Short white coats, complete with OOA armpatch, are at the ready for the largest incoming class of osteopathic medical students ever in Ohio.
THE QUARTERLY PUBLICATION OF THE OHIO OSTEOPATHIC ASSOCIATION | FALL 2018
Thank You!
Through your membership, you protect and promote the osteopathic profession in Ohio.
Whether we are at the Statehouse influencing policy that affects your ability to care for your patients, providing innovative CME, or sharing benefits that help your practice, the Ohio Osteopathic Association is working for you and osteopathic physicians all across the state. Soon we will be announcing additional member benefits for your support of the OOA!
www.ooanet.org
@OhioDOs
OhioDO
The Quarterly Publication of the Ohio Osteopathic Association Fall 2018 • Volume 88 Number 2 • USPS 068-760
OOA Officers President Jennifer J. Hauler, DO President-Elect Charles D. Milligan, DO Vice President Sandra L. Cook, DO Treasurer Henry L. Wehrum, DO Immediate Past President Sean D. Stiltner, DO
Trustees
4 ATHENS Student Update
ON THE COVER All of the 266 members of the Ohio University Heritage College of Osteopathic Medicine Class of 2022 received a white coat with OOA arm patch, compliments of the Ohio Osteopathic Foundation (OOF). It is an annual tradition for the OOF to gift the short coats to all first-year students at Convocation. photo courtesy ou-hcom
District One • Toledo Nicholas G. Espinoza, DO District Two • Lima Wayne A. Feister, DO District Three • Dayton Nicklaus J. Hess, DO District Four • Cincinnati Michael E. Dietz, DO District Five • Sandusky Luis L. Perez, DO District Six • Columbus Andrew P. Eilerman, DO District Seven • Cleveland Katherine H. Eilenfeld, DO District Eight • Akron/Canton Douglas W. Harley, DO District Nine • Athens/Marietta Jennifer L. Gwilym, DO District Ten • Youngstown/ Warren John C. Baker, DO
FEATURES
2 EXECUTIVE INSIGHT Ensuring osteopathic distinctiveness 3 SUPPORT THE OSTEOPATHIC PROFESSION ON #GIVINGTUESDAY
9 LEGISLATION & POLICY Health care bills of interest to OOA members 14 AOA SETTLES CLASS-ACTION LAWSUIT
8 OHIO SUPREME COURT REJECTS PROPOSED KIDNEY DIALYSIS AMENDMENT
DEPARTMENTS
16 COLLEGE NEWS
20 IN THE KNOW
18 OHIO DOs IN THE NEWS
Resident Representative Ryan K. Martin, DO Student Representatives Dubem Obianagha, OMS II Adam Rabe, OMS II Noor Ramahi, OMS II
CORRECTION The summer issue incorrectly listed the tenure of Anita M. Steinbergh, DO, on the State Medical Board of Ohio. She retired from the Board in April after 25 years of service.
OOA Staff Executive Director Matt Harney, MBA
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Buckeye Osteopathic Physician (08983070) is published quarterly for the Ohio Osteopathic Association, 53 W. Third Avenue, Columbus, Ohio 43201. Phone 614-299-2107; Fax 614-294-0457; www.ooanet.org. Subscription price for non-members is $25 per year. Periodicals postage paid at Columbus, Ohio. Send address changes to Buckeye Osteopathic Physician, PO Box 8130, Columbus, Ohio 43201.
Director of Accounting and Membership Joanne Barnhart Director of Communications Cheryl Markino Administrative Assistant Carol C. Tatman Executive Director Emeritus Jon F. Wills
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Editor: Cheryl Markino For advertising information: 614-299-2107, cmarkino@ooanet.org
FALL 2018 ISSUE 1
e v i t u Exec
T H G I S IN Ensuring Osteopathic Distinctiveness By Matt Harney, MBA
DOs,
osteopathic students, and those of us representing them often talk about osteopathic distinctiveness. We convey this in many ways—treating the patient rather than disease. We talk about a holistic approach to wellness with the clear understanding that people are of body, mind, and spirit. The osteopathic approach seeks a path to patient wellness rather than focusing on disease. All of these concepts are central to the profession—beginning in orientation even before stepping foot inside the classroom as a first-year student and all throughout the next four years (and guaranteed years beyond that for those in osteopathic training programs). But after a resident graduates, what makes osteopathic philosophy endure? What sets osteopathic medicine apart? How do physicians carry forward this distinctive identity well into their careers? As I see it, the tenets of osteopathic medicine are instilled during osteopathic medical school and osteopathic training programs. Beyond that, it’s often up to the individual physician to uphold osteopathic values as a component of their practice. These values can fade in the face of increasing burdens in the health care environment. As we know, the modern physician-patient relationship is subject to a devout devotion to regulation, maintenance of electronic health records, and webs of disparate health insurance networks among many other distractions from personalized care. Clearly, these requirements cost the physician and the patient valuable time. Time that physicians had previously shared with patients, outlining a path to wellness. In the wake of these ongoing challenges, it’s incumbent upon us to set the highest standard for physicians. This summer at the AOA House of Delegates, representatives were presented with H-213, a resolution requiring a minimum of 30 hours of 1-A credit in a 3-year cycle for board certification.
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1-A credit is the heart of continuing medical education (CME) featuring formal, face-to-face or online interactive programming that must adhere to any of the seven core competencies. Resolution H-213 would’ve allowed individual certifying boards to exceed the proposed minimum to their desire. Unfortunately, the resolution did not pass. I’m certain a similar policy will be submitted next year and I hope the profession seizes this opportunity. Without a doubt, patients are calling out for a more holistic approach to wellness—in other words, exactly what the osteopathic philosophy teaches. Given the continued intermingling of the osteopathic and allopathic worlds through hospital consolidations, large composite physician groups, and single accreditation among other factors, we must be more creative and assertive in our efforts to ensure osteopathic principles are integrated into practice beyond graduation. So how is this achieved? I believe osteopathic principles are truly reinforced through quality continuing medical education. Education centered on the patient-centered, comprehensive care that addresses wellness in ways that others simply cannot. Attention to personalized care that addresses the root of ailments while outlining a plan for true, all-encompassing wellness. To aid these efforts, the OOA will be expanding its CME offerings in the near future. It is my hope these offerings will not only provide the requirements for licensure and board certification but serve as much more—programs that reinforce a philosophy that makes osteopathic medicine the ultimate model for health care and wellness.
Support the Osteopathic Profession on By Cheryl Markino Celebrated annually on the Tuesday following Thanksgiving and the widely-recognized shopping events Black Friday and Cyber Monday, #GivingTuesday kicks off the charitable season this year on November 27. For many, it’s a time to focus on their end-of-year giving.
The Ohio Osteopathic Foundation (OOF) is joining the #GivingTuesday movement and encouraging contributions to help develop physician leaders and advocates for the osteopathic medical profession. To make a tax-deductible donation, go to www.ooanet.org. According to the founders of #GivingTuesday, which started in 2012 in New York, the day has inspired hundreds of thousands of people to give back and support causes they believe in. Last year, an estimated $274 million was raised by charities, foundations, and other philanthropic groups across the country, with the average donation totaling $134. The OOF, founded in 1963, was established as the Ohio Osteopathic Association’s charitable arm to support osteopathic education and research in Ohio. From June 1975 until April 1983, it was funded by a mandatory assessment on all members, as unanimously approved by the OOA House of Delegates, to support Ohio University Heritage College of Osteopathic Medicine and raised more than $1 million to support development of the college. Today, the OOF’s mission statement has been expanded, by vote of the trustees, to support osteopathic medicine through education and outreach, leadership development, and community health initiatives. OOF President Matt Harney, MBA, noted that while the current campaign focuses on monetary donations, there are many ways to give longterm. “It doesn’t need to be a cash contribution,” he said. “You can support the profession by designating the OOF as a beneficiary of an IRA, 401(k), or life insurance policy. Gifts of annuities, real estate, marketable securities, and home/auto titles are also among the possibilities. And because the OOF is a 501(c)3 organization, there are tax
benefits.” Many of the current OOF projects focus on the future of the profession, with an eye toward students at the Heritage College. For example, the OOF gifts white coats to all first-year students; sponsors professional speakers and conducts leadership workshops for student government; provides grants to student chapter affiliates to cover expenses for participation at national meetings and scientific events; and awards three scholarships annually. Past projects include the installation of a commemorative walkway at the OOA office in Columbus to celebrate the association’s 110th anniversary. Donors purchased engraved bricks to pay tribute to colleagues and mentors while leaving a lasting imprint. For the 115th anniversary, OOF funded a public awareness campaign. That project consisted of radio advertising in all 88 Ohio counties, an online promotional video, and digital banner ads targeted to Ohioans searching for health-related information online. In 2015, with support from the Warren General Hospital (WGH) Fund, the OOF sponsored the Osteopathic Manipulative Medicine Lab at the Heritage College Cleveland campus. The Fund, established 12 years ago, was endowed by the WGH Board with an $804,000 gift to support osteopathic medical education, particularly in northeast Ohio. Harney said these types of projects help enhance Ohio’s strong osteopathic roots. “Whether it’s developing an outreach program or fostering student leaders or supporting medical education, the OOF will continue to build and grow the profession with your help,” he said. “Your contribution has the power to strengthen osteopathic medicine for generations to come.” Make your donation at www.ooanet.org
FALL 2018 ISSUE 3
Student Update:
ATHENS
CAMPUS Despite rigorous academics and busy schedules, students at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) regularly make time for their peers, for their community, and for their profession. The OOA works with many of these student leaders, in particular the presidents of the Student Government Association (SGA) and Student Osteopathic Medical Association (SOMA). SGA presidents from each campus— Athens, Dublin, and Cleveland—attend OOA Board meetings and are allotted time on the agenda to report on campus activities. SOMA is an AOA affiliate and the nation’s largest network of osteopathic medical students. In this issue of Buckeye Osteopathic Physician, we invite Athens campus leaders to provide an update.
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Greetings from the OU-HCOM Athens Campus! We have exciting news coming from our campus. This summer we welcomed over 150 first-year medical students. It was several days of orientation and now students are in high spirits and ready to face the challenges ahead. Faculty and staff are also excited to launch the new curriculum known as the Pathway to Health and Wellness Curriculum (PHWC). It emphasizes active learning and team-based activities to prepare our students for the health care environment where they will be working in an interdisciplinary setting. Second-year students are grandfathered into the old curriculum and hence will remain in the CPC 2 curriculum. Students participated in a variety of activities throughout the fall, including: • Heritage College New Building Open House: The Facility planning committee showcased a blueprint of what the proposed building will look like and hoped to get some ideas and recommendations on how to make it better for staff, faculty and students. • COMrade Mentor Dinner: Upperclass students meet the first-year student(s) who they will mentor throughout their four years of medical school. • Organization Fair: This is an avenue for student leaders to showcase their clubs and organizations and educate their peers about what the club does and how to get involved. The Athens campus hosts about 30 clubs, so students are bound to find one that lines up with their goals and passion. • OMED Conference in San Diego, California: It offers students a research workshop focused on the fundamentals as well as a research poster contest, specialty mentoring sessions, and more. As SGA president, I was fortunate to attend the AOA House of Delegates in Chicago in July and the OOA House of Delegates in Columbus in April. These policy-making sessions give insight to the multitude of issues facing medicine today and offer students an opportunity to voice concerns about issues that directly affect them. One of the annual SGA tasks is to organize the annual Student Organizations Fair at the start of the academic year. This year, the event was held in Grosvenor Hall, rather than Irvine, and by all accounts was a smashing success. Thirty unique and amazing student organizations were on hand to recruit new members and show off their accomplishments from the previous year. Along with established organizations, a few new groups were welcomed, including Ophthalmology Club, Wellness Club, Radiology Club, and Students for a National Health Program. The new venue allowed for a better flow of traffic and more opportunities for enthusiastic second-year students to connect with first-years. Many clubs are reporting record enrollment of new members, and the upcoming year promises to be exciting, productive, and fun! The Athens SGA was thrilled to have the opportunity to promote our amazing student organizations. Medical students are exceptional people. The events, workshops, services, and volunteer opportunities provided by these student groups are a great way to showcase the outstanding quality of our students
DUBEM OBIANAGHA, MPH, MBA, OMS-II
SGA President and National Representative, Athens Campus
as they develop professionally and give back to the community, to the school, and to one another. National Osteopathic Medicine (NOM) Week, held in April, was another highlight. The goal of the nationwide program initiated by the American Osteopathic Association is to promote awareness of the profession. Our students reached out to the community and represented the school brilliantly! It was amazing to watch their enthusiasm, initiative, cooperation, and creativity. HCOM students were all over the Athens campus at seven different events throughout the week: • The Emergency Medicine Club, Student Osteopathic Internal Medicine Association, Lifestyle Medicine Club, and Sigma Sigma Phi worked together to put on two days of “Osteopathic Jeopardy” in Baker Student Center where they answered questions and informed passersby about osteopathic medicine. • The Pediatrics Club, Student American Academy of Osteopathy, and OB/GYN Club sponsored a demonstration, Osteopathic Treatment for Pregnant Patients, with a guest lecturer. • The American Medical Student Association, Student Osteopathic Medical Association, Medical Mentoring, Oncology Club, and Student Association of the American College of Osteopathic Family Physicians set up an Instagram photo booth in Baker Center. • The Association of Women Surgeons, Student National Medical Association, Physicians for Patients, and Ohio Women in Medicine offered a lunchtime yoga class. • The Student AMA and Sports Medicine conducted a bone marrow drive and SNMA invited students to contribute to Cards for a Cause. The SGA board also organized a Primary Care Associate (PCA) Appreciation Event to thank the PCAs for the phenomenal impact they had in the learning experience of our students. PCAs are fourth-year medical students who take a year out of their regular curriculum to serve as faculty teaching in different areas such as Osteopathic Manipulative Medicine and Primary Care. They help students develop the skill set needed to be ready as physicians. The event had over 70 students in attendance who recounted the specific ways PCAs impacted their lives. Of special interest, the Athens campus now has an in-house psychologist. Dr. Bradford Meyers officially started his duties this semester and will be involved with programming geared towards promoting the health and wellness of our students, faculty and staff.
FALL 2018 ISSUE 5
The SOMA chapter has a host of activities lined up on the academic calendar. With so many events planned, we’re looking forward to a successful year! Activities actually started last spring—and National Osteopathic Medicine (NOM) Week in April was one of the highlights. We organized a photo booth with the theme “Can You Make the Cut?” complete with surgical attire to dress up and take Instagram-worthy pics. The idea was to underscore that DOs can choose any specialty and to break through the stigma that DOs can’t become surgeons. To kick-off the fall semester, we had an ice cream social as our first general body meeting. It was a delicious success—and over 80 new members from the class of 2022 joined SOMA. Other events for the year include: • An OMM demonstration and suturing clinic with PreSOMA, undergraduates at Ohio University who are interested in pursuing osteopathic medical school. • Red Cross blood drives that we help organize donors and volunteers. • Casseroles for Comfort, a program where we enlist volunteers to make bulk casserole dishes to be delivered to local home-bound elderly. • A talent show and ugly Christmas sweater fundraisers for Good Works, an Athens non-profit to help people struggling with poverty and homelessness in rural Appalachia, and My Sister’s Place, a domestic violence agency in Athens.
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KAITLYN ECKERT, OMS-II
SOMA President Athens Campus
• A special event to help local Girl Scouts earn their nutrition badge. • Participation of several Board members at AOA’s OMED Conference in San Diego. In addition, throughout the year we host a Social Medicine lecture series, often linking with other student groups. We recruit student volunteers to lead the 10 workshops that cover timely topics about race, economics, ethics, gender, etc. and how they relate to medicine. The conversations are thoughtprovoking and focus on ways to eliminate disparities. SOMA enjoys a partnership with the OOA. Each year SOMA officers work with OOA staff on State Science Day, a huge statewide science fair with over 1,000 middle school and high school students. We spend the day in Columbus judging projects for the Osteopathic Medical Award.
Student Leaders Student Government Association, Athens Dubem Obianagha, President/National Representative Kevin Chase, Vice President Sarah Gaston, Secretary Alex Merk, Treasurer Tiffany Downs, Student Director for Community Outreach Greg Turissini, Graduate Senate Representative Braden Crouse, OU Senate Student Representative Student Osteopathic Medical Association, Athens Kaitlyn Eckert, President Marisa DeSanto, National Liaison Officer Katie Fasoli, Vice President Liza Zimmerman-Slayton, Treasurer Laila Almassri, Community Outreach Director Amy Mehlman, Pre-SOMA Director Brylie Schafer, Secretary
FALL 2018 ISSUE 7
Ohio Supreme Court Rejects Proposed
KIDNEY DIALYSIS
AMENDMENT But will it return?
In August, the Ohio Supreme Court determined that individuals collecting signatures for the issue failed to submit the requisite disclosures and deemed the entire petition invalid. As a result, the proposed amendment failed to qualify for the November 2018 general election. The amendment’s sponsor — California-based Service Employees International Union (SEIU)— funded the $4 million paid petition drive. The OOA aligned with the Ohio Renal Association and a coalition of more than 20 other kidney care, medical and patient advocacy organizations to oppose the amendment because of the harm it would bring to the 18,000 Ohioans who rely on the high-quality, life-saving dialysis care provided by the state’s 326 outpatient dialysis clinics. The proposed Constitutional amendment sought to increase the alreadyrigorous regulation of dialysis clinics and to set arbitrary limits on clinic revenues, which could lead many clinics to consolidate services, cut back or close — particularly those in poor, disadvantaged, and rural areas. OOA Treasurer Henry L. Wehrum, DO, a nephrologist in Columbus with more than 25 years of experience, brought the issue to the OOA’s attention earlier this year when the amendment was first proposed. His concern was that the initiative was sponsored by a special interest group with no experience in the treatment, management, or regulation of dialysis. “This proposal puts the health of Ohio’s kidney dialysis patients at needless risk,” he said. “I’ve seen first-hand the devastating health consequences my dialysis patients face without proper access to care.” Wehrum also noted the state constitution
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“
This proposal puts the health of Ohio’s kidney dialysis patients at needless risk.
”
- Henry L. Wehrum DO, OOA Treasurer
is not the place for complicated health care policy. “If a Constitutional Amendment is adopted, it can only be changed by another Constitutional Amendment when things go wrong—that’s not a risk I’m willing to take on behalf of my patients.” Gene Pierce, a spokesperson for the coalition against the proposal said the SEIU has a long history of leveraging controversial ballot issue campaigns to advance its own political agenda. “That its amendment would actually harm Ohio dialysis patients comes as no surprise to those familiar with the SEIU’s strong-arm tactics,” he said. SEIU represents workers in many industries and is one of the largest unions of health care workers in the country. Wehrum said he wouldn’t be surprised if the SEIU decides to try again in the future to put the measure before voters. “They’ve already invested a lot of money in Ohio. In California, they were able to get the issue on the ballot but voters rejected it,” he said. “Regardless, the coalition will remain prepared to educate Ohio voters about the dangers of this reckless proposal.”
LATION
LEGIS
&
POLICY By Cheryl Markino
Summer and early fall during an election year are generally quiet times at the Ohio Statehouse as legislators recess to gear up for campaigning. All 99 seats of the Ohio House of Representatives appear on the ballot every two years, along with half of the state’s 33 Senate districts. So it was a bit of a surprise in August when State Rep. Theresa Gavarone (R-Bowling Green) introduced HB 726, legislation that would eliminate the current requirement that advance practice registered nurses (APRNs) collaborate with a physician. FALL 2018 ISSUE 9
LEGISLATIVE UPDATE APRNs Seek Independent Practice Rights—Again
It’s déjà vu all over again. Two years ago, state lawmakers considered HB 216, which also proposed removing APRN supervisory agreement requirements from state law. Ultimately, after a year and a half of meetings and deliberations, the measure passed and became law with several scope expansions for APRNs—but not independent practice authority. Gavarone said this new bill, which she calls the “Better Access, Better Care Act,” will modernize Ohio law to allow APRNs to practice independently and to the full extent of their education, training, and certification. But what she fails to mention, according to OOA Health Policy Chair Jennifer L. Gwilym, DO, is their education and training is substantially less than physicians. “Physicians and nurses are not interchangeable,” she said. “We have a decade of medical education in order to diagnose and treat patients. APRNs do not. So ‘Better Care’ is inaccurate.” Gavarone also said the demand for
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primary care services is projected to increase much faster than physician supply over the next few years. But OOA Executive Director Matt Harney noted while that may be a national trend, Ohio is looking to reverse it. “The osteopathic profession is doing its part,” he said. “OU-HCOM graduated its largest class ever this year with 181 new osteopathic physicians; next year, physician graduates will approach 250. The Heritage College is poised to graduate 1,000 DOs every four years.” Citing a report from the Association of American Medical Colleges, Harney said Ohio ranks second in the nation for physicians under the age of 40. “Ohio’s physician community is well-positioned to lead the health care team into the future,” he said. Proponents Push for Passage of Step Therapy Reform Bill
In other legislative news, a coalition of physician and patient organizations, including the OOA, continues to push for passage of SB 56/HB 72. The legislation,
written by State Rep. Terry Johnson, DO (R-McDermott) and others, calls for reforms to step therapy, a practice health insurance companies use to deny coverage for certain prescriptions until the patient first tries a similar medicine—usually at less cost to the insurer. This “fail first” practice does not take a patient’s medical history or other factors into account, but instead relies on a predetermined prescription drug formulary or protocol. “For some patients, to fail on a medication could mean serious health setbacks,” said Shannon Trotter, DO, a dermatologist in Springfield, who has been a vocal proponent of the legislation. “For example, someone with epilepsy could have a seizure; someone with mental illness could have a psychotic episode; someone with psoriasis could endure a prolonged skin rash outbreak; for someone with arthritis, the pain and swelling of joints could persist to the point of needing surgery; or for someone with cancer, the chance of reaching remission or being cured, could be delayed while the cancer worsens.”
POLICY UPDATE T
he OOA, as part of the Medical Association Coalition (MAC), continues to work on rules for the State Medical Board of Ohio’s “one-bite” program that provides treatment and monitoring for health care providers with substance abuse issues. Harney, who participated in several meetings on the issue in the fall, acknowledged the complexity of the Medical Board’s role in protecting the public while, at the same time, promoting the health and well-being of licensees who struggle with possible impairment and mental illnesses. “Interestingly, the US Preventive Services Task Force calls for depression screening in all patients,” Harney said. “Yet, fear of professional
repercussions from state medical boards has been identified as one of the main barriers for physicians seeking mental health and addiction treatment.” Harney said the OOA has an obligation to patient safety and to its membership to make sure they receive the same protection as all Ohioans against the career-ending stigma of mental illness and addiction. “That’s why we support a strong, confidential process to identify, help, and refer at-risk physicians to early treatment before harm is done and disciplinary action is necessary,” he said. At an October 2018 meeting with the Medical Board and the Common Sense Initiative, MAC representatives advocated for the following changes to the proposed rules.
Comments from Medical Association Coalition (MAC) October 3, 2018 Below outlines suggested changes to 4731-16-17 through 4731-16-21 that were reviewed and discussed during the September 26, 2018 meeting with the Common Sense Initiative (CSI) office. We appreciate the opportunity to provide comments on the proposed one-bite program rules. 4731-16-17 Requirements for one-bite program
Current language: (H)(1) The licensee shall be required to provide random, observed toxicology screenings of biological materials, including but not limited to, blood, urine, hair, saliva, breath, or fingernail samples for drugs and alcohol as directed by the monitoring organization with a minimum of four random, observed toxicology screens per month for the first year of the agreement with the monitoring organization and a minimum of two random, observed toxicology screenings per month for the remainder of the agreement with the monitoring organization. Proposed language: The licensee shall be required to provide random, observed toxicology screenings of biological materials, including but not limited to, blood, urine, hair, saliva, breath, or fingernail samples for drugs and alcohol as directed by the monitoring organization with a minimum of two random, observed toxicology screenings per month. CSI discussion/explanation: This change was requested based on information highlighted from the Federation of State Medical Board’s Policy on Physician Impairment that states toxicology testing panels and frequency should be based on individual case specifics.
Licensees participating in the one-bite program are doing so for clinical and therapeutic support and not under the terms established through disciplinary action by the medical board. Research was presented to further support this change by reporting the average toxicology testing frequency is 2 tests per month for professionals being monitored for a substance use disorder. This change will allow the implementation of national standards and the use of individualized monitoring terms based on the clinical expertise of the monitoring organization.
Current language: (H)(2) The licensee shall attend drug and alcohol support group meetings (e.g. alcoholics anonymous or narcotics anonymous) as directed by the monitoring organization with a minimum of attendance at three meetings per week for the first year of the agreement with the monitoring organization and at least two meetings per week, with a minimum of 10 meetings per month for the remainder of the agreement with the monitoring organization. Proposed language: The licensee shall attend drug and alcohol support group meetings (e.g. alcoholics anonymous or narcotics anonymous) as directed by the monitoring organization with a minimum of 10 meetings per month. CSI discussion/explanation: This change was requested based on information highlighted from the Federation of State Medical Board’s Policy on Physician Impairment that regular attendance at mutual help program meetings such as AA, NA, or equivalent programs should be required but should be based on individual
FALL 2018 ISSUE 11
case specifics. It was discussed that there is no direct correlation for healthcare professionals being monitored of increased number of meetings attended to lower relapse rates. This change will allow for individualized monitoring terms and the implementation of additional therapeutic support meetings based on the clinical expertise of the monitoring organization.
Current language: (I) Any relapse as defined in paragraph (B) of rule 4731-16-01 or confirmed positive drug screen shall be reported to the board by the medical director of the monitoring organization and the licensee. Proposed language: Any relapse as defined in paragraph (B) of rule 4731-16-01 shall be reported to the board by the medical director of the monitoring organization and the licensee. CSI discussion/explanation: Confirmed positive toxicology tests may result from reasons other than relapse. This includes environmental exposure, incidental exposure, collector error, and others. Any confirmed positive result related to relapse would be reported as defined in 4731-16-01(B). Concerns were identified that if a confirmed positive result was reported to the medical board and it was not related to a relapse, this would violate sections 1 through 5 of Ohio Revised Code 4731.251.(D).
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Current language: (J) The board shall develop guidelines for the reporting of non-compliance with conditions of the one-bite program. Non-compliance shall be reported to the Board by the licensee and the medical director of the monitoring organization. Proposed language: The board shall develop guidelines in collaboration with the monitoring organization for the reporting of non-compliance with conditions of the one- bite program. Non-compliance shall be reported to the Board by the licensee and the medical director of the monitoring organization. CSI discussion/explanation: Sections of 4731.251 state that the monitoring organization shall establish individualized terms and conditions with which eligible practitioners must comply for continued participation in and successful completion of the program. It also states that the monitoring organization, in consultation with the board shall develop procedures to govern specific parameters of the program. Due to this and to utilize the clinical expertise of the monitoring organization, it would be appropriate that the guidelines are established jointly by the medical board and the monitoring organization. 4731-16-19 Monitoring organization for one-bite program
Current language: (A)(6) At the request of the board, the medical director of the monitoring provider shall provide testimony in any disciplinary proceeding involving a licensee reported to the board by the monitoring organization. Proposed language: Remove section CSI discussion/explanation: It is required by the medical director of the monitoring organization to report: any relapse, any licensee who fails to comply with the monitoring agreement in accordance with the non-compliance guidelines, and any failure to complete treatment or continuing care. The medical board agreed to check with the attorney general’s office to determine whether a written report from the medical director of the monitoring organization would be sufficient for their disciplinary proceedings. Current language: (B)(1) The agreement shall provide that the licensee is required to participate in random, observed toxicology screenings of biological materials, including but not limited to, blood, urine, hair, saliva, breath, or fingernail samples for drugs and alcohol no less than four time per month for the first year of the agreement and no less than two times per month for the remainder of the agreement. Proposed language: The agreement shall provide that the licensee is required to participate in random, observed toxicology screenings of biological materials, including but not limited to, blood, urine, hair, saliva, breath, or fingernail samples for drugs and alcohol no less than two times per month. CSI discussion/explanation: This change was requested based on information highlighted from the Federation of State Medical Board’s Policy on Physician Impairment that states toxicology testing panels and frequency should be based on individual case specifics. Licensees participating in the one-bite program are doing so for clinical and therapeutic support and not under the terms established through disciplinary action by the medical board. Research was presented to further support this change by reporting the average toxicology testing frequency is 2 tests per month for professionals being monitored for a substance use disorder. This change will allow the implementation of national standards and the use of individualized monitoring terms based on the clinical expertise of the monitoring organization. Current language: (B)(2) The licensee shall attend drug and alcohol support group meetings (e.g. alcoholics anonymous or narcotics anonymous) as directed by the monitoring organization with a minimum of attendance at three meetings per week for the first year of the agreement with the monitoring organization and at least two meetings per week, with a minimum of 10 meetings per month for the remainder of the agreement with the monitoring organization. Proposed language:
The licensee shall attend drug and alcohol support group meetings (e.g. alcoholics anonymous or narcotics anonymous) as directed by the monitoring organization with a minimum of 10 meetings per month.
CSI discussion/explanation: This change was requested based on information highlighted from the Federation of State Medical Board’s Policy on Physician Impairment that regular attendance at mutual help program meetings such as AA, NA, or equivalent programs should be required but should be based on individual case specifics. It was discussed that there is no direct correlation for healthcare professionals being monitored of increased number of meetings attended to lower relapse rates. This change will allow for individualized monitoring terms and the implementation of additional therapeutic support meetings based on the clinical expertise of the monitoring organization. 4731-16-20 Treatment providers in the one-bite program
Current language: (A)(9) The treatment provider provides levels of patient care, including medical detoxification; inpatient or residential treatment; extended residential treatment; partial hospitalization, intensive outpatient treatment, continuing care and others as necessary. Proposed language: The treatment provider provides levels of patient care, including medical detoxification; inpatient or residential treatment; extended residential treatment; partial hospitalization, intensive outpatient treatment, continuing care or others as necessary. CSI discussion/explanation: Many treatment providers offer a variety or most of the levels of care listed but requiring all levels of care in order to be an approved treatment provider may result in significant reduction or elimination in approved treatment providers (specifically in-state). Additional quality measures have been put in place to ensure treatment providers approved for the one-bite program specialize in the treating of healthcare professionals. 4731-16-21 Continuing care for one-bite program
Current language: (C) A continuing care provider shall provide therapy, including group therapy, led by a psychologist or masters-level chemical dependency counselor, social worker, or therapist. Proposed language: A continuing care provider shall provide therapy led by a psychologist or masters-level chemical dependency counselor, social worker, or therapist. CSI discussion/explanation: This change was requested to allow for the use of individualized therapy when necessary due to geographic limitations or other barriers that exist related to group therapy. This change will allow for the use of individualized monitoring terms based on the clinical expertise of the monitoring organization.
FALL 2018 ISSUE 13
AOA SETTLES
CLASS-ACTION LAWSUIT Board certification to be uncoupled from membership and dues reduced
E
arlier this year, the American Osteopathic Association (AOA) agreed to settle a lawsuit brought by four of its members and, after final approval of the settlement, will no longer require that its board-certified physicians maintain membership in the association. According to the AOA, the business practices at issue in the lawsuit were lawful. The organization chose to settle because litigation appeared likely to extend for several years, which would have prevented the AOA from fully implementing strategic initiatives in membership and board certification and strained staff resources. “For wo years, the AOA’s human and financial resources have been diverted to defending this lawsuit rather than to refining our organization to meet the needs of a rapidly growing profession,” said AOA President William S. Mayo, DO. “Our business is to serve the 137,000 osteopathic medical students and DOs in the United States. Settling this lawsuit allows us to focus on the impactful work that is only done by the AOA, such as practice rights protection, legal assistance and federal advocacy for DOs.” A $90 reduction of membership dues was part of the settlement agreement. As approved by the AOA House of Delegates at the July 2018 meeting, the dues reduction applies to regular members for three years starting June 1, 2019. Since the AOA is a physician-led organization in which
members set their own dues, the vote was necessary. The AOA also will suspend board certification maintenance fees of $90 for three years. Further, the AOA will recognize online continuing medical education (CME) as equivalent to live CME for the purpose of meeting membership requirements and will offer AOA members two free online CME courses for three years, a value of $40 to $150 per year, depending on specialty. The AOA will also continue its brand awareness campaign through May 31, 2021. The plaintiffs’ attorneys, Philadelphia-based Duane Morris, LLP, will receive fees and costs in an amount not to exceed $2,617,000. Subject to court approval, Duane Morris will then pay $15,000 to each of the four plaintiffs – Albert Talone, DO, Craig Wax, DO, Richard Renza, DO, and Roy Stoller, DO – from its legal fees. There is no other monetary settlement. The suit was brought by the three New Jersey physicians and one from Pennsylvania on behalf of a nationwide class of DOs. The suit claimed physicians were forced to purchase annual memberships, at $683 per year, in order to maintain their board certifications. Antitrust laws prohibit tying arrangements in which consumers who are interested in one product are forced to also purchase a second, the plaintiffs asserted.
From the AOA: LAWSUIT SETTLEMENT FAQ SETTLEMENT REQUIREMENTS
If the AOA believes coupling membership and certification is legal, why did it settle the lawsuit? Continued litigation was expected to take years and would have required significant financial and staff resources from the AOA. More important, AOA strategic initiatives to expand membership and market board certification to a new market of physicians were “shelved” until the litigation was resolved. The AOA is now free to pursue these important growth strategies without concern about how discussions and actions could be taken out of context in the litigation.
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What is decoupling? Decoupling is the separation of AOA membership from board certification. Since the inception of AOA board certification in the 1930s, AOA has offered certification only to members. Board certified diplomates are required to maintain AOA membership to keep their certification active. After decoupling, AOA certification will be open to non-members – DOs and MDs – and diplomates will no longer be required to maintain membership in the AOA.
When does decoupling go into effect? Decoupling is one of the provisions in the settlement agreement. The effective date for implementing the settlement is 30 days after the settlement is fully approved by the court. The earliest this could happen is December 2018 if there are no appeals or delays. Are member dues being used to pay for the settlement? No. Payments required by the settlement are covered by insurance. What happens after three years? The settlement agreement prohibits the AOA from increasing regular member dues for three years. During this time, AOA retains the right to recommend dues changes in other member categories, and could also reduce regular member dues further based on market demand and fiscal assessment. After three years, the AOA could recommend an increase in regular dues. Any membership dues recommendations must be approved by the House of Delegates. Will AOA ever re-couple board certification and membership? There are no plans to do so, and the settlement terms require court approval for AOA to reinstate the policy requiring membership for board certification.
Will OCC continue to be required to maintain board certification? Yes. AOA certification and OCC reflect your commitment to ongoing evidence-based education that results in highquality, whole-person care and improves patient outcomes and satisfaction. Efforts are underway to make board certification and OCC more cost efficient, easier to maintain and more relevant to today’s practicing physicians. Will CME be required for OCC in my specialty? Individual certifying boards are making changes to CME requirements and exploring opportunities to leverage technology for cognitive assessment. The American Osteopathic Board of Radiology announced a new pilot format for cognitive assessment that eliminates the 10-year OCC examination. Do I still need 1-A CME to maintain board certification? Each AOA certifying board sets its own CME requirements. Most require some amount of Category 1-A CME. Who will track my CME if I am no longer an AOA member? Physicians will need to keep comprehensive records to document completion of the required CME and provide such documentation to the applicable certifying board. AOA’s TraCME service is available only to members.
BOARD CERTIFICATION & CME
Do I have to be a member of AOA to maintain my board certification? Yes, this is current AOA policy. The policy will change on the effective date after the settlement is fully approved by the court. The earliest this could happen is December 2018 if there are no appeals or delays. When can I stop my AOA membership without jeopardizing my board certification? On the effective date after the settlement is fully approved by the court. The earliest this could happen is December 2018 if there are no appeals or delays. Does the settlement change board certification? After decoupling, AOA certification will be open to nonmember physicians, including MDs who complete their training in osteopathically recognized ACGME programs. Diplomates will no longer be required to maintain membership in the AOA to keep their certification in active status. Does the settlement change CME requirements for membership? Under the terms of the settlement, AOA can no longer suspend a physician’s membership for failing to meet a CME requirement, provided the physician satisfies the CME requirements for state licensure. However, each AOA certifying board will continue to set CME requirements for maintaining certification.
How do I get my free CME? Assuming court approval of the settlement, the free CME will be available beginning in January 2019. The AOA will provide details after the settlement is approved. Can I sit for allopathic boards? Yes, if you meet the requirements identified by the ABMS certifying boards. MEMBERSHIP
What does AOA do with membership dues? Dues are used to fund the cost of AOA programming and operations. Details can be found on page 17 of the 2018 Annual Report: https://osteopathic.org/wp-content/ uploads/2018-annual-report.pdf Will AOA defend my licensure and certification if I am not a member? AOA will always advocate for the recognition of osteopathic credentials – the DO degree, AOA residency training, and AOA certification. However, legal advocacy for individual DOs is a benefit of membership. Can I get a refund on my 2018 membership dues after decoupling? No, AOA bylaws do not allow for refunds of membership dues. For more details, go to www.osteopathic.org.
FALL 2018 ISSUE 15
COLLEGE NEWS
The Ohio University Heritage College of Osteopathic Medicine Class of 2022 recites the Osteopathic Pledge of Commitment during the 43rd Annual Convocation and White Coat Ceremony, September 23, 2018. PHOTOS COURTESY OU-HCOM
Health Care Changes Require Doctors to Rethink Roles, Speaker Tells Medical Students
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hile advancing technology will enable doctors “to do things for patients that hitherto we couldn’t have dreamed of,” it will also challenge them to “rethink our role as physicians,” a top executive from OhioHealth told the 266 incoming medical students at Ohio University Heritage College of Osteopathic Medicine, September 23, 2018. It is OU-HCOM’s largest class in its history. Bruce Vanderhoff, MD, spoke at the medical school’s 43rd Annual Convocation and White Coat Ceremony, held at the Athens campus. Students received their short white coats, a gift from the Ohio Osteopathic Foundation, signifying their status as physicians in training. Vanderhoff, chief medical officer and senior vice president of OhioHealth, the largest health care system in central Ohio, also received the college’s Phillips Medal of Public Service, which he
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called “the greatest honor that has been bestowed upon me in my career.” Vanderhoff asked the future doctors to consider, “what role will you play in writing the continuing history” of the medical profession. The most promising future for health care, he suggested, is one in which care is more affordable and easier for patients to navigate, doctors focus on “keeping people well rather than waiting to treat them when they’re sick,” and the physician is not just a care provider, but also an educator and a team leader. OhioHealth is the Heritage College’s preeminent education partner for its Dublin, Ohio, campus. Vanderhoff, who played a key role in creating this partnership, noted that the close relationship between the college and OhioHealth has a long history, with OhioHealth Doctors Hospital serving as one of the first clinical training sites for Heritage
College students. Throughout their histories, the two organizations have shared a commitment to training the next generation of physicians to practice in Ohio communities, Vanderhoff noted. “Our organizations have such common culture,” he said. “But while both OhioHealth and Ohio University have rich histories of service in our state, both remain forwardthinking institutions.” In his opening remarks, Kenneth Johnson, DO, Heritage College executive dean and Ohio University chief medical affairs officer, congratulated the students on being the first to be trained in the college’s new Pathways to Health and Wellness Curriculum, putting them “at the front lines of important changes in medical education.” He also expressed his pride in the fact that 94 percent of the incoming class members are from Ohio, 21 percent are from minority backgrounds
and 22 percent are first-generation college students. OOA President Jennifer J. Hauler, DO, participated in the ceremony, coating students and offering words of welcome. She noted students were considered members of the OOA as soon as they matriculated to OUHCOM. “We’re incredibly proud to advocate on your behalf during medical school, your residency, and throughout your medical practice,” she said. Adam Rabe, OMS II, president of the Student Government Association at the Dublin campus and a representative on the OOA Board of Trustees, told the class of 2022 that their white coats “will change people’s perspective of you. Every time you walk into a patient’s room, you will bring with you every memory that patient has of their interaction with physicians, both good and bad.” Therefore, he said, the students will have the responsibility to use the respect conferred by the white coat “to leave each patient a little better off than you found them.”
With 266 students, the OU-HCOM Class of 2022 is the largest in the college’s history.
120,000 GROSS SQUARE FT. BREAKING GROUND MAY 2019 OPENING SPRING 2021 http://bit.ly/NewMedEdFacilities
FALL 2018 ISSUE 17
OHIO DOs IN THE NEWS William J. Burke, DO, was elected chair of the Osteopathic International Alliance, the leading organization for the advancement and unity of the global osteopathic medical profession. He was installed during the OIA annual meeting and conference, Sept. 27-29, 2018, in Dubai, United Arab Emirates. Burke is dean of the Ohio University Heritage College of Osteopathic Medicine at Dublin. The OIA was launched in June 2003, incorporated in the United States in December 2004, and in July 2005, held its inaugural conference in Washington, DC. Today it represents 71 organizations from 20 countries on five continents, including over 120,000 osteopathic practitioners. In February 2018 it was admitted into official relations with the World Health Organization as a nongovernmental organization. Todd R. Fredricks, DO, of Amesville, was named president of the Association of Military Osteopathic Physicians and Surgeons. AMOPS main focus is informing the American Osteopathic Association (AOA) on the duties and needs of more than 2,200 DOs practicing in uniform. Fredricks is an assistant professor of family medicine at Ohio University Heritage College of Osteopathic Medicine. Ohioans Recognized at OMED Gala Three Ohioans were among those recognized at the 2018 Honors Gala, hosted by the American Osteopathic Foundation Oct. 5 in San Diego. The event, held in conjunction with OMED, a five-day CME conference, drew approximately 700 guests. Congratulations to: Gregory Liller, OMS II, of Chardon, who was a Golden Ticket Scholarship Finalist. He is an OU-HCOM student. Alexandra M. McKenna, DO, who was named Outstanding Resident of the Year in Family Medicine. She completed her residency at OhioHealth Doctors Hospital in Columbus and is an OUHCOM graduate. Alyssa M. Ritchie, OMS IV, of Dublin, the LEAD Scholar Award Winner. The honor recognizes students whose Leadership, Excellence, Achievement, and Dedication are proven in the classroom and community. She is a student at OUHCOM, Dublin.
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Volunteer! We need you to DO your part! The OOA mission is to promote the distinctive philosophy and practice of osteopathic medicine. To achieve that, we need your help.
Be a Special Advocate We’re continually seeking experts with special knowledge, experience, or interest regarding insurance, Medicaid, scope of practice issues, physician payment, and pharmacology among other topics. Your participation could include testimony at the Statehouse, interested party meetings, legislation review, or media engagement.
Allow Undergraduates to Shadow You Get the next osteopathic generation off to a great start by exposing interested students to the osteopathic profession.
Present at a CME Event Share your knowledge with your peers.
Host an Osteopathic Medical Student Many medical students scramble to pay for housing while doing rotations away from their home site. You can help by providing an osteopathic medical student with a free place to stay.
To sign up and for more information, go to www.ooanet.org.
Match to Physician Career Opportunities at acemapp.org Communicate with in-house employers
Receive job matching email alerts
Search jobs
Track CEs
Create & share online ePortfolio
Store CV & other documents
Formerly Medical Opportunities
SAVE THE DATE
OHIO OSTEOPATHIC SYMPOSIUM A collaboration of Ohio University Heritage College of Osteopathic Medicine and Ohio Osteopathic Association
APRIL 24-28, 2019 Hilton Columbus, Easton Town Center #OhioOsteo
Statement of Ownership Management, and Circulation (Required by 39 USC 3785)
Buckeye Osteopathic Physician, published quarterly at 53 W Third Ave., Columbus, Franklin County, Ohio 43201 as filed October 1, 2018. The general business offices of the publisher are located at 53 W Third Ave., Columbus, Franklin County, Ohio 43201. The names and address of the publisher, managing editor/editor are: Publisher Matt Harney, 53 W Third Ave., Columbus, Franklin County, Ohio 43201; Managing editor/editor, Cheryl Markino, 53 W Third Ave., Columbus, Franklin County, Ohio 43201. The owner is the Ohio Osteopathic Association, 53 W Third Ave., Columbus, Franklin County, Ohio 43201. The names and addresses of known bondholders, mortgagees, and other security holders owning or holding 1% or more of the total bonds, mortgages, or other securities: none. Tax status; has not changed during the preceding 12 months. The average number of copies each issue during the preceding 12 months are: a. total number of copies (net press run) 3550; b. paid and/or requested circulation: 2794 1.) Mailed outside-county paid subscriptions stated on PS 3541: 2794 2.) Paid in-county subscriptions: 585 3.) Paid distribution outside the mails: none 4.) Paid distribution through other classes of mail through USPS: none c.) Total paid distribution: 3379 d.) Free distribution by mail: 146 e.) Total free distribution: 146 f.) Total distribution 3525 g.) Copies not distributed: 25 h.) Total sum: 3550 i.) Percent paid: 96%. I certify that the statements made by me are correct and complete. -Cheryl Markino Editor, Buckeye Osteopathic Physician
FALL 2018 ISSUE 19
IN THE KNOW
U.S. Surgeon General @Surgeon_General
As Surgeon General, I’m also calling for a cultural shift in the way we think about, talk about, & respond to the opioid crisis. The life of addiction can be dark. Help me in shining a light on ways we can help end this crisis. Learn more at Surgeongeneral.gov #SGSpotlight
OOA Executive Director Matt Harney and Osteopathic Heritage Foundations President/CEO Terri Donlin Huesman were in Athens this fall for an OU-HCOM tour and briefing.
Birthday greetings to OOA President Jennifer J. Hauler, DO. (November 3)
OhioOsteopathicAssn @OhioDOs
In 1976, OOA booked a charter flight for members to go to the @AOAforDOs Convention. For $249! Non-stop Columbus to San Francisco! Inflight meals and unlimited bar/beverage service! đ&#x;’Żđ&#x;”Ľâ?¤ď¸?â ‰ď¸? #TBThursday
wellness and resilience resources www.cordem.org
!
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OU-HCOM had the highest in-state match rate this year of all seven medical schools in Ohio—64 percent!
How can I make a difference? Before prescribing pain medication, discuss other ways to manage pain with your patient:
Healthy Alternatives to Pain Management
Patient Education on the Risks of Addiction
A Safe Pain Management Plan
It’s time to take charge, Ohio. Educate patients on medication safety at TakeChargeOhio.org
Buckeye Osteopathic Physician Ohio Osteopathic Association 53 West Third Avenue Columbus, Ohio 43201-0130 www.ooanet.org
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Here’s to another
120 years!
On December 31, 1898, a small group of Ohio DOs formed the Ohio Osteopathic Association. What a way to bring in the new year!
A Distinguished Past . . . A Dynamic Future