critical settings, while schools

have started reminding medical students to focus

on patients instead of gadgets, even as the students

are being given more devices. Many hospitals and

outpatient facilities have implemented policies

advising physicians on how to minimize distraction

on their mobile devices.

An article published in Anesthesiology, February 2013 – Vol. 118

– Issue 2 – p.376 – 381, is a study to assess the effects of divided

attention on patient monitoring, such as detecting auditory changes

in arterial oxygen saturation via pulse oximetry. The study concluded

that “most anesthesia accidents are initiated by small errors that

cascade into serious events. Lack of monitor vigilance and inattention

are two of the more commonly cited factors. Reducing such errors is

thus a priority for improving patient safety.”

The American Association of Nurse Anesthetists (AANA) recently

issued a new policy stating that, “Continuous observation and vigilance

are the basis of safe anesthesia care.” Non-essential distractions,

especially those associated with use of mobile devices (smart phones,

tablets, PDAs) may lead to significant patient safety lapses.”

Consider this misadventure. A 65-year-old man with dementia

was admitted to a major medical center from a nursing home for

replacement of a PEG tube, which had become dislodged. The

patient had a history of an intracardiac mural thrombus and was on

long-term anticoagulation with warfarin. At the time of admission,

his INR was 1.4. Since the goal INR was 2.0–3.0, he was not

adequately anticoagulated and was at risk for stroke from the

cardiac thrombus.

He underwent successful PEG tube replacement on hospital day

one. Later that day, the resident on the team decided to prescribe

warfarin 10 mg per day, an increase over the patient’s usual dose

of 5 mg/day, for 3 days in an attempt to increase the INR into the

target range.

On hospital day two, the resident and intern were

rounding with the attending and discussed the plan

for ongoing anticoagulation. The attending wanted

to confirm that the intracardiac thrombus was still

present to justify ongoing anticoagulation. The

attending asked the resident to stop the warfarin until

they could obtain an echocardiogram of the heart.

The medical center had a robust CPOE system

that allowed entry of orders using handheld devices

and smart phones. When the attending said to stop

the anticoagulation for this patient, the resident began

to enter the order into his smart phone. As he was

entering the order, he received a text message from a

friend regarding an upcoming party, and he confirmed

his attendance through text messaging. The team

moved on to the next patient.

The resident never completed the order to

discontinue the warfarin, and the patient continued

to receive 10 mg each day for the next 3 days.

Because everyone on the team thought the

medication had been stopped, no one checked the

patient’s INR.

On hospital day four, the patient developed shortness of

breath, tachycardia, and hypotension. An echocardiogram revealed

hemopericardium with evidence of tamponade. The patient required

emergency open heart surgery. His INR was 8.5 at the time. The

team felt he had spontaneous bleeding into the pericardium from

receiving the extra doses of warfarin. The patient survived the

operation and ultimately was discharged back to the nursing home

after a 3-week hospital stay.

Perhaps it’s time to consider the issue of medical mindfulness.

Mindfulness is as much a matter of self-preservation as it is an

obligation to those physicians serve.

Distracted Physicianingby Judy Avery, RN, BSN, Education Coordinator, RMS, MICA


Features


Features

Physicians play a vital role in preventing catheter-associated

urinary tract infections (CAUTIs), which are the most

common hospital infection and are associated with an

estimated 13,000 deaths each year in the United States. Physician

leadership can help implement interventions emphasizing the

appropriate use and timely removal of indwelling catheters in

hospitals in order to make a significant difference in patients’ lives.

There is a great need for CAUTI improvement in Arizona.

The state’s standardized infection ratio

(SIR)—a risk-adjusted measure of the number

of observed CAUTI divided by the number

of expected CAUTI—is significantly higher

than the national SIR, according to the latest

data published on the Centers for Medicare &

Medicaid Services’ Hospital Compare website.

Understanding that quality improvement

is everyone’s responsibility, a concerned group

of healthcare leaders across the state have

joined together to form the Arizona Partners in

Action: STOP CAUTI collaborative to support

physicians’ work in reducing this threat to patient safety.

“Regardless of your specialty, it is every doctor’s duty to

ensure the health of patients is protected from preventable

infections,” said Dr. Peter Kelly, MD, FACP, Infectious Disease

Specialist, Arizona Department of Health Services, who is an

Infectious disease advisor to the collaborative. “It is, therefore,

imperative that physicians across Arizona work together to

implement, support, and spread appropriate interventions to

reduce CAUTI.”

Prolonged catheter use is the number one risk factor for

CAUTI, and 15–25 percent of hospitalized patients receive a

urinary catheter inserted into the bladder.

The Hospital Compare data reveal that Arizona hospitals

averaged approximately 10 CAUTIs annually, resulting in 515

infected patients throughout the state. Recent research tells us

many of these CAUTIs can be prevented. Therefore, the goal of

the collaborative is to unite healthcare professionals to reduce the

number of CAUTIs in Arizona hospitals by 25 percent—130

fewer CAUTIs from baseline—by March 31, 2016.

This goal can be accomplished by working together, pooling

resources, and sharing best practices. The Arizona Partners in

Action: STOP CAUTI collaborative’s work includes in-person

learning sessions, webinars, coaching calls, and on-site visits.

This approach will help hospitals, physicians, and medical staff

members implement evidence-based practices, such as reducing

unnecessary catheter use, ensuring catheters are in place no

longer than appropriate, and ordering of cultures only when it is

clinically indicated.

Many partners are joining these efforts, which currently

include the Arizona Hospital and Healthcare Association, Health

Services Advisory Group, Inc., the Arizona Department of

Health Services, the Association for Professionals in Infection

Control and Epidemiology-Grand Canyon Chapter, the Arizona

Healthcare Association, and the Center for Rural Health. By

working together and supporting the collaborative’s effort to

reduce CAUTI, healthcare providers throughout Arizona can

strengthen their ability to provide better patient care, improve

population health, and reduce costs.

For more information about CAUTI or how your

organization can join the Arizona Partners in Actions: STOP

CAUTI collaborative, contact Sandy Severson, RN, BS, MBA, at

[email protected] or at 602.445.4303.

Preventing CAUTI

Regardless of your specialty, it is

every doctor’s duty to ensure the

health of patients is protected

from preventable infections.


Features

On August 1, 2014, Health Services Advisory Group, Inc.

(HSAG)—the Medicare Quality Innovation Network-Quality

Improvement Organization (QIN-QIO) for Arizona, California,

Florida, Ohio, and the U.S. Virgin Islands—started its five-year

quality-improvement contract with the Centers for Medicare &

Medicaid Services (CMS). As it has done for more than 35 years,

HSAG will continue as a resource and willing partner,

furnishing information and assistance for quality

improvement to the physicians and patients it serves.

Specifically, HSAG works with physicians in

Arizona to improve cardiac health, reduce health

disparities in diabetes care, and promote the effective prevention

of chronic disease through meaningful use of health information

technology (HIT). This work is done at the local level through HSAG

providing direct technical assistance at physician offices, convening

learning and action networks for sharing best practices, and collecting

and analyzing data to help identify areas for improvement.

Improving Cardiac HealthHeart disease and stroke are, respectively, the first- and fourth-

leading causes of death in the United States for all demographic

groups, according to the Centers for Disease Control and Prevention

(CDC). The disproportionate impact of these diseases on racial and

ethnic minorities is a key target of HSAG’s work with Medicare

beneficiaries and their families, providers, and community stakeholders.

In alignment with the Million Hearts® goal to prevent one

million heart attacks and strokes by 2017, HSAG focuses on

improving the ABCS of cardiac risk reduction (Aspirin therapy when

appropriate, Blood pressure control, Cholesterol management, and

Smoking screening and cessation). As part of this national effort,

HSAG is working alongside physicians to target blood-pressure

measurement and control. This focus can help prevent heart attacks

and strokes and decrease the number of people who die unnecessarily

as a result of untreated hypertension.

Reducing Disparities in Diabetes CareIn the United States, nearly one-third of adults 65 years and

older have diabetes, according to the National Institutes of Health.

Diabetes is the most common cause of blindness, kidney failure, and

amputations in adults and a leading cause of heart disease and stroke.

Like heart disease, diabetes disproportionately affects racial and ethnic

minorities. Targeting these populations and Medicare beneficiaries of

any ethnicity living in rural areas, HSAG, through the Everyone With

Diabetes Counts program, helps patients and families, providers, and

communities address this serious chronic condition.

HSAG works with familiar and trusted people and organizations

within communities to provide diabetes self-management education

where it is convenient. This community-based approach encourages

participation and provides a structure to support people in their

ongoing commitment to self-management. By working with

healthcare providers, practitioners, certified diabetes educators,

and community health workers, people with diabetes acquire the

knowledge and skills necessary to improve the quality of their lives.

Coordinating Prevention through Health ITEffective use of health IT improves access to medical records,

facilitates care coordination among providers, and helps reduce hospital

readmissions and adverse drug events. HSAG has many years of

experience working with physician practices and Regional Extension

Centers (RECs) to support the use of certified electronic health

record technology as a tool for better patient care. Currently, HSAG

is providing targeted technical assistance to physicians who qualify for

the Medicare Electronic Health Record (EHR) Incentive Program

and have significant barriers to using EHR functionality for quality

improvement. HSAG continues to collaborate with RECs to increase

the number of practices that employ an IT-enabled care management

approach for primary care prevention and early diagnosis. Examples

of this approach include using EHR functionalities, like registries, to

identify patients who need a mammogram, immunizations, or other

preventive service. By participating in HSAG’s QIN-QIO health IT

initiatives, physicians also will be well-positioned for future payment

incentives linked to clinical data reporting.

Learn More and Become InvolvedHSAG invites and encourages all providers, community

stakeholders, Medicare beneficiaries, family members and caregivers

in Arizona to become partners in its improvement initiatives. To

learn more about the support available from HSAG, please contact

Padma Taggarse, MMI, MBA, at [email protected].

Health Services Advisory Group – QIN-QIO

This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Innovation Network-Quality Improvement Organization for Arizona under contract with the Centers for Medicare & Medicaid

Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-11SOW-XC-09152014-01


Features

As a result of the overwhelming response for the February

2014 continuing medical education lecture The Good, the Bad,

and the Ugly: A Panel Discussion on Opioid Prescribing, the

Arizona Board of Osteopathic Examiners is offering an Extended-

Release and Long-Acting Opioid Analgesics Risk Evaluation

and Mitigation Strategy (ER/LA REMS) lecture—Opioids: The

Epidemic That YOU Can Cure. Co-sponsored by the Arizona

Osteopathic Medical Association, the lecture will be held a total six

times at locations across the state of Arizona. Presented by AOMA

members Patrick Hogan, D.O., Barbara Prah-Wix, D.O., and Scott

Steingard, D.O., to date more than 200 medical professions have

already attended the lecture.

According to the Centers for Disease Control, reported drug

overdose deaths from opioids increased from 3,822 in 1999 to

16,651 in 2010. These deaths are in direct correlation with the

increased sales of opioids. The quantity sold in 2010 was four times

that sold in 1999. That’s enough opioids to give every American

adult a 5mg Vicodin every 4 hours for a month!

The risks of ER/LA Opioids Analgesics are:

• Overdose with ER/LA formulations

• Abuse by patient or household contacts

Especially adolescent children

• Inadvertent exposure by household contacts

• Misuse and addiction

• Physical dependence and tolerance

• Interactions with other medications and substances

Medication reconciliation

• Financial (diverting drugs for illegal sale)

The free program, funded through a grant secured from the

FSMB Foundation in collaboration with University of Nebraska

Medical Center Center for Continuing Education, the France

Foundation and CE City, continues the critical need for stemming

the widespread abuse, misuse, and diversion of prescription drugs.

The learning objectives for the lecture are:

• Appropriately assess patients for the treatment of pain with

ER/LA opioid analgesics, including analyzing risks versus

potential benefits

• Assess patient’s risk of abuse, including substance use and

psychiatric history

• Identify state and federal regulations on opioid prescribing

• Incorporate strategies to effectively initiate therapy, modify

dosing or discontinue use of ER/LA opioid analgesics in

patients with pain

• Manage ongoing therapy with ER/LA opioid analgesics

• Incorporate effective counseling for patients and caregivers

about the safe use of ER/LA opioid analgesics

• Discuss general and product-specific drug information related

to ER/LA opioid analgesics

Several more sessions for Opioids: The Epidemic That YOU Can

Cure are scheduled through early December. There is no charge for

this program, but advance registration is requested. Space is limited.

Register by email at [email protected] or call (602) 771-2521.

The Epidemic that YOU Can Cure


Business Partner Listings

AOMA Business PartnersProvide Services for a Health Practice and your Finance

USE YOUR MEMBER DISCOUNT

ACCOUNTING

McGladreyJason Bernstein, CPA501 N. 44th St., Ste. 300Phoenix, AZ 85008(602) [email protected]

McGladrey is a leading provider of tax planning and compliance (individual and practice), assurance and consulting services to physicians, physician groups and health care companies. AOMA members will receive a 20% discount off regular fees.

BANKING

Bankers TrustKeith Kormos, Senior Vice President2325 E. Camelback Rd., Ste. 100Phoenix, AZ 85016(602) [email protected]

Bankers Trust provides core banking services, mortgages, treasury services and trust accounts. To AOMA members (private banking clients) will receive: free checking, free printed checks, free electronic statements and free mobile banking.

BANK CARD PROCESSING

AffinipayVisit the AOMA website, Member Services Business Partner Listings or call (800) 644-9060 Ext. 6974

AOMA members are entitled to a very special processing package from Affinipay. Their on-line reporting lets you quickly see your deposit and payment information.

BILLING & COLLECTIONS

Delivery Financial Services, LLC.Dean Grandlienard – Sales Manager(602) 490-3956 Direct [email protected]

A technologically superior medical collection agency. They provide cutting-edge services like real-time online performance results. Delivery Financial Services maintains an excellent record for ethical and professional standards with its clients with an outstanding A+ rating. All AOMA members will receive a significant discounted fee.

J.R. Brothers Financial, Inc.Robert Antenucci – President (602) [email protected]

J.R. Brothers Financial, Inc. ( JRB) is a medical collection agency since 1986. AOMA members are offered a lower collection fee with exceptional service and recovery. Clients can access the status of their accounts online through the JRB Client View Program.

XOLMed Revenue Cycle Management Corp.J. Patrick Laux(602) 396-5900 [email protected]

We provide exceptional billing, coding, and collection services for physician practices. We offer AOMA members a comprehensive billing and chart preview at no charge to determine how we can increase practice revenue, and shorten collection cycles.

CAR RENTAL

Avis & HertzDiscount coupons available through the AOMA Office, call (602) 266-6699 or our toll free number (888) 266-6699. You may also request coupons by emailing [email protected], or go to the AOMA website www.az-osteo.org and under Member Services, select Business Partner Services.

FINANCIAL

Mosaic Financial AssociatesAnthony C. Williams, President4650 E. Cotton Center Blvd., #130Phoenix, AZ 85040(480) 776-5920Fax: (480) [email protected]

Mosaic Financial Associates provides a holistic approach to wealth management. They believe your financial advisor should provide a pathway to the financial goals you dream of and work hard to achieve, while taking into account all aspects of your life and building a long-term relationship based on trust and top-notch service.


Business Partner Listings

HEALTH INFORMATION TECHNOLOGY Information Strategy Design (ISD)Michele Liebau(480) 970-2255 [email protected]

Information Strategy Design (ISD), a leading healthcare technology solutions provider with its central office in Mesa. ISD has been providing network design and implementation to Heathcare Practices in the South West since 1996. ISD’s focus is on medical practices to allow them to provide cost-effective computer networking, telephony, off-site backup and remote monitoring. ISD’s value offering to AOMA members allows for one time and ongoing discounts based on using two or more ISD services.

INSURANCE

AFLACKaren Jones, Independent Agent16211 N Scottsdale Rd., Ste. A6A 614Scottsdale, AZ 85254(602) 229-1970 x213

No Deductible, No Copay, No Preauthorization. AFLAC supplemental insurance policies are available at special Association Rates for AOMA members and their families.

Mutual Insurance Company of Arizona (MICA)(602) 956-5276(800) 352-0402www.mica-insurance.com

Each medical practice is unique with individual risk management needs based on specialty and practice characteristics. Their experienced Risk Management Consultants can assist you in assessing and providing service designed to reduce your risk of a malpractice claim or suit. MICA is owned by all of the physicians it covers and provides educational grants to AOMA.

LEGAL – DISABILITY INSURANCE CLAIMS AND HEALTHCARE LITIGATION

Comitz|BeetheEdward O. Comitz, Esq. Scottsdale Spectrum 6720 N. Scottsdale Rd., Ste. 150 Scottsdale, AZ 85253 (480) 998-7800 Fax (480) 219-5599 [email protected] www.disabilitycounsel.net

Mr. Comitz has extensive experience in disability insurance and healthcare litigation, representing physicians in reversing the denial or termination of their disability insurance benefits. Mr. Comitz has earned a national reputation for prosecuting claims based on fraud and unfair practices in the insurance industry. A free consultation is provided to AOMA members.

MEDICAL RECORD SCANNING & MANAGEMENT

ASDD Document DestructionRyan Shinn(480) [email protected] www.assuredsecurityaz.com

ASDD Company is an offsite and onsite “AAA” certified document shredding, electronic media and x-ray destruction. We are HIPPA and FACTA compliant. We offer AOMA members discounts on offsite and onsite services.

PAYROLL PROCESSING

Human Capital StrategiesNick.Mawrenko (480) [email protected] www.hcscando.com

Human Capital Strategies is a national provider of Professional Employer Organizations (PEO) Services, Administrative Services, Organizations (ASO) Services, and Payroll Services. Managing every aspect of payroll, human resources, taxes, employee benefits, 401(k) plans and workers’ compensation management is what makes Human Capital Strategies “the next best thing to no employees!” Human Capital Strategies offers a 10% discount and $0 setup fees for AOMA Members.

Payroll Strategies GroupNick Mawrenko (480) [email protected]

Payroll Strategies Group is a local payroll service that is designed for the small medical practice. If you have one employee and don’t want to do your own payroll, call Nick. Our custom service enables us to reduce overhead and pass the savings on to you. Call Nick to see if our approach will fit your practice. Payroll Strategies Group offers AOMA members a $0 setup fee.

PRACTICE MANAGEMENT

Wolfe Consulting Group Elizabeth Medina, Consultant(602) [email protected]

AOMA members will receive a free initial problem definition meeting and also receive a discount on a wide array of business consulting services. Services, from Improving Income to Practice Sale for Retirement, will serve as the basis for the free initial consultation. A listing of these services can be reviewed at www.wolfeconsultinggroup.com. Real Estate services from Office Leasing to Building Purchase are also available through a wholly owned subsidiary of Wolfe Consulting Group, Ltd., Healthcare Realty Advisors, Inc., at no direct cost to AOMA’s members.

REAL ESTATE

RE/Max ExcaliburKevin Weil, Realtor(602) [email protected]

Kevin Weil of RE/Max Excalibur is one of the top realtors in the valley and specializes in serving the needs of physicians. AOMA members are entitled to video previewing of homes of interest and other services uniquely designed to save the time of, and maximize the interests of AOMA members. Kevin and RE/Max Excalibur have selected Arizona Osteopathic Charities as the charity to receive a donation based upon member participation.


Welcome New Members

Welcome New AOMA Members

Danielle Barnett Duell, D.O.

Family Medicine

Phoenix, AZ

(602) 406-3382

Brendan Curley, D.O.

Internal Medicine–Board Certified

Scottsdale, AZ

(480) 585-4673

Robert Devine, D.O.

Family Medicine

Glendale, AZ

(602) 547-8184

Bryan Friedman, D.O.

Otolaryngological &

Facial Plastic Surgery

Scottsdale, AZ

(480) 464-8000

Jason Chanh Ly, D.O.

Physical Medicine & Rehabilitation

Tempe, AZ

(480) 962-0071

Peter Reding, D.O.

Family Medicine–Board Certified

Tucson, AZ

(520) 838-7387

_______ _____ __________________ _____ ___________ First Year Members _______ _____ __________________ _____ ___________

Keikhosrow Mosallaie, D.O.

Physical Medicine & Rehabilitation–

Board Certified

Pain Management–Board Certified

Tempe, AZ

(480) 962-0071

Nina Patel-Hinkle, D.O.

Family Practice–Board Certified

Sports Medicine/Family Practice–

Board Certified

Phoenix, AZ

(866) 974-2673

Sharon Obadia, D.O.

Internal Medicine–Board Certified

Mesa, AZ

(480) 245-6254

_________ Full Membership _________

Anthony Dekker, D.O.

Family Medicine–Board Certified

Woodbridge, VA

(571) 231-4689

____________ Out of State ____________

Farewell Jonathon R. Kirsch, D.O. Thank You for Your Leadership!

We are sad to report that one of AOMA’s finest leaders Jonathon R.

Kirsch, D.O. is moving to Stevens Point, Wisconsin, to open his own

OMM practice and be closer to his extended family

in the Midwest.

Dr. Kirsch is currently the AOMA Vice

President and Associate Professor of OMM at A.T.

Still University School of Osteopathic Medicine

Arizona. He is a Health Policy Fellow and has been

an active leader and member of the AOMA since

1998.

“The AOMA has been an instrumental part of

my career since the very beginning,” Dr. Kirsch said.

“The benefits I have received from the AOMA have far exceeded everything

I’ve ever given. The many friends and connections I’ve made have been a big

part of my professional development.”

During his 16 years with the AOMA, he has served eight years on the

Board of Trustees, has been an AOA Delegate for four years, and chaired the

Public Awareness Committee for two years. Recently, Dr. Kirsch served on

the AOA House of Delegates Professional Affairs Reference Committee for

2013-2014.

On behalf everyone in the AOMA family, we wish you the very best, Dr.

Kirsch. There will always be a home for you in Arizona.


Osteopathic Community News

The D.O. Dashboard has a new look. Now a monthly

eNewsletter, the D.O. Dashboard contains valuable

information about

Are You Receiving the

D.O. Dashboard?AOMA events, upcoming CME opportunities,

osteopathic medical profession updates, and more.

To be sure you don’t miss the next

issue, logon to the AOMA website

and updated your member profile and

email address. When you do, you will

be entered into a drawing for a $100

VISA gift card. You could be our next

winner! Drawing is December 1, 2014.



2015 AOMA Clinical Case Competition and Poster Forum

Eric Romney’s winning research poster from the

2014 Competition

Each year the Arizona Osteopathic Medical Association sponsors a clini-

cal case and poster forum. We are looking for interesting clinical cases

and original research that osteopathic medical students, residents, and faculty

have participated in, seen, and diagnosed. If you or your students have a clini-

cal case or original research, we invite you to participate. This is a scientific,

peer-reviewed opportunity.

The Professional Education Committee will review all of the clinical case

submissions and select three finalists to present and participate in the clinical

case competition on Friday, May 8, 2015 at the AOMA Convention in

Phoenix, Arizona. First place award for this competition is $500.

Authors whose case is not selected for the oral clinical case competition are

encouraged to submit their research to the Poster Forum.

All poster submissions that are accepted will be displayed and judged on

Saturday, May 9, 2015. The top three entrants in each poster category and

clinical case will be invited to the Awards Lunch on Sunday, May 10, 2015 at

which time the winners will be announced and monetary award will be given.

Please take advantage of this opportunity to show off the great, scholarly

work being done in the clinical and research settings. Complete details for

entry submission, including past examples of winning entries, is available

on the AOMA website under the CME/Clinical Case & Poster Forum

tab at www.az-osteo.org. If you have additional questions, please contact

Teresa Roland at the Arizona Osteopathic Medical Association by calling

(602) 761-2697 or via email [email protected].

IMPORTANT DATES:Poster Abstract Submission Deadline:

March 13, 2015 (including evidence of

IRB submission)

Clinical Case Presentation Deadline

(in PDF format): March 13, 2015

(including evidence of IRB submission)

Notification to Authors of Acceptance/

Exclusion: March 23, 2015

Poster Submission Deadline (in PDF

format): April 6, 2015

Clinical Case Finalists Submission

Deadline (PowerPoint Presentation):

April 20, 2015

Clinical Case Presentations:

May 8, 2015

Poster Forum Judging:

May 9, 2015

5

Name

Company Name (only if using a company address)

Mailing Address Suite or Apt.

City State Zip

Telephone (including area code)

Email

For more information or to make a pledge online go toBIRDIESFORCHARITYAZ.COM

per birdie pledge1¢ minimum

one time donation$20.00 minimum

make checks payable to THUNDERBIRDS CHARITIES

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Arizona Osteopathic Charities5150 N. 16th St., Suite A-122, Phoenix, AZ 85016

please return to:

.

JANUARY 26, 2015 – FEBRUARY 1, 2015TPC Scottsdale602.216.7328

Going into our 11th year Birdies For Charity has made a difference for local charities:

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Thunderbirds Charities is recognized by the IRS as an Internal Revenue Code Section 501(c)(3) charitable organization. Consult

your tax advisor on the application of tax deductions.

G U I D E L I N E S• Return pledge forms to Arizona Osteopathic Charities

or donate online at birdiesforcharityaz.com.• Pledge deadline is February 1, 2015

• If one or more days of the Waste Management PhoenixOpen are cancelled, the birdie count substituted for thosedays will be: Thurs: 500 | Fri: 500 | Sat: 300 | Sun: 300

• Complete set of rules can be requested at [email protected]

HOW DO BIRDIES MEAN BUCKS?You can make a Arizona Osteopathic Charities a big bucks winner by making a pledge in the Birdies For Charity competition at the 2015 Waste Management Phoenix Open! Arizona Osteopathic Charities will receive every single penny of collected pledges.

HOW DO I PLAY BIRDIES FOR CHARITY?Simply pledge one cent or more for every birdie that willbe made by the PGA TOUR players, Thursday throughSunday of the 2015 Waste Management Phoenix Open.It’s estimated that between 1,300 and 1,800 birdies willbe made. Inclement weather may affect the total.

HOW MUCH WILL I OWE & WHOM DO I PAY? Say you pledge one cent per birdie and 1,500 birdies are made, after the tournament, you’ll receive an invoice for$15.00 from Thunderbirds Charities. You can either make your check payable to “Thunderbirds Charities” or provide credit card information, (Do not pay AzDoCharities directly.) For other possible pledge amounts check the chart below.

BIRDIES CAN ALSO MEAN BONUS BUCKSWe can receive a 15 percent BONUS on the total amount of pledges collected on our behalf during the 2015 Waste Management Phoenix Open Birdies For Charity Program. It’s as simple as it sounds. Example: If Arizona Osteopathic Charities collects $20,000 in pledges, it will receive 15 percent of that, or $3,000, for their charity courtesy of Thunderbirds Charities.

if 1500 birdies are made my total pledge would be:1¢ = $15 | 2¢ = $30 | 3¢ = $45 | 4¢ = $60 | 5¢ = $75 | 10¢ = $150

Birdies Mean Bucks for Arizona Osteopathic Charities

2015 11 years strong



When Andrew Taylor

Still “flung the banner

of Osteopathy to the

breeze” in 1874, do you think he

had Arizona in mind? Could

he have imagined the gleaming

campuses of the Arizona College

of Osteopathic Medicine or the

School of Osteopathic Medicine in

Arizona?

It’s doubtful.

More people lived within 20

miles of Kirksville, Missouri than

in the entire Arizona Territory. The 1870 US Census listed Arizona

with a population of 9,658.

Yet as Still’s reputation grew he knew he could teach the science

to generations of successors. He opened the American School of

Osteopathy at Kirksville in 1892. It graduated its first class in 1894;

by then, according to his autobiography, Dr. Still wanted osteopathy

to spread throughout the world.

The profession reached here first not in its largest city, Tucson,

but in Phoenix—population 5,500.

On August 20, 1898 Colonel A.L. Conger arrived in Phoenix

with brothers Washington and David Conner, 1897 and 1898

graduates of the American School of Osteopathy. Col. Conger

was a prominent Ohio Republican who had suffered a stroke and

preferred treatment by osteopaths. Together they took over the lease

of the Alhambra Hotel, located at Third Avenue and Adams. For

two years it had been run, unsuccessfully, as a sanitarium by Darius

Purman, M.D. and Ancil Martin, M.D. According to Medicine

in Territorial Arizona the sanitarium had “rich Brussels carpet,

furniture of antique oak and mahogany, with beautiful portieres

(door curtains) and fancy table coverings.” Bathrooms had hot and

cold water with flush toilets. In an advertisement in the Journal of

Osteopathy, the brothers Conner said Phoenix was the “great natural

sanitarium of the United States with an unapproachable climate

for invalids” and that their infirmary allowed “invalids to avail

themselves to osteopathic treatment while enjoying this unrivaled

climate.”

Unfortunately the infirmary at this location was no more

successful under the Conners than it had been under Purman and

Martin. The infirmary was closed by March, 1899.

Tucson got its first osteopathic physician in 1900. The May 22,

1900 Arizona Daily Citizen carried a front page ad:

After this one record, Dr. Parcels disappears from Arizona

history. Today we would assume that physicians like the Conner

brothers and Parcels were somehow unable to build a practice or

fell out of favor. Nothing could be further from the truth. They were

looking for the greenest pasture.

Trains brought rafts of physicians to Arizona. At the time

there was one doctor for every 568 Americans (according to

Abraham Flexner, who, ten years later wrote the seminal Medical

Education in the United States and Canada). These doctors came

from various disciplines—medical doctors (called “regulars”),

osteopathic physicians, naturopaths, chiropractors, eclectics, and

homeopaths. Many were seeking Arizona mining or ranching

riches, using practice to keep them in beans and mules before they

returned home.

Although TOMF is usually locked on the future – planning its next conference or program – it has also done

its share in preserving the rich tradition of osteopathic medicine in the state, because, like the mountain climber

gazing at the summit, heart can often be found by looking back and observing how far we’ve come.

Steve NashExecutive Director Tucson Osteopathic Medical Foundation

Arizona’s Rich Osteopathic Tradition



For example, Toronto Medical School graduate John W.

Lennox, M.D., who was a co-founder of the Pima County Medical

Society, kept a Tucson office but mainly practiced – and mined – at

Helvetia. Eventually he gave up his dreams of striking it rich and

returned to Canada. He was twice the president of the medical

society in Victoria, British Columbia, where he practiced until

he died in 1958. The Great Register kept by the Arizona licensing

board merely lists Dr. Lennox as “left state” in 1909. There are many

such entries.

One who stayed was George W. Martin, D.O. He arrived in

Tucson two months after Dr. Parcels, a newly minted Pacific

School of Osteopathy graduate, and set up his first office across

the street from the one Dr. Parcels had. Over 40 years he

practiced from his homes at 47 W. Pennington, 104 N. Stone, and

518 E. First Street – all among the homes/offices of the majority

of Tucson’s physician community. In 1919, Dr. Martin was the

lone osteopathic representative on the Arizona Board of Medical

Examiners, which licensed all Arizona physicians at the time. He

died in Tucson in 1944.

In the Territory there were decidedly few Arizonans who

became doctors through medical school training. A case can be

made that the first Arizonan to get training and return was an

osteopathic physician. And it was a woman.

Eva Stevens came to Arizona in the early 1890s to teach at

a school near former Camp Crittenden, between Sonoita and

Patagonia. According to Scott Johnson in Something More…

Osteopathic Medicine in Southern Arizona (published by TOMF)

she went east to study under Dr. Still at Kirksville and graduated in

1902. After a stint in Oklahoma territory she returned to Arizona

in 1907, married, and practiced as Eva Stevens Henderson, D.O. in

Patagonia.

Too often we mistake our pioneer forbearers as stern role

models, driven with Manifest Destiny, and forget they were real

people. Take this riposte: Dr. Henderson was once asked what

difference was there between a chiropractor and an osteopathic

physician. “About three years,” she said, not batting an eye. She

lived to age 94, dying in 1965—in her beloved Patagonia.

As of September, 2014 nearly 55,600 MDs and D.Os. have

been given Arizona medical licenses. Dr. Henderson carried license

number 945 until July 1942 when she was given license number 12

by the new Arizona State Board of Osteopathic Examiners. Today

nearly 6,600 D.O. licenses have been granted by Arizona.

Sometimes it is good to remember where you stand…on giant

shoulders.



So far, 2014 is making for

a very interesting year.

ICD-10 was on then off and

might be back on again. Hospitals

and large physician groups are

buying practices. Electronic

medical record adoption is

climbing but incentive money is

getting harder to obtain. M.D

and D.O. residency certification is

combining.

Many challenges continue

to face osteopathic family

physicians. ICD 10 adoption was

required and many offices and

organizations scrambled to implement changes only to be told

that it was delayed, yet again, for at least another year. The large

hospital-owned physician network I work for decided to go ahead

with the implementation despite this. Many others will take a

wait-and-see approach.

Speaking of hospital-owned practices, the buying of

smaller and medium-sized practices continues in an on-going

consolidation of the medical sector. Osteopathic family physicians

look at the growing demands of HIPPA, OSHA, Affordable

Care Act, Meaningful Use, and Accountable Care Organizations

and decide that independent practice is not as easy as they once

found. Joining a large organization can be difficult as one-time

independents find that their voice and control over their practice

dwindles. The best health delivery systems have physicians in

leadership positions at every level and encourage us to participate.

Electronic Health Record adoption continues to grow

as physicians and networks see the benefits of increased

communication, error checking, and Meaningful Use monetary

incentives. This is balanced against a perceived (sometimes) and

real (usually) loss of productivity. Add this to the increased cost

of capable EHRs and osteopathic family physicians are seeing a

crunch. Many doctors are finding innovative ways to boost their

productivity such as shortcuts in their EHRs or using dictation

or having their medical assistants do more of the routine work of

documentation. However, love-it-or-hate-it, EHRs are here to

stay. These days, EHR purchase is likely to be one of, if not the

biggest, capital investment in a practice. A good EHR choice can

be a great satisfier in a physician practice but a poor one, or one

with poor support, can kill morale and tank productivity.

Over the next few years, The AOA and the ACGME are

working to combine residency certification. The ACOFP has

been clear that any combined program must not waver on the

following:

• The ability of AOA-trained and certified physicians to serve

as program directors;

• The maintenance of smaller, rural and community-based

training programs;

• The number of solely AOA-certified physicians serving as

program directors in each specialty;

• The number of osteopathic-identified GME programs and

number of osteopathic-identified GME positions gained and

lost;

• The number of osteopathic residents taking osteopathic board

certification exams;

• The status of recognition of osteopathic board certification

being deemed equivalent by the ACGME; and

• The importance of osteopathic board certification as a valid

outcome benchmark of the quality of osteopathic residency

programs.

Continue to stay tuned, I am sure the remainder of 2014 will

be interesting as well.

Arizona Society of ACOFP

Aaron B. Boor, D.O.

2014-2015 President

Arizona Society of the

American College of

Osteopathic Family

Physicians

The best health delivery systems have

physicians in leadership positions

at every level and encourage us to

participate.





Dr. Hover named

Health Policy Fellow

Mara Hover, D.O., associate

chair, Community Medicine,

ATSU’s School of Osteopathic

Medicine in Arizona (ATSU-

SOMA), has been selected as a

Health Policy Fellow, Class of 2015,

by the Arizona Osteopathic Medical

Association (AOMA). According

to AOMA, the Health Policy

Fellowship program is designed for practicing or teaching

osteopathic physicians who are preparing for leadership

roles in the profession and positions of influence in health

policy, and for individuals with a professional connection

to the osteopathic profession.

Dr. Hover has also assumed a new position within

ATSU-SOMA as chair of Clinical Curriculum

Development, Assessments, and Outcomes.

ATSU Associate Vice president-Academic Innovations appointed

Ann Boyle, D.M.D., has been named A.T. Still University’s (ATSU) Associate Vice president-

Academic Innovations, in the Office of Academic Affairs.

Dr. Boyle comes to ATSU from Southern Illinois University-Edwardsville (SIUE). She served nine

years as dean of SIU’s School of Dental Medicine, and for the last three years as interim provost of SIUE.

As Associate Vice president-Academic Innovations, Dr. Boyle has administrative oversight of the

following programs: University Library, Interprofessional Education and Collaboration, Office of

Assessment & Accreditation, Aging Studies Project, Teaching & Learning Center, and National Center

for American Indian Health Professions. She also is working with deans, directors, and faculty on

developing academic initiatives on both ATSU campuses.

Dr. Boyle is based on the ATSU Arizona Campus and began her tenure on August 1, 2014.

Lisa Ncube, Ph.D., has been appointed as the

inaugural director of the A.T. Still University

(ATSU) Office of Assessment & Accreditation

in the Office of Academic Affairs, effective July

1, 2014. Previously, Dr. Ncube served as associate

dean of assessment, accreditation, and quality

improvement in the ATSU Arizona School of

Health Sciences.

The Office of Assessment & Accreditation

(OAA) will support assessment, accreditation, and quality

improvement efforts of ATSU through evidence-based planning and

evaluation.

The core function of the OAA will be to effectively manage data

which will allow for accurate and timely provision of information and

reports to members of the ATSU community including the Board

of Trustees, administrators, faculty, staff, and students, as well as to

appropriate external constituencies.

Dr. Mara Hover, D.O.Dr. Lisa Ncube, Ph.D.

Dr. Ann Boyle, D.M.D.

Inaugural Director of the Office of Assessment &

Accreditation announced



Beyond the Campus Walls: Alice Chen, OMS IV

Alice Chen, OMS IV, A.T. Still University-

School of Osteopathic Medicine in Arizona

(ATSU-SOMA), says that choosing to study

osteopathic medicine was a

natural and easy decision for her.

“I have always been interested in

science and philosophy, and this

profession sits at the intersection

of these two spheres,” said

Chen. “The philosophical

underpinnings of osteopathic

medicine have provided a

foundation on which I have and want to continue to

learn and practice medicine.”

Chen is currently doing her clinical rotation

in physical medicine and rehabilitation at the

Lutheran Family Health Centers in Brooklyn,

New York, where she spends her days in a variety

of settings including Lutheran’s outpatient clinics,

inpatient acute rehabilitation floors, and outpatient

osteopathic manipulative medicine clinic (OMM).

The Lutheran Family Health Centers is one of

ATSU’s 12 Community Health Center campuses

where ATSU-SOMA students complete their

clinical rotations.

“I get to interact with patients from a variety of

cultural backgrounds and through this rotation, I

feel like I am getting a comprehensive overview of

physical medicine and rehabilitation,” said Chen.

“I also get to work with other health care providers

such as occupational therapists, physical therapists

and speech therapists.” One of the outpatient clinics

where Chen works is the OMM clinic at Brooklyn

Chinese, where she works with Regina Asaro, D.O.,

who is second-year OMM faculty at the Brooklyn

site. Having completed a pre-doctoral OMM

fellowship at ATSU-SOMA, Chen is excited for

this opportunity.

Chen, who was also selected as the student

representative on the American Osteopathic

Association Board of Trustees for 2014-15, says

that through her education at ATSU-SOMA she

has received invaluable mentorship that has helped

her re-frame how she understands the diversity and

complexity of individuals. In addition, after seeing

how hands-on manipulation can be used to help

others, she wants to utilize OMM in her future

practice.

White coat ceremonies mark milestone for students

Alice Chen

More than 300 ATSU students confirmed their professional

commitment at the annual white coat and pinning ceremony

at the Mesa Arts Center’s Ikeda Theater on July 14, 2014, in Mesa,

Arizona.

The Arizona School of Dentistry & Oral Health’s (ASDOH) class

of 2018, the School of Osteopathic Medicine (SOMA) in Arizona’s

class of 2018, and the Arizona School of Health Sciences physician

assistant (PA) class of 2016 and physical therapy (PT) class of 2015

were presented white coats in four separate ceremonies. The PA class of

2015 participated in a pinning ceremony, representing the completion

of a didactic year of study and entry into the clinical phase of the

program. Overall, the numbers of students who received their white

coats or pinning were: 61 (PT); 109 (SOMA); 76 (ASDOH); 52 (PA

white coats); and 50 (PA pinning).

On July 12, 2014, the Kirksville College of Osteopathic Medicine

(KCOM) class of 2018 and the Missouri School of Dentistry &

Oral Health (MOSDOH) class of 2018 celebrated their white coat

ceremonies with 172 KCOM and 42 MOSDOH students receiving

their white coats at Baldwin Hall Auditorium, Truman State University

in Kirksville, Missouri.



Poverty simulations held on Arizona campus

A.T. Still University’s School of Osteopathic Medicine in Arizona

(ATSU-SOMA) students, faculty and staff participated in

a unique poverty simulation on the Arizona campus, Wednesday,

July 30, 2014 in the Javelina and Owl classrooms. Two simulations

were held to accommodate the 110 SOMA students and other

ATSU faculty from the Arizona School of Dentistry & Oral Health

(ATSU-ASDOH), Arizona School of Health Sciences (ATSU-

ASHS), and Student Services who also participated.

According to Lorree Ratto, Ph.D., associate professor and chair,

medical humanities and healthcare leadership, ATSU-SOMA,

and who coordinated the event, the poverty simulation is a unique,

interactive experience that helps people begin to understand what

life is like with a shortage of money and an abundance of stress. “The

simulation moves you to be more sensitive to the feelings and needs

of those who are living in poverty,” said Dr. Ratto.

The participants took on the roles of members of families who

face a variety of socio-economic and healthcare challenges, but

typical circumstances for most underserved and people living in

poverty. Participants were seated in family clusters, and community

resources were located at tables around the perimeter of the room.

The simulation offered four 15-minute weeks, compressing time and

adding to the chaotic and sometimes hectic life families living in

poverty face.

“There are more than 50 million people in the United States living

in poverty,” said Dr. Ratto. “Our students need to be prepared to

assist these patients with resources when they are at their Community

Health Centers next year, and hopefully this exercise will make

our students more empathetic towards their patients,” Dr. Ratto

concluded.

July 14, 2014 was special day for the ATSU

School of Osteopathic Medicine (ATSU-

SOMA) first-year students. Prior to the white

coat ceremony held on that day, the ATSU-

SOMA Class of 2018 was introduced to the

Virtual Community Health Center (VCHC)

concept, known as Envision™ CHC. Frederic

Schwartz, D.O., ’69, FACOFP, associate dean

for clinical education and chair of family

and community medicine, ATSU-SOMA,

provided an overview of Envision CHC to

the first-year students who will be engaged

with patients and families from the VCHC.

Tom Trompeter, CEO of HealthPoint

Community Health Center (CHC) in Seattle,

Washington, and who was also the keynote

speaker at the white coat ceremony, led a

discussion among students to help them orient

to primary care, painting a picture of how a

CHC works on transforming a community.

Following this discussion, students were

requested to work in teams to discuss how

they, as medical students, could benefit their

future CHC communities. Some of their

comments include:

“Know the community we are serving,

including cultural strengths and needs.”

“Inspire and encourage community

members to let them know they have a voice

and the ability to create change among their

own community.”

“Bridge the gap between the community

and health teams through education.”

ATSU-SOMA students introduced to Virtual Community Health Center



Midwestern University Arizona College of Osteopathic Medicine

First-Year AZCOM Students Practice Patient Analysis at Art Museum

To develop a foundation for the basic observation skills needed

to become good physicians, 250 AZCOM students attended a

“Learning to Observe” orientation event at the end of July at the Phoenix

Art Museum.

Lori Kemper, D.O., Dean of AZCOM, joined students as they

toured through many of the museum’s galleries, from Modern to Asian,

European, and Western. Students traveled in small groups to the museum

for the afternoon, where they received thought-provoking instruction on

how to observe, analyze, and interpret different artworks, including details

such as emotion, color, and setting . After practicing the new skills in the

galleries, the students came together again to discuss ways to apply their

new observation skills to patient interactions.

BRIGHT LIGHTS, SHINING STARS GA LA

In October, Midwestern University

held its annual Bright Lights, Shining

Stars gala. The black-tie-optional

gala was an opportunity for the

University and community leaders

to come together to recognize

and honor individuals for their

commitment to helping others, with

proceeds benefiting Midwestern

University student scholarships.

The event featured a silent auction,

dinner, and dancing under the stars.

Harry and Rose Papp, Partners,

L. Roy Papp & Associates, LLP,

were the joint recipients of the

2014 COMET (Community

Outreach: Motivating Excellence for

Tomorrow) Award, which recognizes

outstanding individuals who have

shown exemplary commitment to

the community.

The COMET Award was

presented to Mr. and Ms. Papp by

Kathleen H. Goeppinger, Ph.D.,

President and Chief Executive

Officer of Midwestern University.

In addition to the COMET

Award, Dr. Goeppinger presented

the 2014 Shooting Star Award,

which recognizes a community

leader for outstanding contributions

to healthcare and education, to

Steven Hansen, D.V.M, M.B.A.,

DACAW, President and Chief

Executive Officer, Arizona Humane

Society.



Incoming D.O. Students Receive Stethoscopes from Jason Madachy Foundation

During orientation for AZCOM students in July, special presentations were made to

the incoming D.O. students from the Jason Madachy Foundation.

Each member of the Class of 2018 received a brand-new stethoscope with the words

“Excel in Leaving a Mark” engraved in the metal.

The presentation was made by Dolly Madachy, the mother of the late Jason Madachy, a

medical student at Marshall University’s Joan C. Edwards School of Medicine who passed

away unexpectedly in 2007.

AZCOM students will also be invited to a pre-graduation reception co-sponsored by the

Foundation in 2018. They will be encouraged to reflect on the moments that followed their

receipt of the stethoscopes and encourage them to give back in kind to future classes.

Midwestern Helps Raise $20,000 for MISS Foundation

Midwestern University also served as the site this spring

of a community event to support families who have

experienced the untimely death of a child.

The Kindness 5K and Memorial Walk, which raised funds

and awareness for the MISS Foundation, featured a five-

kilometer run and a memorial walk around the Glendale

Campus. The MISS Foundation is a 501 (c) 3, volunteer-based

organization committed to providing C.A.R.E. (Counseling,

Advocacy, Research, and Education) services to families who

have lost a child.

The event drew over 200 people to the campus and raised

more than $20,000 to support the MISS Foundation. The

Foundation presented the University an engraved vase as a

thank-you gift, which was accepted by Ross Kosinski, Ph.D.,

Dean of Students and Community Outreach.

Phoenix-area “Top Doctors” List Features AZCOM

Faculty and AlumniIn its annual ranking of Valley of the Sun

physicians, PHOENIX Magazine named

eight Midwestern University osteopathic

medical faculty and alumni as “Top Doctors”

for 2014.

The list of Phoenix-area physicians with

ties to Midwestern University includes

graduates from AZCOM and MWU’s

Chicago College of Osteopathic Medicine

(CCOM), three of whom also currently

serve in faculty positions at the University’s

Glendale Campus.

Those receiving recognition include

Charles Finch, D.O. (Chair, Integrated

Medicine, AZCOM); Sara Giali, D.O.

(AZCOM 2001); Randall Ricardi, D.O.

(CCOM 1984 and Clinical Assistant

Professor, AZCOM); Carlton Richie III,

D.O. (CCOM 1995 and Clinical Associate

Professor, AZCOM); and Matthew

Troester, D.O. (AZCOM 2002).

Additionally, the 2014 “Top Doctors” list

contains the names of over 70 osteopathic

and allopathic physicians who serve as

preceptors and mentors to AZCOM

medical students.



AZCOM Students Get Rotation and Residency Advice

This past spring, the Midwestern University Osteopathic Postdoctoral

Training Institute (MWU/OPTI) and AZCOM joined forces for

the annual Rotation and Residency Opportunities Day. The event provides

meaningful opportunities to assist second- and third-year AZCOM students

with understanding clinical rotations and selecting residency programs as part

of the continuum of education theme.

This year’s program was expanded to a full-day, three-part event featuring

program exhibits, expert panels of chief residents, and program director-led

mock-interviews. Second- and third-year medical students participated in

Q&A panels focused on clinical rotations and residency program selection.

Mock interviews were led by program director representatives from various

programs: MWU/OPTI, local, statewide, and nationwide. Participants

included approximately 300 students, 13 program directors, six chief residents,

clinical faculty, and 35 exhibitors representing specialties, hospital rotations,

and residency programs from around the state and nation.

AZCOM APPOINTMENTS, AWARDS & GRANTS

Farshad Agahi, M.D., FACOG, Chair, Obstetrics

and Gynecology, began serving as the President of the

Phoenix Obstetrical and Gynecological Society in May.

Second-year students Hari Avedissian and

Michelle Dyrholm received $150 McGraw-Hill/Lange

Medical Student Book Awards in March.

Dominic Derenge, Senior OMM Scholar, received

first-place awards in three separate national academic

competitions: the American Academy of Osteopathy

(AAO) Poster Contest, the American College of

Osteopathic Family Practice (ACOFP) Poster Contest,

and the AAO A. Hollis Wolf Case Competition (oral).

Mr. Derenge earned the awards for three different case

presentations.

Lori Kemper, D.O., Dean, received the 2014

Mentor of the Year Award from the Arizona

Osteopathic Medical Association in April.

Third-year student David Larsen received a

$10,000 Spirit of Service Scholarship at the annual

Bright Lights, Shining Stars gala held on the Glendale

Campus in October.

Second-year student Dana Osburn was selected

to participate in the GE-National Medical Fellowship

Primary Care Leadership Program (PCLP) at the

Wesley Health Center in south Phoenix.

Third-year student Eric Romney was awarded first

prize for his research poster that he presented at the

AOMA annual convention held in Scottsdale, AZ in

April.

Lawrence Sands, D.O., M.P.H., Clinical

Assistant Professor, was appointed to the National

Board of Osteopathic Medical Examiners (NBOME)

National Faculty in the Preventive Medicine and

Health Promotion – Division of Public Health and

Preventative Medicine in April.

Third-year student Hannah Tilden and second-

year student Austin LaBanc have been selected to

participate In the Paul Ambrose Scholar Program

sponsored by the Association of Prevention Teaching

and Research. Upon returning from a three-day

Student Leadership Symposium in Washington, DC,

both students have up to one year to implement a

community-based project that addresses one of the

Healthy People 2020 Leading Health Indicators.

Gregg Zankman, D.O., FACOP, Chair, Pediatrics,

received the 2014 Humanitarian Award from the

Arizona Osteopathic Medical Association in April.

AZCOM OMM CHAIR WINS PATIENTS’ CHOICE AWARD

Anthony Will, D.O., Chair of Osteopathic Manipulative Medicine for

AZCOM and a physician at the University’s Multispecialty Clinic in

Glendale, Arizona, has been recognized as a Patients’ Choice physician.

The Patients’ Choice Award recognizes physicians for the positive

influence of their work. The honor, tabulated from hundreds of thousands of

patient reviews, was awarded to physicians who received consistently near-

perfect scores—only five percent of the nation’s 870,000 active physicians

in 2012. The award represents the fourth consecutive year that Dr. Will has

been so honored.



Recruit a new member,get a $100 AOMA credit!

Do you know someone who isn’t a member of the Arizona Osteopathic Medical Association. . . and should be? Recruit a New Member and both the

New Member and you receive a $100 Credit

towards membership dues or Continuing

Medical Education fees!

As a member, you understand the value of AOMA’s

membership. Share that knowledge firsthand with your

colleagues in the medical field. A growing and healthy AOMA

means greater recognition for the profession, more resources to

support member programs, more representation with healthcare

leaders, and a stronger voice when advocating issues with state

and national legislative members.

Recruiting new AOMA members is simple: • Review your network of colleagues. You may be surprised

who is not a member.

• Check their membership status using the online member

directory or by calling the AOMA office at (602) 266-6699.

• Ask them to join! Express how membership has benefited you.

For all the details on how to recruit a new member and receive

your credit, visit the AOMA website at www.az-osteo.org

under the Members tab or contact Sharon Daggett, Member

Services Manager, at [email protected]

Update Your Member Profile and Win!

You could win a $100 VISA gift

card. Please take the time to visit

the AOMA website and login to

update your professional profile

information for

the online AOMA

Directory. Deadline to be entered

into the gift card drawing is

November 30, 2014.

In the past few months we have

added new features to the AOMA

website including a refreshed

Arizona Osteopathic Charities

webpage and online donations

for the AOMA Political Action

Committee.

Check back often for future

enhancements and features.



Advertisers’ IndexMICA ............................................................... Inside front cover

AOMA Fall Seminar ...........................................................Page 3

Comitz | Beethe .............................................................. Page 10

Arizona Osteopathic Charities ..........................................Page 16

Catalina Medical Recruiters ..............................................Page 39

River Trading Post .............................................................Page 39

AOMA Career Center ......................................................Page 41

Hospice of the Valley ...................................................Back Cover


Meeting Dates & Locations

NOVEMBER 14, 2014

AOMA Board of Trustees Meeting

7:00 p.m.

Hilton Tucson El Conquistador Resort

NOVEMBER 15, 2014

AOMA House of Delegates

3:00 p.m.


NOVEMBER 15-16, 2014

AOMA Fall Seminar


10000 N. Oracle Road

Tucson, AZ 85704

(520) 544-5000

JANUARY 31, 2015


9:00 a.m.

Midwestern University

MAY 6, 2015


7:00 p.m.

Arizona Grand Resort

MAY 6 – 10, 2015

AOMA 93rd Annual Convention


8000 Arizona Grand Parkway

Phoenix, AZ 85044

(602) 438-9000

MAY 8, 2015

AOMA House of Delegates

3:45 p.m.


2014-2015 Calendar of Events

5150 N. 16TH STREET, SUITE A-122

PHOENIX, AZ 85016

Documents

AOMA Digest Fall 2014