NYCOMEC Corp. – Committed to Quality Osteopathic ...€¦ · nycomec.org @nycomeccorp presenter inform ation = = } 9 : 2 0 a . m .:pvs 'jstu +pc 8ibu :pv 8fsfohu 5bvhiu jo .fejdbm

The NYIT College of Osteopathic Medicine is accredited by the American Osteopathic

Association to provide Osteopathic Continuing Medical Education for physicians. The

NYIT College of Osteopathic Medicine anticipates CME credits for a maximum of 5

hours and will report CME and specialty credits commensurate with the extent of the

physician’s participation in this activity.

Wednesday, November 288:30 a.m. - 3:05 p.m. (EST) W. Kenneth Riland Health Care Center- AuditoriumNYITCOM- Old Westbury Campus

FALL 2018

GRAND

ROUNDS

NYCOMEC

Program Guideth

NYCOMEC.org @NYCOMECCorp

PROGRAMSCHEDULE

Registration and Breakfast WelcomeBette Coppola, M.Ed., Education Manager, NYCOMEC "Your First Job- What You Weren't Taught in Medical School"John Kraljic, J.D., Partner, Garfunkel Wild, P.C. Remarks, New York State Osteopathic Medical Society (NYSOMS)Sherman Dunn, D.O., President Break "Palliative Care: It’s Always Too Early Until It’s Too Late"Alan Roth, D.O., FAAFP, Director of Medical Education, MediSys Health Network Research Options: NYCOMEC Poster CompetitionDavid Yens, Ph.D., Director, Research, NYCOMEC "Why I DO Research”William Doss, D.O., Nassau University Medical Center NYCOMEC Trainee Committee AnnouncementStephanie LaBarbera, M.H.A., Manager, Trainee Services, NYCOMEC Lunch GreetingDavid Broder, D.O., FACP, FACOI, President, NYCOMEC "American Osteopathic Association (AOA) Update for Students and Residents"Ronald R. Burns, D.O., President-elect, American Osteopathic Association "Personal Experiences and Lessons Learned in Combat"Philip Volpe, D.O., Major General, United States Army (ret) Break "Practical Approaches for Clinicians to Lead and Engage in Quality & Patient Safety"Zeynep Sumer King, M.S., Greater New York Hospital AssociationHillary Jalon, M.S., New York City Health & Hospitals Closing Bette Coppola, M.Ed.

8:30 a.m.

9:15 a.m.

9:20 a.m.

10:15 a.m.

10:20 a.m.

10:25 a.m.

11:10 a.m.

11:15 a.m.

11:20 a.m.

11:25 a.m.

12:05 p.m.

12:10 p.m.

1:00 p.m.

2:00 p.m.

2:05 p.m.

3:05 p.m.


NYCOMECCORP.

NYCOMEC is an Osteopathic Postdoctoral Training Institution (OPTI) that is

comprised of the NYIT College of Osteopathic Medicine, Touro College of

Osteopathic Medicine, and twenty-seven (27) teaching healthcare facilities

located in New York, New Jersey and Arkansas.

We would like to thank the American Osteopathic Association, Garfunkel Wild,

P.C., Greater New York Hospital Association, MediSys Health Network, and New

York City Health & Hospitals for their generous support.

About NYCOMEC

SAVE THE DATES FOR UPCOMING

NYCOMEC PROGRAMS!

To register for an upcoming program or webinar, please contact:

Ms. Alana Berg

[email protected] or 516.686.1128

Faculty Development Program

Osteopathic Recognition WebinarWednesday, December 5th

Wednesday, December 19thWednesday, January 2ndWednesday, January 5th

Wednesday, January 30th

Thursday, February 14th


Catskill RegionalMedical Center

Harris, NY

Coney Island Hospital

Brooklyn, NY

Eastern Long Island Hospital

Greenport, NY

Ellis Medicine

Schenectady, NY

Flushing HospitalMedical Center

(MediSys Health Network)

Flushing, NY

Good SamaritanHospital Medical Center

West Islip, NY

Gurwin Jewish Nursing & Rehabilitation Center

Commack, NY

Hackensack Meridian Health:Palisades Medical Center

North Bergen, NJ

Jamaica HospitalMedical Center

(MediSys Health Network)

Jamaica, NY

Jersey CityMedical Center

(RWJBarnabas Health)Newark, NJ

Long IslandCommunity Hospital

Patchogue, NY

MaimonidesMedical Center

Brooklyn, NY

Nassau UniversityMedical Center

East Meadow, NY

New York Institute ofTechnology College ofOsteopathic Medicine

Old Westbury, NY&

Jonesboro, AR

Newark BethIsrael Medical Center(RWJBarnabas Health)

Newark, NJ

NYU Langone

Hospital: Brooklyn

Brooklyn, NY

Orange RegionalMedical Center

Middletown, NY

Parker Jewish Institutefor Health Care & Rehabilitation

North Bergen, NJ

Peconic BayMedical CenterRiverhead, NY

Plainview HospitalPlainview, NY

Saint BarnabasMedical Center

(RWJBarnabas Health)Livingston, NJ

Sisters of

Charity HospitalBuffalo, NY

South Nassau

Communities HospitalOceanside, NY

Stony Brook

Southampton HospitalSouthampton, NY

St. Barnabas Hospital

Bronx, NY

St. Bernards Medical CenterJonesboro, AR

The Institute

for Family HealthKingston, NY

Touro College of

Osteopathic MedicineHarlem, NY

&

Middletown, NY

Wyckoff HeightsMedical Center

Brooklyn, NY

MEMBERINSTITUTIONS


PRESENTERINFORMATION

John Kraljic, J.D.

Biography:

9:20 a.m.

"Your First Job-What You Weren't Taught in Medical School"

John P. Kraljic, a Partner in Garfunkel Wild, P.C.’s Business Practice Group, has over twenty years

experience in the healthcare field. Mr. Kraljic's practice at Garfunkel Wild, P.C. includes

corporate transactions for hospitals, physicians, and other health care industry providers. He

has extensive experience in preparing and negotiating employment agreements, structuring

asset and stock acquisition agreements and preparing license agreements. In addition, Mr.

Kraljic has worked on matters relating to not-for-profit corporate governance and tax issues for

large and small hospital and health system clients. Prior to joining the Garfunkel Wild, P.C., Mr.

Kraljic practiced general corporate and corporate bankruptcy law for eleven years. Mr. Kraljic

received his B.A. from Long Island University/C.W. Post College in 1984 and his J.D. from

Georgetown University Law Center in 1987.

GW GARFUNKEL WILD, P.C.AT TO R N E Y S AT L AW

NEW YORK NEW JERSEY CONNECTICUT

© 2018 GARFUNKEL WILD, P.C.

GW GARFUNKEL W I LD, P. C .A T T O R N E Y S A T L A W

Great Neck, NY(516) 393‐2200

Hackensack, NJ(201) 883‐1030

Stamford, CT(203) 316‐0483

Albany, NY(518) 242‐7582


Your Graduated from Medical School – What You Were NOTTaught About Your First Job

NEW YORK NEW JERSEY CONNECTICUT

GW GARFUNKEL W I LD, P. C .A T T O R N E Y S A T L A W


CONGRATULATIONS! – NOW WHAT?

STEP 1 – GO FIND A JOB!!!

© 2018 GARFUNKEL WILD, P.C.4GW www.garfunkelwild.com

POTENTIAL EMPLOYERS

• Physician Practices:• Advantages: Opportunity to Become an Owner

Less Bureaucratic (usually)

• Disadvantages: Decline of Independent Practices

Possibly Less Job Security

• Hospitals:• Advantages: Job Security?

Better Benefits and PTO (usually)

• Disadvantages: No Ownership

Possible Limits on Promotional Opportunities

BureaucraticWho should you pick? TALK TO PEOPLE!!!


TERM SHEET

Is one required? NO

Are there advantages? Sometimes

• Two Caveats:

1. Makes Sure That the Term Sheet is Non‐Binding

2. You May Want to Consult a Lawyer At This Stage – if not earlier


EMPLOYMENT AGREEMENTS

Will Vary by Type of Employer

• Practices – typically are “all encompassing” and are lengthier

• Hospitals – often are short but refer to policies, guidelines, etc.

Usually, there is no such thing as a template. Every transaction stands on its own.

THOROUGHLY REVIEW THE AGREEMENT

• And pay special attention to defined terms!


BASE COMPENSATION

• See if Base Compensation includes annual increases, or atleast COLA.

• For Hospital Agreements, Base Compensation is often guaranteed only for a certain period of time and then goes toan “eat what you kill model”


INCENTIVE COMPENSATION

• Can be based on personally performed collections, wRVUs or discretionary

• Discretionary has many disadvantages!!!

• Collections – typically based on a percentage of collectionsfrom personally performed services over a threshold – the threshold is typically twice the Base– Note: Try to get increased percentages the higher the amount

collected!

• Make sure there is a provision for collections received post‐termination

• wRVUs – common in Hospital AgreementsFor both collections and wRVU‐based compensation, the numbers may look nice, but

are they realistic?


BENEFITS AND VACATION

Benefit and Vacation Packages may be governed by Employer Guidelines

But there are some things to check and ask for:• Moving Expenses

• Extra time off for board examinations

• Reimbursement for license/DEA fees, accreditation fees, CME

• Roll‐over of unused vacation days

• Medical/Maternity leave – there are differences based on the size of the employer and location of the practice

• Parking

• Telephone


BILLINGS

• The Employment Agreement usually includes a general provision under which you assign all your rights to bill and collect to the employer

– See if you can get an indemnity

– Make sure that there is an exception for collections from moonlighting


HOURS

• Usually hours are not fixed but generically refer to full‐time employment

• See if you can get some limitation on your schedule, e.g., no weekend office hours

• Call Obligations – try to get same limited or fixed

• Do you want to Moonlight? And keep the compensation from same?


PROFESSIONAL LIABILITY INSURANCE

Know the difference between Claims Made and Occurrence Policies

Claims Made Requires a Tail. The question is – who pays?

KEEP IN MIND – if you will be responsible for tail, the cost of same needs to be included in your calculation of the total

financial package that is being offered


CONFIDENTIALITY, RESTRICTIVE AND NON‐SOLICITATION COVENANTS

LET’S REMEMBER – THESE COVENANTS CAN BE ENFORCED!!!

And even if a court finds a covenant not to be enforceable as the limitations may not be reasonable, you may have to pay for

your own lawyer’s fees to get the benefit of such a ruling.• Confidentiality. Generally requires you to keep all information concerning the

employer confidential.

• Non‐Solicitation. Generally, requires you to not solicit patients, referral sources or other employees of the employer.

• Restrictive Covenant. Generally is described in the form of a radius from a certain location though occasionally may include prohibitions against working for specific competitors.

• Look at the radius on‐line – remember, radius is as the crow flies.

• What if the employer has multiple offices?

• What if the new employer has multiple offices?


WHAT TO ASK FOR ON CONFIDENTIALITY, RESTRICTIVE AND NON‐SOLICITATION COVENANTS?

• Confidentiality – add exceptions for previously known information

• Non‐Solicitation – family members, own referral sources, and patients one has treated

• Restrictive Covenant –• Lower the radius and time period

• Non‐applicable based on how agreement is terminated

• Non‐applicable for a certain probationary period

• Non‐applicable for certain other potential employers


THE TERM OF THE AGREEMENT – AND TERMINATION

• One can have a fixed term or a term that is not fixed. You caninclude automatic renewal terms.

• Bad Person Clauses. Make sure that notice and cure periods are included.

• Termination Without Cause. Very important to keep same inmind. It may not be a 5‐year contract.

• Add right to terminate if the employer breaches.

• How an agreement terminates may have consequences (e.g., enforceability of the restrictive covenant, unemployment insurance, etc.)


PARTNERSHIP?

Obviously only applies to private practices

• Unlikely that one will get an absolute promise but look for apromise to “talk” about it

• Know the practice• What is the structure? Who owns the real estate?

• Do your due diligence

• Speak to an accountant


CAN ONE BE AN INDEPENDENT CONTRACTOR?

• Usually, more of an issue for the employer

• The government views you as an employee

• Part‐time does not mean one is an independent contractor

• Disadvantages to employees include possibly more taxes and no benefits. But you may be able to deduct expenses

• There are compliance concerns under the Stark and Anti‐Kickback Laws


THE NEED FOR LEGAL ADVICE

• You need an expert in healthcare law – don’t ask a real estate lawyer

• There are costs involved – but they are relatively small incomparison to a multi‐year contract worth hundreds of thousands if not millions of dollars

• Even if you don’t get everything or anything you want in an agreement, you need to know what you are getting yourself into.

• Please – read your contract! It’s important!



Alan Roth, D.O.

Biography:

10:25 a.m.

"Palliative Care:It's Always Too Early Until It's Too Late"

Alan R. Roth D.O., FAAFP, FAAHPM is Chairman of the Department of Family Medicine, Ambulatory

Care and Community Medicine at Jamaica Hospital Medical Center in Queens, NY. He is also Chief

of Palliative Care and Director of the Hospice and Palliative Medicine Fellowship Program and

former Family Medicine Residency Program Director. Dr. Roth, a graduate of NYIT College of

Osteopathic Medicine, is a practicing and academic Family Medicine and Palliative Care Physician

and the recipient of numerous “Best Doctor” awards. He is a Professor of Family Medicine at

NYITCOM and Assistant Professor of Social and Family Medicine at Albert Einstein College of

Medicine. Presenting and publishing widely over the course of his extensive career, Dr. Roth

consistently advocates for his patients and primary care values as a healthcare leader. He

currently serves as the Chair of the Primary Care Council of the Right Care Alliance. His

professional areas of interest are vast and include retaining a focus on patients during

healthcare transformation, teaching and integrative health.

Palliative Care:“It’s Always Too Early…….. ………..Until It’s Too Late”

Alan R. Roth DO, FAAFP,FAAHPMChairman Department of Family Medicine, Ambulatory Care

and Community MedicineProgram Director, Hospice and Palliative Medicine Fellowship

Clinical Professor of Family Medicine NYITCOM

I have no conflict of interest

Objectives

Review Basics of Palliative Care, Who isAppropriate for Palliative Care and Timing ofConsultation.

Discuss How to Explain Hospice and PalliativeCare to Patients and Families.

Demonstrate How to Collaborate with anMultidisciplinary Palliative Care Team.

Definitions

“The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and families.”

(WHO, 1990)

WHO‐Palliative Care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until

death; offers a support system to help the family cope during the patients

illness and in their own bereavement; uses a team approach to address the needs of patients and their

families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course

of illness; is applicable early in the course of illness, in conjunction with other

therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Types of Palliative Care Medicine

Palliative Care Consultation Service

Ambulatory and Home Palliative CareServices

Dedicated Palliative Care Units in Hospitalsand Nursing Homes

Hospice Care‐ Inpatient, nursing home andhome

There is a Fate Worse than Death

To Live with Poor Quality of Life

To Live in Pain

To Suffer

To Be Alone

To Have Unfinished Business

To Live as a Burdon to Others

To Live without Dignity

Palliative Care

Specialized interdisciplinary health care

Progressive incurable terminal illness

Improve quality of lifePhysicalEmotional

SocialSpiritual

Alternative to Hospice

Restoring the Balance

Palliative Care

Life Prolonging Care

Patient

Clinical Information

Prognostication

Communication

Delivering Bad News

The GOC Family Meeting

Changing Goals of Care

Communication

Goals of Care Potential goals of care

Cure of disease

Avoidance of premature death

Maintenance or improvement in function

Prolongation of life

Relief of suffering

Quality of life

Staying in control

A good death

Support for families and loved ones

Routine outpatient visit, chronic life‐limiting disease(optimal), but …

Difficult to schedule sufficient time for thorough discussion

Difficult to anticipate all possible scenarios

Times of crisis;

Worst possible time to make difficult decisions

Usually when the “big” decision are actually made

When Should Goals Be Established?

Palliative Care Patients CHF, COPD, Cancer, etc. Expected prognosis <36 months HomeboundDeteriorating medical condition at risk for needing symptom management

Family conflicts Emphasis of care in the home setting 2 or more ED or Inpatient admissions in the last year

Functional or Performance Scale Score Low

PALLIATIVE CARE CONSULTATION CRITERIA

A. Primary Disease Process

□ Cancer ( Active / Metastatic / Recurrent)

□ Advanced COPD

□ Advanced CHF, EF < 25%

□ Cardio-Respiratory Arrest with Cerebral Hypoxia/ Anoxia

□ Shock (septic, etc.) with MODS

□ Advanced neurodegenerative disease ( Dementia, Parkinson’s , ALS)

□ ESRD and/or ESLD

□ Stroke (with at least 50% decreased functional ability)

□ Actively dying patient


B. Concomitant Factors

□ Hemodialysis

□ Liver disease

□ Moderate CHF, CAD, Severe Valvular disease, Cardiomyopathy, Pulmonary HTN.

□ Bed Bound/Dysphagia/ Failure to Thrive/Functional Decline/ Pressure ulcers

□ Complex medical decision making. Pt/family disagreements about care or conflicts

□ Patients from Long Term Care Centers

□ Patients on home hospice


C. Other Criteria to Consider The Patient is / has:

□ not a candidate for curative therapy

□ a life-limiting illness

□ unacceptable level of pain >24 hours

□ uncontrolled symptoms (i.e.dyspnea, nausea, vomiting, anxiety)

□ frequent visits to the Emergency Department

□ more than one hospital admission for the same diagnosis in last 30 days

□ prolonged ICU/ hospital stay without evidence of progress or improvement

□ transferred from ICU to floors and back to ICU

□ S/P Code 99/ Code 66.

□ Medical Futility

□ _________________________________________________________________________


D. Call consult before discussions about:

□ PEG tube for artificial nutrition ( e.g. Pt with failed swallow test)

□ Tracheostomy for prolonged mechanical ventilation

□ Shiley or Permacath for HD

□ Withdrawal of ventilatory support

□ _________________________________________________________________________

“The Surprise Question”

Clinicians often will not identify patients withserious life threatening illnesses as terminal

When asked, “Is this patient dying?”

Most say, “No”

YET…

When asked, “Would you be surprised if thispatient died within the next year?”

Most say, “No”

How Palliative Care Can Help

Assessment and Management of Pain

Physical Symptom Control

Artificial Nutrition

Psychosocial issues

Assessing treatment goals

Communication/Family Conferences

Advanced Directives/DNR/DNI

Discharge Planning and Disposition

Timing of Palliative Care

“It’s always to early………….

……………….Until its too late”

Palliative Care:When should it be discussed?

Patients who experience difficult to treatsymptoms

Patients who fear future sufferingPatients who face uncertain medical choicesPatients who are imminently dyingAll patients with serious illness?Relieving pain and symptomsDiscussing hopes and fearsDiscussing prognosis

PrognosisImportant because enables better decisionmaking about care options

General physician bias – overly optimisticby 2 to 5 fold

Easier for some illnesses

Poor prediction skills may reflect educationaldeficiencies for clinicians

We MUST accept certain degree of prognosticuncertainty

Prognostication

The Disease

The Clinical Picture‐ History and Physical

Progression and Natural History ofCondition

PCP and Specialist Input

Prior Treatment Success/Failures

The Patients wishes and Goals of Care

MVA/Trauma/Homicide/SuicideCVA/MI/Cardiac Arrest

CHF/COPD/ESLD/ESRD

Cancer

/Dementia

PrognosticationGeneral Indicators of Health and Disease

General and Functional Assessment ScalesKarnofsky Performance Scale, PPS

Disease Specific ScalesDementia‐ FASTCHF‐ Seattle Heart Failure ModelCOPD‐ BODEESLD‐ MELDCancer ECOG and Disease Specific

Patients Wishes and GOC

Reasons Prognostication is Important

Its All About the Patient

Its All About the Family

Relationship Building

Goals of Care

Impacts almost every decision a patient makes

Cost Benefit Analysis

To Test or Not to Test?

To Treat or Not to Treat?

Communication of Bad News Communicating prognosis…

Some patients want to plan

Others are seeking reassurance

Tough questions:

“Am I dying?”

“How long do I have to live?”

…Communicating prognosis

Inquire about reasons for asking“Yes… but I don’t know when it will be”

“What are you expecting to happen?”

“What are your fears?”

“Are there things you need to finish before you die?”

“What experiences have you had with:others with same illness?

others who have died?”

…Communicating prognosis

Patients vary

“planners” want more details

those seeking reassurance want less

Avoid precise answers

hours to days … months to years

Remember, we are not good at this

Comparing Hospice vs. Palliative Care

Hospice

Prognosis of 6 months or less

Focus on comfort care

Medicare hospice benefit

Volunteers integral and required aspect of the program

Palliative Care

Any time during illness

May be combined with curative care

Independent of payer

Health care professionals

Challenges of the Hospice Discussion

Hospice requires a “bad news” discussion

Acceptance that medical treatment isn’t working

Acceptance of likelihood of death in 6 months

Giving up on hospitalization and disease‐driven treatment

Many patients don’t want to stop all treatment

May be willing to stop burdensome treatment

May want to continue to maintain more options

Small chances of cure or longer life maintain hope

Initially feels a lot like “giving up”

Palliative Care:Who should do it?

Primary Palliative Care • Basic pain and symptom management • Goals of treatment discussion • Discussion about resuscitation and invasive treatments • Responsibility of all clinicians (primary care and

specialty) Specialty palliative care • Complex pain and symptom management • Conflict around goals of care or treatments • Negotiation within families or between treating teams Quill TE, Abernethy AP. Generalist plus specialist palliative

Palliative Care Team

Hospice

41

Chronic disease or functional decline

Advancing chronic illness

Multiple co-morbidities, with increasing frailty

Death with dignity

Maintain & maximize health and

independence

Healthy and independent

Compassion, Support and Education along the Continuum

Advance Care PlanningAdvance Care PlanningTerminology of

Advance Directives Advance care planning

Process of discussion, documentation, implementation

Advance directives Instructional statement

living will

values history

personal letter

medical directive

MOLST/POLST Form

Proxy designation Health care proxy

Durable power‐of‐attorney for health care

Last StepsACP: Establish a specific plan of care expressed in medical orders using the POLST paradigm.

Adults whom it would not be a surprise if they died in

the next 12 months.

Next StepsACP: Determine what goals of treatment should be followed if complications result in “bad” outcomes.

Adults with progressive,life-limiting illness, suffering

frequent complications

First StepsACP: Create POAHC and consider when a serious, permanent neurological injury would change goals of treatment.

Healthy adults between ages 55 and 65 or at young age if diagnosed with a

serious illness

Stages of Advance Care Planning Over the Life Time of Adults

Medicare pays for ACP

Encounters must be face‐to‐faceconversations with the patient and/or theirsurrogate (patient does not need to bepresent)

99497 and 99498

Advance Care Directive does not have to becompleted but the documentation shouldrecord discussion of patient wishes aboutfuture medical treatment.

Palliative Care:Hoping and Preparing

“Lets hope for the best…” Join in the search for medical options Open exploration of improbable/ experimental Rx Ensure fully informed consent “…attend to the present…” Make sure pain and physical symptoms are fully managed Attend to depression and any current psychosocial issues Maximize current quality of life “...and prepare for the worst.” Make sure affairs (financial/personal) are settled Think about unfinished business Open spiritual and existential issues



Ronald R. Burns, D.O.

Biography:

12:10 p.m.

"American Osteopathic Association (AOA)Update for Students and Residents"

An AOA board-certified family physician, Ronald R. Burns, D.O., serves on the board of the National

Board of Osteopathic Medical Examiners and is a member of the American College of Osteopathic

Family Physicians. He also is past president of the Florida Osteopathic Medical Association

(FOMA).

Dr. Burns has been an active member of the AOA Board of Trustees since 2007. He served as chair

of the Department of Business Affairs and received FOMA’s Physician of the Year award in 2002,

as well as its Distinguished Service Award in 2007.

Dr. Burns completed his osteopathic medicine degree from what is now the Ohio University

Heritage College of Osteopathic Medicine in Athens. Following completion of his degree, he

completed his postdoctoral medical training at the Doctors Hospital of Stark County in

Massillon, Ohio, and the Florida Hospital – East Orlando.

AOA VISION:Present and Future Directions

Ronald Burns, DOAOA President‐elect

NYIT COLLEGE OF OSTEOPATHIC MEDICINE

NOV. 28, 2018

Expanding Our PresenceOver 30 years, the number of DOs practicing in the US has more than tripled

145,000 DOs and osteopathic medical students in the US

115,000 DOs in the US 300% increase in 25 years

Strategic Focus

International Impact

Board Certification Member Value

Governance Alignment

Affiliate Alignment

SPECIALTY COLLEGES

OSTEOPATHIC ORGANIZATIONS

AOA: What We DO for YOU• Board Certification, OCC & CME

• Advocacy

• Career & Practice Success

• Public Awareness

• Lifestyle

AOA Certification International Impact

Focus Areas:Practice rightsMission/global healthAffiliate relationsResearchMedical school accreditation

Single Accreditation System Transition

72% of 1,244 AOA programs applied, transitioned, or accredited

193 have received or applied for Osteopathic Recognition

• Intentionally designed to preserve osteopathic identity and principles in GME

• AOA is committed to protect residents during the transition

• Revised Common Program Requirements recognize AOA

Single Accreditation System Transition

AOA Annual Research Grants

• Pre‐FY16 – $250,000 average• FY 2016 – $1.1M• FY 2017 – $1.3M• FY 2018 – $1.1M• FY 2019 – $1.4M

Research on Osteopathic Impact

Osteopathic Philosophy

Chronic Conditions

Musculoskeletal Injuries & Prevention

Pain Management

OMM/OMT

Student Grants – Building the PipelineGrantee Institution Title of Research Project

Kathleen Ackert, OMS‐II

Philadelphia College of Osteopathic Medicine

Leveling the Playing Field: Evaluating How Prerequisite Classes Affects Perceived Stress Levels in Medical Students

Katrina Bantis, OSM‐II

NYIT COM The Cardioprotective Benefits of Prolonged Fasting

Kate Slaymaker, OMS‐II

Edward Via College of Osteopathic Medicine ‐Virginia Campus

Inviting Interdisciplinary Input: An Osteopathic Approach to Leveraging Community Support for Prevention and Management of Chronic Disease in Rural and Appalachian Virginia

Brand Awareness

648,291 Find Your DO Profile Views 1.08 BILLION ad impressions

A Voice in Health Care

Opportunities abound! Family Unity

THERE IS NEVER A BETTER TIME TO BE A DO …

THANK YOU!



Philip Volpe, D.O.

Biography:

1:00 p.m.

"Personal Experiencesand Lessons Learned in Combat"

Major General Philip Volpe retired from the United States Army after 30 years of distinguished

service, in 2013. His final duty assignment was as the Commanding General at the Army Medical

Department Center and School in San Antonio, Texas, where he led and managed education,

training, and leader development for all of Army Medicine. He currently serves as assistant

professor at the Kansas City University of Medicine and Biosciences, and also provides services

as an independent health care and leadership consultant. After graduating from NYIT College of

Osteopathic Medicine, he became a board-certified family physician. He participated in

numerous combat deployments and has been awarded the Defense Superior Service Medal,

Bronze Star, Purple Heart, and Army Commendation Medal with “V” Device for Valor. Dr. Volpe

was selected as the Military Family Physician of the Year in 1996 and served as co-chair of the

Department of Defense Task Force on the Prevention of Suicide by Members of the Armed

Forces from 2008-2011.

Personal Experiencesand

Lessons Learnedin

Combat

NYCOMEC Grand Rounds

28 November 2018

Philip Volpe, DOFamily Medicine

Major General, United States Army (Retired)

Objectives

Share lessons about medical practices which enhance pre-hospital survivability.

Share lessons about medical and public health factors which reduce morbidity and mortality.

Share personal stories of the heroic actions of our wounded warriors; as well as some of the successes & failures as a physician.

LESSONS LEARNEDTraining and preparation reduces

morbidity & mortality!

Train; Rehearse; Repeat

Field Sanitation & Hygiene

Nutrition & Water

Sleep Discipline & Rest

Lesson #1

Lesson #2Prevention trumps treatment!

Lesson #3Everyday conditions occur every day!

Lesson #4Safety and discipline keep people alive!

Lesson #5

Triage requires expertise & practice!

Lesson #6Triage is temporary and it’s fluid!

Lesson #7

First … STOP Hemorrhage!

Lesson #8Small wounds; bad injuries!

Improvise, if you must!Lesson #9 Lesson #10

Humans are the best blood bank!

Lesson #11Leave tissue on & don’t close wounds!

Lesson #12Think compartment syndrome!

Lesson #13Physician resiliency is essential!

The Top Advancements resulting from the Battle of Mogadishu

Critical Care Aeromedical Transport TeamsModern TourniquetsTC3 – Tactical Combat Casualty CareBody ArmorShock Management Protocols/GuidelinesHemostatic DressingsOver-pressure Hearing ProtectionBlood Product Administration & Rapid Testing

QUESTIONS?



Zeynep Sumer King, M.S.

Biography:

2:05 p.m.

"Practical Approaches for Clinicians to Lead and Engage in Quality and Patient Safety"

Zeynep Sumer King joined Greater New York Hospital Association (GNYHA) in 2006. She is responsible for leading a number quality initiatives and assisting members on quality improvement, health information technology, and health care workforce issues. Prior to joining GNYHA, Ms. Sumer King worked for IPRO, the quality improvement organization for New York State, under a quality improvement contract with the Centers for Medicare & Medicaid Services. She holds an M.S. in Health Communication from Tufts University School of Medicine and a B.A. in Communications from Michigan State University.



Biography:

2:05 p.m.

"Practical Approaches for Clinicians to Lead and Engage in Quality and Patient Safety"

Hillary Jalon has worked at NYC Health + Hospitals since September 2016 and is currently Assistant Vice President for Quality & Safety in the Office of Quality & Safety for the System. In this role, she is responsible for designing and implementing tiers of quality improvement training for the clinical and non-clinical workforce, as well as working with leadership to define priorities for the Quality Assurance and Performance Improvement Quality Committee to the Board. Ms. Jalon is currently an Adjunct Assistant Professor of Health Policy and Management of NYU’s Robert F. Wagner Graduate School of Public Service for the Continuous Quality Improvement course. Previously, Ms. Jalon was employed at the United Hospital Fund (UHF) for over 11 years, most recently as Director of Quality Improvement, being responsible for providing strategic direction of UHF’s quality initiatives. She was also a member of the New York State Department of Health’s Hospital-Acquired Infection Technical Advisory Workgroup. Prior to joining UHF, Ms. Jalon was employed at New York-Presbyterian Hospital for over six years, in several roles, including as Manager of Service Improvement and Performance Improvement Specialist.

Hillary Jalon M.S.

Practical Approaches to Engage Clinicians in Quality

Improvement

Hillary Jalon, NYC Health + HospitalsZeynep Sumer King, GNYHA

Presentation to New York College of Osteopathic Medicine Educational Consortium

November 28, 2018

Today’s Objectives*

1. Describe why engaging the healthcare workforce in quality improvement is important

2. Compare the fundamental differences between Quality Assurance and Quality Improvement

3. Describe how to use a sub-set of common quality improvement tools

4. Explain the basics of how to use a quality improvement methodology, like the Model for Improvement

5. Define common challenges in quality improvement and potential ways to overcome those them (we won’t go through this objective—slides are included at the end for you to review on your own)

*Attribution goes to the GNYHA/United Hospital Fund Clinical Quality Fellowship Program for using a sub‐set of slides from a “Tools in Quality Improvement” presentation from that program. Other attribution given throughout the presentation.

Objective 1. Describe why engaging the healthcare workforce in quality improvement is important

What’s wrong with care?

Amount spent versus outcomes

Errors –Unsafe care

Overuse/underuse

Not aligned with patient needs, less thansatisfactory patient experience

5

Florence Nightingale Ernest Armory Codman 1820-1910 1869-1940

Nurse, active in philanthropy,ministering to the ill and poor

Early innovator in patient safety –harm prevention

Organized a team of 34 nurses to tend to fallen soldiers in Crimean War Unsafe, unsanitary conditions

Her work with the team reduced the hospital’s death rate by two-thirds

Wrote a book analyzing her experience Proposed reforms for other military

hospitals

• Surgeon• Founder of Outcomes

Management• Lost privileges at Mass General

due to “radical” plan to monitor surgeon competence

• Established his own hospital to pursue performance improvement

*Attribution goes to the GNYHA/United Hospital Fund Clinical Quality Fellowship Program and Steven Kaplan, MD, for using this slide.

Pioneers in Quality…

Preventable adverse events…

Rarely due to just one individual

Multiple failures

Complex, time pressured work environments inhealthcare

Normalization of deviancy

Consistent “Work arounds” in healthcare

Institute of Medicine (IOM): To Err is Human (1999) Harm caused by medical care

At least 44,000 and potentially as high as98,000 die in the US annually due to medical errors

More than for traffic accidents, breast cancer

Medications – 7,000 deaths

Improve by: Systems (not individuals)

Reporting

Learning from events (not solely training)

Six Domains described:• Timely• Effective• Safe• Patient centered• Equitable• Efficient

IOM: Crossing the Quality Chasm (2001)

How do We Get There? Key Components Value

Data Transparency

Measurement

Improvement We will be talking about this today

System, Provider, Patient engagement

Objective 2. Compare the fundamental differences between Quality Assurance and Quality Improvement

Quality Assurance vs. Quality Improvement

Providing the right care, to the right patient every time

*Attribution goes to David Koterwas, NP at NYC Health +Hospitals/Bellevue for using this slide.

Quality Assurance vs. Quality Improvement

• Key processes in how we improve the care that we

deliver and how we maintain these changes

• Closely linked, integrally connected, but different in

approach

*Attribution goes to David Koterwas, NP at NYC Health + Hospitals/Bellevue for using this slide.

Quality Assurance Quality Improvement

Goal Monitoring and ensuring compliance with a previously

determined metric or standard

Continuously evaluating systems and processes to

deliver the best care possible

Orientation Reactive, typically mandated Proactive, guided by gaps

Focus Outliers, “fall-outs”, individuals

Processes and systems

Responsibility Specific committee or appointed group

Staff involved in the process at every level

Scope Individual healthcare provider

Patient care process

Who initiates and leads Leadership Frontline staff

Time frame Prescribed and typically static

Continuous and evolving

Attribution goes to Eric Wei, MD, MBA, Chief Quality Officer at NYC Health + Hospitals, for this slide.

Foundational Differences Between Quality Assurance and Quality Improvement: A Primer

Quality Assurance frequently drives Quality Improvement efforts (example)

Quality Assurance Quality ImprovementMonitor Flu vaccinations Rates in comparison to local standards

Develop an initiative to:• Identify process and individualbarriers to obtaining flu vaccinations

• Develop alternative processes to provide improved access

• Develop inservicing programs to overcome individual barriers

• Continuously evaluate where processes fall short when ratesdecrease and address them by engaging in tests of change to improve them

*Attribution goes to David Koterwas, NP at NYC Health + Hospitals/Bellevue for using this slide.

Objective 3. Describe how to use a sub-set of common quality improvement tools

Assesses a problem orarea you think needsimprovement Narrows down on an

issue Identifies improvement

priorities Engages teams to

focus on improvement We’ll only discuss a

sub-set of commonlyused tools today

Why Use Quality Improvement Tools?

www.ihi.org

BrainstormingAn activity (formal or informal) in which people put forward any idea(s) that occur to them at the moment • No ideas should be judged or perceive negatively• The more ideas, the better

The group may re‐consider the ideas, make decisions about their relevance and importance, and prioritize them.

Three Potential Tools for Problem Analysis

Fishbone Diagram

Pareto Chart

Flow Chart

What are the possible causes of the problem at your health care

organization?

Where should your health care organization’s team focus its

energies and limited resources to address the problem?

What is the current process? Can the team learn from this, and

eventually design a flow to reflect an ideal state?

Effect orProblem

People(Manpower)

Procedures(Materials)

Policies(Methods)

Plant(Machinery)

Source: Kelly, D. L. 2006. Applying Quality Management in Healthcare, 2nd Edition. Chicago: Health Administration Press. Reprintedwith permission.

Cause

Tip: Don’t get stuck on the # of bones! Can

have more, but probably not less than 4.

Fishbone DiagramAKA: Ishikawa or Cause and Effect Diagram

A visual tool to help identify the cause and effect of a problem

Cause

Cause CauseKey Points:

• Cause and Effect

• Name the problem, organize reasons for the problem in categories (e.g., people, policies, procedures, plant, systems, environment)

Attribution to New York‐Presbyterian Hospital for this as well as Karen Scott, MD.

Example of Fishbone – Possible Causes of All-Cause Readmissions

Example of Fishbone – Possible Causes of Surgical Site Infections (SSIs)

Patients Equipment Procedure/Technique

Environment Clinical Decisions

SSIsCulture

Age

Pressure ulcer

Diabetes/glucose levels

Compliance

Diagnosis/ disease

Comorbidities

Nutrition/diet

Surgical equipment

OR cleaning solutions

Bed type

Wound care materials

OR cleaning process

Procedure type

Surgical technique

Aseptic practice

Hair removal

Patient hand-off Communication

Pre-op and Post-op education

Intra/Post-op Pt. temp

Wound care technique

Providers/Staff

OR air filter maintenance

OR cleaning crew

Post-op recovery location

PACU traffic

Shift change

Surgical team consistency

OR temperature

OR traffic

Inpt room traffic

Staff changes

Surgical fellowship turnover

Multiple patients in case load

Inadequate aseptic technique

Nurse/Surgeon/ Anesthesiologist

Lack of awareness

Post-op medications

Post-op discharge follow-up

Dressing change

Post-op antibiotics

Wound care

Antibiotic selection & administration

Repeat antibiotic

Pre-op antibiotic

Post-op glucose

Pre-op pain mgmt

Central line

Time-out procedurePost-count debrief with OR team

Modified from Joint Commission’s Center for Transforming Healthcare, Cleveland Clinic Surgical Site Infection InitiativeUsed in a GNYHA/HANYS NYS Partnership for Patients conference, 2013.

Pareto Chart

• Graphically demonstrates the relative importance ofproblems

• Based on the proven “Pareto” principle: 20% of thesources cause 80% of any problem

• Focus on key problems that offer the greatestpotential for improvement

• Helps prevent shifting the “problem” to where the“solution” removes some causes but worsensothers and does not fix the problem

Example of Pareto: Reasons for Canceled Clinic Appointments

Run Chart

Graphical display of data plotted in some type of order Studies how a process changes over time

Helps us learn about performance of a process with minimal complexity

Displays data to make process performance visible

Determines if changes tested result in improvement

Determines if we are holding the gains made by our improvement

Constructing a Run Chart

Horizontal axis is typically time scale (e.g., days,weeks, months, quarters)

Could also include sequential patients, visits orprocedures

Vertical axis represents the quality indicator beingstudied (e.g., infection rates, patient falls, readmissionrates)

Run Chart Example: Number of Unreconciled Medications

Weeks Monitored

Control Chart

Constructing a run chart is the first step to developing a control chart

Control charts build on run charts and are a key tool used to display variation in the process Similar to run chart, studies how a process changes over time

Includes an upper line for the upper control limit and a lower line for the lower control limit Lines are determined from historical data

By comparing current data to the upper and lower lines, you can draw conclusions about whether the process variation is consistent (in control) or is unpredictable (“out of control,” affected by special causes of variation)

Determine if a process is stable http://asq.org/

Control Chart Example: Number of Unreconciled Medications

(control chart)

Weeks Monitored

Circled points are “out of control” points—find out, what happened during these times?

New residents come in during Week 8

Staffing change, with nurse on leave in during Week 19

Objective 4. Explain the basics of how to use a quality improvement methodology, like the Model for Improvement

Improvement Methods: Execution

Improvement is a science Defined methods Data driven Variety of methodologies Tools (some described in Objective 3) Qualitative as well as quantitative methods for

measurement Interdisciplinary approach is critically important

(clinical, administrative, social, systems)

Several improvement methods, one is notbetter than another

Some Improvement Methods, Common Objectives

CHARACTERISTICS PDSA* SIX SIGMA LEAN

Structured problem-solving methodology X X X

Solutions aimed at minimizing / eliminating root causes of problems

+/- X X

Rapid experimentation or tests of solutions on a small scale prior to spreading widely

X +/-

Metrics selected and data collected to measure whether an improvement has been made

X X X

Improvement requires a continuous cycle of adjusting the process to enable improved results

X

Empowerment of front-line staff to manage the sustainment of improvements

X X X

*PDSA=Plan‐Do‐Study‐Act, using the Institute for Healthcare Improvement’s Model for Improvement

*Attribution goes to Karen Scott, MD for using this slide.

The Model for Improvement

• What are we trying to accomplish?

• Team Aims

• How will we know that the change is an improvement?

• Measurement

• What changes can we make that will result in an improvement?

• Tests of Change/Interventions

Source: www.ihi.org

Developing an AIM Statement

State Aim clearly Describe what needs to be improved

Include numerical goals Helps to create need for change and directs measurement

Set stretch goals, BUT don’t be too ambitious Communicates that maintaining status quo is not an option

Be prepared to refocus the Aim if your team finds it isunrealistic Keep within a manageable scope Focus on a smaller part of issue Be realistic!

Avoid “Aim Drift” Make sure you don’t slip back on your goals; continue to repeat Aim

http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementTipsforSettingAims.aspxAccessed on January 12, 2018

Aim Statement Example: What are We Trying to Accomplish?

Reduce 30-day all cause preventable readmissionrates at Hospital A+.

Reduce 30-day preventable readmission rates by5% over the next 12 months for patients withcongestive heart failure on 5 West unit at HospitalA+.

Thoughts? What can be improved?

How Will We Know that the Change is an Improvement? Measurement

Substantiates need for change Demonstrating performance gap overall Demonstrating variability in performance

Designed to help your improvement team learn and establish improvement priorities

Like a growth curve: it’s not where you are, but where you are going

Answers the question: Are changes an improvement?

IS NOT: Designed for criticism or punishment Supposed to end (it should be sustainable)

Types of Measures1. Outcome Measures

Results in performance attributable to testing or implementing an intervention

How is the health of the patient affected? EXAMPLES: Number symptom free days for asthma patients Emergency Department asthma visits

2. Process Measures Steps in a process that lead to a change (either positive or

negative) to an outcome measure EXAMPLE: Number of patients with Asthma Action Plan

3. Balancing Measures Measures unintended consequences of change(s) in the system

expected, or not EXAMPLE: Cycle Time

*Attribution goes to Melissa Lee, MD at NYC Health + Hospitals/Kings for using example measures.

What Changes Can We Make that will Result in Improvement? PDSA Cycles

Making small changes over a short period

of time to test if the change works

PDSA=Plan, Do, Study, Act

Plan: identify the change you want to make

Do: make the change

Study: it for a pre-set period of time

Act: on the change, keep it, refine it, or drop it

Onto the next change or stepSource: www.ihi.org

Tips To Consider When ConductingSmall Tests of Change

1. Plan multiple cycles for a test of a change2. Scale down the size of the test (the number of patients or

location)3. Test with volunteer staff or clinicians 4. Do not try to get complete consensus during tests5. Be innovative to make the test feasible6. Collect useful data during each test 7. Test over a wide range of conditions, and try a test quickly

Source: www.ihi.org

Run Chart Example Corresponding with Tests of Change

Percent of Patients with Planned Care Visits

0%10%20%30%40%50%60%70%80%90%

100%

Janu

ary

Febru

ary

Mar

chApr

ilM

ayJu

ne July

Augus

t

Septe

mbe

r

Octob

er

Novem

ber

Decem

ber

Tried encounter forms

Nurse Smith left

GOAL

Tested Change of developing registry

*Fictitious data *Attribution goes to Karen Scott, MD for using this slide.

Quality Improvement Project Example*

What are we trying to accomplish? (Aim): Expedite medication refill process for stable patients in an internal medicine clinic to save 20 hours of provider time to spend on unstable patients within the next 6 months.• Why is this important?

– Improves: access to care; clinic efficiency; patient/family experience with care; clinician satisfaction

– Organizational imperative/executive leadership support– Part of Patient Centered Medical Home certification

How will we know that a change is an improvement? Stable patients will receive medication in a timely manner Provider-patient time saved Measures to be collected: Number of stable patients receiving refills without a Primary Care

Physician (PCP) visit Patient Experience (ease of getting refills w/o seeing PCP)

*Attribution goes to Amanda Ascher, MD; this was a project she led with an interdisciplinary teamduring her time in the GNYHA/United Hospital Fund Clinical Quality Fellowship Program.

Quality Improvement Project Example (continued)

What changes can we make that will result in an improvement? New expedited refill process tested on one PCP first

• Nurse and clerk engaged in understanding expedited refill process• Stable patients and their caregiver inserviced about how to expedite

medication process by nurse and clerk• Patient/caregiver tells clerk if refill is needed

Results from initial test: 30 initial patients received expedited medication refills (versus 0

at baseline) 10 hours of provider-patient time saved** Improved experience with ease of getting refills: 20%

Good/Excellent at baseline vs. 56% after intervention implemented

Wound up being sustainable in internal medicine and spread toGYN service

Model spread to other clinics and services

**based on an average of 20 minutes face time per visit with PCP.

*Attribution goes to Amanda Ascher, MD; this was a project she led with an interdisciplinary teamduring her time in the GNYHA/United Hospital Fund Clinical Quality Fellowship Program.

Objective 5. Define common challenges in quality improvement and potential ways to overcome them (we won’t go through this—included for you to review on your own)

Common Challenges in Quality Improvement…

Challenge/Barrier Examples Suggested Solutions

Lack of leadership commitment

• Try to identify: Who drives quality in your organization? Who overseesquality improvement at the leadership level?

• With leadership identified, try to identify and set realistic, achievable quality improvement goals.

Lack of participation by clinical or front line staff: fear of change

• Identify clinicians and administrative personnel with energy and interest in making change.

• Set common goals with team; this will help them understand quality improvement impact.

• Continuously engage leadership to encourage accountability and obtain their buy-in to provide support.

Lack of resources to supportquality improvement (Material, Human, and Time)

• Present your progress to leadership to show that what you are doing ishaving an impact.

• Before asking leadership for new resources (human or equipment), examine current process, analyze data, initiate tests of change—don’t just jump to “no resources” mentality.

Failure or inability to link quality improvement efforts with costs

• Try to make the business case for quality improvement (see example onnext page).

• Obtain support from the Chief Financial Officer, if possible.

Common Challenges in Quality Improvement…(continued)


Scope too large/Lack of Clarity or Focus

• Focus on 1-2 aspects at first; keep focus narrow at first; conduct small tests.

• Set aside other aspects of project until you have a grasp on primary focus.• Too many priorities puts you at risk for, ”this is the flavor of the month.”

Think through small tests within 1 or 2 areas of focus first.

”Scope Creep” • If new or too many topics are identified by team, eventually spin off sub-groups.

• Stay on track with primary focus at first.

Flawed Measurement Systems, Inaccurate or unavailable data

• Try to identify something measurable, using small amounts of data at first; if you get hung up on “big data” or a complicated measurement strategy, you will not move forward.

• Before jumping into something, think through: How will we measure success?

• Continue to refine your data collection process.

Common Challenges in Quality Improvement…(continued)


Perverse regulatory, reimbursement incentives

• Keep the momentum by focusing on, “This is what we need to accomplish to improve patient care and outcomes.”

• Your team can identify areas of focus that impact the regulatory environment, while improving patient care (e.g., hospital-acquired condition reduction efforts, Delivery System Incentive Reimbursement Payment program priorities, etc.)

Sustainability, Holding Gains in Quality Improvement (this is the #1 challenge in quality improvement!)

• Team gets focused on other priorities. Make sure this effort is an imperative of leadership and that you have buy-in from the team. That is the surest way to sustain and spread gains.

Remember…

Improvement is a science There are defined methods It should be data driven There are a variety of methodologies Many tools can be used in improvement science,

and only a subset were described today Qualitative as well as quantitative methods for

measurement Interdisciplinary approach is critically important in

improvement (clinical, administrative, social, systems)

Not one improvement methodology is better thananother!

Questions?

Contact information:

Hillary Jalon, Assistant Vice President, Quality & Safety, NYC Health + Hospitals

[email protected], 212-788-5443, or 646-456-4155

Zeynep Sumer King, Vice President, Regulatory and Professional Affairs, GNYHA

[email protected] or 212-258-5315


LEADERSHIP& STAFF

Stuart Almer, FACHE

Eric Appelbaum, D.O.

Gerard Baltazar, D.O.

Terence Brady, M.D.

Tara Bounocore-Rut, M.H.A.

Shawn P. Cannon, D.O.

Catherine Caronia, M.D.

R. Keith Felstead, D.O.

David Forstein, D.O.

E. Kenneth Freiberg, D.O.

Robin Gitman, M.P.H.

Peter Guiney, D.O.

Scott Ippolito, M.D.

Ronald Israelski, M.D.

Mark Josefski, M.D.

Jenny Kakleas, M.P.A.

Daniel Lombardi, D.O.

Sara Nehring, D.O.

Paul Pipia, M.D.

Cynthia Rosenthal, D.O.

Alan Roth, D.O.

Shane Speights, D.O.

Kenneth Steier, D.O.

Peter Urazov, D.O.

John Vullo, D.O.

Nicole Wadsworth, D.O.

Tara Zahtila, D.O.

2018 NYCOMEC Board of Directors

Chairman of the BoardJerry Balentine, D.O.

Secretary

Robert Yost, M.S.

President / CEODavid Broder, D.O.

Vice Chairman of the BoardGregory Rokosz, D.O.

Treasurer

Jerry Balentine, D.O.

NYCOMECPresident

David Broder, D.O.

Director,Research

David Yens, Ph.D.

Manager,Education

Bette Coppola, M.Ed.

Manager,Trainee Services

Stephanie Labarbera, M.H.A.

Manager,Communications& Special Projects

Sharon Player

Coordinator,Meetings & Events

Alana Berg

Coordinator,Accreditation

Joseph De Nicola

Coordinator,Administration& Strategic PlanningDaniela Popa, M.H.A.

Administrative

AssistantAllison Springer

2018 NYCOMEC Officers

2018 NYCOMEC Staff

PHONE516.686.3730

FAX516.686.3767

LOCATIONOld Westbury , NY

WEBNYCOMEC.org

Documents

NYCOMEC Corp. – Committed to Quality Osteopathic ...€¦ · nycomec.org @nycomeccorp presenter inform ation = = } 9 : 2 0 a . m .:pvs 'jstu +pc 8ibu :pv 8fsfohu 5bvhiu jo .fejdbm