January/February 2012 Physicians Bulletin by Omaha Magazine

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Dr. Marvin Bittner MOMS 2012-2013 President

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thisissue

What Will Happen in 2012?

Legal Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 The Anatomy of a Loan Transaction: Preventive Care for Guarantors

Young Physician Report . . . . . . . . . . . . . . . . . . 17 Getting Involved by Chance

Clinical Update . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Terminating a Physician-Patient Relationship

Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Member News. . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Campus Updates . . . . . . . . . . . . . . . . . . . . . . . . . 34

6 PHYSICIANS BULLETIN January/February 2012

E S R

NMA Message . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Why Greg?

Perfect Matches . . . . . . . . . . . . . . . . . . . . . . . 20

Food Bank for the Heartland and MOMS Kids + School-based Clinics = Access. . . . 22 Cover story: MOMS’ New President . . . . . 24

Chemistry’s Loss was Medicine’s Gain

A T

Editor’s Desk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Marcus Balters, M.D.. . . . . . . . . . . . . . . . . . . 28

F E

D E P A R T M E N T S

Table of Contents: January/February

Where is Health-care Reform?. . . . . . . . . . 30

Doesn’t Mind Being “That Guy”

Greg Bazylewicz, M.D. Weighs In

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January/February 2012 VOLUME 33, NUMBER 1

A Publication of the

Metro Omaha Medical Society

7906 Davenport St. • Omaha, NE 68114 (402)393-1415 • www.omahamedical.com

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402-884-2000 Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD, P.O. Box 461208, Omaha NE 68046-1208. © 2012. No whole or part of contents herein may be reproduced without prior permission of Omaha Magazine or the Metro Omaha Medical Society, excepting individually copyrighted articles and photographs. Unsolicited manuscripts are accepted, however, no responsibility will be assumed for such solicitations. Omaha Magazine and the Metro Omaha Medical Society in no way endorse any opinions or statements in this publication except those accurately reflecting official MOMS actions.

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editor’sdesk

Marvin Bittner, M.D.

Why Greg? One of the articles

in this issue may seem odd. It is an article about a physician. Articles in this publication about physicians are usually articles about physicians who are MOMS members. In this issue, though, there’s an article about a physician who is not a MOMS member. His name is Greg Bazylewicz. Yet I thought it was very important to publish an interview with him. Here’s why: We have heard a lot about health-care reform. Much of what we have heard has come from shrill, ideologically motivated voices. We have heard from those who detest government intervention in health care. We have heard from those who, in contrast, would like to see government run a single payer system of health care. We have heard from those with other ideas. We have also heard from policy wonks. Some of the wonks have been utterly baffling. Despite all that I have read and heard about health-care reform, there’s been something of which I’ve heard only a little: calmly reasoned, reality-based observations. That’s where Greg comes in. Greg is a family physician in Massachusetts. That’s important. Massachusetts has been the model for the federal program of health-care reform. The Massachusetts reforms are not exactly the same as the Affordable Care Act. However, they do share some key features. Both the Massachusetts and federal reforms involve a mandate for individuals to have insurance, for example. Because Massachusetts is, in many respects, the model for what’s happening nationally, the experience of Massachusetts has something to teach all of us. Greg has a special role in teaching us about Massachusetts.

10 PHYSICIANS BULLETIN January/February 2012

Greg can teach us a lot because Greg is, well, Greg. I have known Greg almost 40 years. We were classmates at Harvard Medical School. Because our small groups were assigned alphabetically, Bazylewicz and Bittner were in the same section. I got to know Greg. At times, medical school was stressful. Greg, like most of us, felt stress at stressful times. Yet he handled it reasonably. He was calm. He smiled. Greg had goals. Greg’s goals were important to him. He was persistent in pursuing them. For example, Greg wanted to be a family physician. That may not seem strange. At Harvard Medical School, though, it was strange. Harvard did not have a family medicine department. The school didn’t think much of family medicine. That, however, did not deter Greg. In his reasonable, calm manner, he persisted along the pathway to family medicine. That’s why he’s a family physician now. Greg’s role as a family physician is important to understanding the impact of health-care reform. The shrill voices have said a lot about the impact of health care reform on primary care physicians, like Greg. Advocates of the Affordable Care Act have depicted primary care physicians, like Greg, as about to enter a nirvana of sorts, with financial barriers between physician and patient about to disappear. Opponents of the Affordable Care Act, in contrast, would have us believe that Greg’s patients would struggle with bureaucracy and delay. What can a sensitive but reasonable family physician like Greg tell us about the reality of health care reform? Turn the pages and read.

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By Dale Mahlman, Executive Vice President, Nebraska Medical Association

What Will Happen in 2012?

The 2012 Nebraska Legislature

will be the last session for nine of our current senators. The class of 2004 has reached the end of its second term and, for some, the end of their political careers. Additionally, 16 other districts will be up for re-election and as of this date only a handful of incumbents have expressed interest in running for re-election. I assume that number will grow quickly as the primary season draws near. I’d like to take this opportunity to thank all these individuals for their service to state government, whether they were with us or not on our issues, their commitment of time and effort needs to be recognized. Each year, MOMS does a great job in inviting the current senators to the table to discuss the issues of importance to medicine, as well as the issues of importance to the senators. The ability to have an open discussion is always appreciated and, while we don’t always walk away from the meetings in agreement, we better understand the issues and each side’s positions. Many thanks go out to the Omaha physicians who have made the 7 a.m. meetings part of their busy schedule. For some, these meetings serve as introductions to their elected official and the start of a long-term relationship. For others, the chance to get reacquainted and visit past issues and educate about new issues is not lost. It also gives us a heads up regarding new legislation and time to prepare and educate the NMA membership. With the legislature scheduled to adjourn Sine Die on April 4th, you can bet the campaign season will be running on a parallel track across the state throughout the winter and early spring. Our U.S. Senate race, together with the always interesting races for the House of Representatives, will

allow our physicians multiple opportunities to interact with candidates and incumbents alike. As our current NMA president, Dr. Chuck Gregorius has been encouraging members to get involved in the political process in some way or another. It can be as easy as attending a reception or fundraiser, making a phone call, sending an email or, better yet, dropping a personal note and including a contribution to the campaign. Dr. Gregorius will be doing all he can to improve our participation in NMPAC, our political action committee. Since the 2012 elections are drawing near, please consider getting more active in the process as your opinions and participation in any form are most welcome. Our Commission on Legislation takes its responsibility seriously and will review all newly introduced legislation at our late January meeting. If any of you ever have a concern or piece of legislation that you have an interest in, please don’t hesitate to contact our office and let us know. We will once again be represented at the Legislature by our longtime lobbyist David Buntain of Cline Williams Law Office. David has been the voice and face of the NMA at the Legislature the past 29 years and always has the physicians’ best interest in mind. However, with term limits he can use all the local help you can provide so consider being a legislative contact for any senator that you are familiar or have a relationship with. Together with David’s on site presence, this will be a very effective partnership. The Nebraska Medical Association will continue to advocate for physicians and the health of all Nebraskans. Please let us know how we can serve you better in 2012!

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Legalupdate

By Richard D. Vroman and Matthew J. Speiker Attorneys with the law firm of Koley Jessen, P.C., L.L.O.

The Anatomy of a Loan Transaction: Preventive Care for Guarantors

Businesses of all types and sizes, across all industries, utilize capital provided by lenders to support their operations. Medical practices and other businesses in the health-care industry are no exception. The basic premise of a loan transaction is always the same: The lender makes a loan to the borrower and the borrower agrees to repay the loan with interest. From the lender’s perspective, the primary goal is to reduce the risk that the loan is not repaid. To accomplish this goal, the lender may consider securing the borrower’s promise to repay with property of sufficient value (i.e., collateral). The lender may also seek a personal guaranty from the owners (i.e., a personal promise to pay the debt of the business). For closely held service businesses, such as medical practices, a loan transaction will often require both, collateral and a personal guaranty from the owner (or owners). The premise is that oftentimes, in a closely held business, the owner of the company is the business. That is, without the day-to-day efforts of the owner the business could not operate and, thus, the risk to the lender is much greater. For those businesses where the owner’s direct efforts are required for the business to continue as a going concern, the lender will want assurances that the owner is committed to maintaining those efforts – at least until the loan is repaid and that the owner will not just “walk away” if the business is failing. Unfortunately, such protection for the lender flies directly in the face of many asset protection measures taken by the owners of medical practices. For example, the most common asset protection strategy used in general is the formation of a limited liability entity to own and operate the business. A properly formed and maintained limited liability entity protects the owners of the business from individual/personal liability for the debts and obligations of the business. In other words, if the business fails, the owners will lose their respective investments in the business, but not their homes, cars or 14 PHYSICIANS BULLETIN January/February 2012

other personal assets. An owner’s personal guaranty, however, effectively eliminates the protection of a limited liability company and becomes a promise to the lender, that not only allows the lender to seek the assets of the business to recover amounts owed, but also the owners’ personal assets. Although our advice is to always engage competent legal counsel in matters of significance to the business, our experience is that many, if not most, small business loans are implemented without legal representation of either the lender or borrower. In such cases, lenders use “standard” loan documents which invariably contain very broad provisions intended to protect the lender but which may not be appropriate or necessary for the specific transaction. Our experience also reveals that borrowers, and even some lenders, will rarely read the details of these standard loan document; resulting, often times in unintended consequences. This do-it-yourself approach may be due to the mistaken belief that nothing can be changed in the standard loan documents, or it may simply be an ill-advised effort to minimize costs. We typically see three primary concerns with the guaranties used in standard loan documents, particularly those that are not negotiated. First, many guaranties provide that in the event of the death of a guarantor, the loan automatically becomes due. Such a provision makes little sense when multiple guarantors are present or replacement guarantors are available. Second, guaranties typically provide that the guaranty is unlimited in amount and duration. That is, the guaranty will continue indefinitely until all of the indebtedness of the borrower (including future debts) is paid in full. Third, if the loan transaction involves more than one guarantor, the liability of the guarantors will typically be characterized as joint and several (i.e., each guarantor is liable for the total amount of the indebtedness regardless of the number of guarantors).

Richard D. Vroman

Matthew J. Speiker

These “standard” guaranties can be problematic for an owner of a closely held business. For example, if a guaranty is unlimited and continuing, an owner may not be able to exit from the business when desired without remaining liable for debts of an entity he or she no longer controls. In addition, some guaranties, by default, place limitations on the guarantors’ ability to sell personal assets or incur debts or grant liens. Oftentimes, these provisions are overly broad and if enforced literally, could prevent a guarantor from obtaining personal credit (i.e., home loan or auto loan) or selling personal assets or might give rise to inadvertent events of default as to the underlying loan. A lender is typically justified in contractually prohibiting a guarantor from impoverishing himself or herself, but if a guaranty is necessary, a well-crafted guaranty can make a distinction between such conduct and normal course activities, and can further be drafted to address the primary concerns noted above without negating the security sought by the lender. In conclusion, it is important for both lenders and borrowers to understand that credit arrangements involving a closely held business give rise to a number of issues not found in loan transactions with larger companies. Where the circumstances warrant, lenders and borrowers should consider whether a guaranty can be limited, or in the right circumstances, altogether eliminated. A multitude of factors impact this decision, such as the size of the loan, the borrower’s expectation for pricing, the number of owners/guarantors, the value of collateral, etc. Careful drafting of loan documents and willingness to avoid the “one size fits all” form is imperative for both lenders and borrowers in this new lending environment. Engaging competent legal counsel, experienced in structuring such loan transactions, can add significant value whether you are the lender, the borrower, or the guarantor.

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together. The AMA also includes various sections. These include the resident and fellow section and the international medical graduate section as well as the state medical associations. The House of Delegates debates and acts on major resolutions. In my years of schooling in India leading up to residency in the United States, I had a variety of extracurricular experiences seemingly quite different from my involvement with the AMA. I was one of only a few students selected as Friendship Ambassador from India to what was then East Germany. I actively participated in the National Cadet Corps. My high school was very close to a military base. As a result, I was involved with camps at which military personnel conducted training on subjects such as disaster relief and leadership skills. This work on leadership skills did help me approach my involvement with the AMA. One topic that particularly interests me is the resident survey conducted by the Accreditation Council for Graduate Medical Education. I’m interested in studying how this survey provides value for smaller training programs. I have considerable interest in being active in the AMA, and I hope to employ my articulate voice and passion for organized medicine to advance the goals of residents and fellows--ultimately turning them into AMA policy.

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in the American Medical Association as the result of a chance occurrence. Back in June 2010, I was on a busy rotation. At that time, my husband went to Chicago to visit. By chance, the AMA was having a conference in the hotel where he was staying. He chatted with some residents who were attending the conference. That’s how he got involved with the AMA. He talked with me, and we both understood how valuable the AMA is in patient advocacy. One of the issues that interested us was teenage and childhood obesity. We were concerned about subsidies to the sugar industry. This general subject came up at the recent AMA interim meeting in New Orleans. We understood the importance of organized medicine. I got involved, and I became a member of the AMA Resident and Fellow Section Membership Committee in 2010-11. That involvement found me reaching out to others in a 50-state initiative to convince others about the benefits of the AMA for residents and fellows. Among the issues: improving working conditions, better duty hours, employment resources, seed grant money for research, advice on careers and contracts, and the American Medical Political Action Committee. Because I started my residency at St. Louis University and transferred to Creighton in July 2010, I have had the opportunity to see two state medical societies – Missouri and Nebraska – in action. Missouri and Nebraska are in two separate regional caucuses within the AMA’s House of Delegates. These regional caucuses are groups with similar interests that work

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clinicalupdate

By Dr. Alan M. Lembitz, COPIC Vice President of Patient Safety and Risk Management

Terminating a

Physician-Patient Relationship

The termination of the

physician-patient relationship is a subject of concern for many. Because the physician-patient relationship is voluntary for both parties, either can terminate the relationship at any time. However, be aware that the issue that led to termination could trigger the initiation of a medical malpractice action. Therefore, you must proceed with caution when terminating any patient relationship. The following are some important issues to consider when terminating a relationship with a patient: Abandonment: Unless certain conditions are addressed, allegations of abandonment may be made if a physician terminates care during the treatment of a medical condition. You must give adequate notice, provide emergency medical care for a specified period and assist with the continuity of care by expeditiously providing the patient’s new physician with copies of medical records when requested. It is recommended that the emergency care period is 30 days. However, it may be necessary for the period to be longer in certain clinical situations due to ongoing medical care issues and the availability of other medical resources. Extreme caution should be exercised in the termination of any obstetrical patient. A physician cannot withhold the transfer of records for a patient’s failure to pay for medical care. However, if a patient requests copies for personal reasons, you can charge them a reasonable copying fee. The patient must be in a stable condition prior to discharge. The physician needs to be particularly aware of the Emergency Medical Treatment and Active Labor Act and its application prior to discharge of a patient with an emergency medical condition. Discrimination: You should be aware that termination may not be based upon gender, race, religion, disability, ethnic origin, national origin or age. Disability status can be complex and contentious. Further, local laws might protect against discrimination based on issues such as sexual orientation.

18 PHYSICIANS BULLETIN January/February 2012

Contract issues: Be cautious when terminating patients who are members of managed care plans. Your contracts with health plans might specify the manner of termination with a member patient. Furthermore, plans might need notification of the reason for termination to prevent allegations of dismissing a patient because he/she is “too expensive to treat.” The patient might also have different time constraints for the health plan to complete reassignment to a new physician. Manner of Termination Terminations should be documented in writing so that the physician’s staff knows not to schedule the patient again (except during the emergency care period) and the patient understands the need to find another physician. Termination letters should follow these guidelines: • Be succinct. • Spell out that emergency care will be provided for a period of 30 days. • State that a new physician should be sought and the health plan might assist in providing names. • Assure the patient that all medical records will be provided at his or her request with a valid authorization. • Avoid editorializing or restating your side of a dispute in the termination letter. A simple “It has been determined that I can no longer function as your physician” is adequate. The documentation in the medical record can be more detailed, but should remain factual and avoid pejorative or emotional statements regarding the termination.

feature

Perfect Matches Support for the Food Bank

of the Heartland through the MOMS Foundation Match Program is just another example of how Omaha physicians care about their community. “Physicians are part of this community, and we want to help make it a better place for those who need a hand,” said James Newland, M.D., MOMS Foundation president. Each year, the MOMS Foundation selects a worthy local nonprofit organization to benefit from this special program. Past recipients include Hospice House – the Josie Harper Residence, Lasting Hope Recovery Center and Hope Medical Outreach Coalition. Here’s how the Match Program works: Members of the MOMS Foundation Board of Directors investigate local charities that are candidates for selection and choose one. MOMS members are encouraged to support the designated charity, and the Foundation matches those donations up to $5,000. Hunger strikes everyone, even in the Midwest, said Susan Ogborn, president and CEO of the Food Bank for the Heartland. 20 PHYSICIANS BULLETIN January/February 2012

“We greatly appreciate the support from the MOMS Foundation Match Program. It’s difficult to imagine hunger being a serious issue in the bread basket of the country. Research indicates approximately 200,000 people in Nebraska and western Iowa are food insecure. This means they may not know where their next meal is coming from.” Food Bank for the Heartland operates its own programs that serve vulnerable populations in our community. They include Kids Cafe, Food for Seniors, BackPack, Mobile Pantry and most recently, Fresh Produce. As the number of hungry children, families and seniors increases, the Food Bank expands these programs to meet the growing need, Ogborn said. • Kids Cafe is one of the nation’s largest free meal service programs for children. Founded in 1993 by Feeding America, ConAgra Foods became the program’s national sponsor six years later, and today there are over 1,300 Kids Cafe locations throughout the country. Food Bank for the Heartland provides food for 10 Kids

Cafes and four after-school snack sites in the Omaha and Council Bluffs metro area. The program provides meals each week for 2,000 children who are at-risk of being hungry. • The BackPack Program is designed to provide food for hungry children at times when other resources are not available, such as during weekends and school vacations. Staff members at local elementary schools identify chronically hungry students and then Food Bank for the Heartland supplies bags filled with child-friendly, nonperishable food for those children to take home on Friday afternoons. Each bag provides two breakfast meals and two lunch or dinner meals. They are delivered to participating schools by dedicated Food Bank for the Heartland volunteers and staff members. • Food for Seniors provides bakery goods to seniors living in low-income housing in Omaha and Council Bluffs. With deliveries being made bimonthly, this program serves approximately 650 senior citizens in our community and places a strong emphasis on healthy, nutritious food selections. • Mobile Pantry is a traveling food pantry that delivers food directly to families for a one-day food distribution. Nonprofit agencies can collaborate with Food Bank for the Heartland to host a Mobile Pantry, which extends its services and helps even more people in need by distributing additional food and household items to underserved areas. The Food Bank will assist agencies in scheduling a Mobile Pantry and advertising it to their clients and other people in the community. • Fresh Produce, which started in June 2010, helps meet an important need in the community. During the summer months, fresh fruits and vegetables are distributed each week from stands that are set up at locations in eastern Nebraska and western Iowa. The Fresh Produce stands are run by Food Bank staff members and volunteers. “This generous gift will help us greatly in our mission to eliminate hunger,” Ogborn said.

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Kids + School-based Clinics = Access School-Based Health

Centers are all about providing access to children who might not otherwise have access to health care. “Every child that we have treated – the children and their families – has had multiple barriers to receiving care,” said Jeanee Wiess, executive director for Healthy Futures – the lead organization behind the school clinics. “We can’t just give them a phone number and say make an appointment. It won’t happen. You help make the appointments. Is transportation an issue? Is child care? “You really have to problem-solve. If you don’t, the family often will revert to using emergency rooms for care.” The clinics, which opened for the 2010-11 school year, are situated at six Omaha Public Schools sites. Five are staffed by nurse practitioners, with the sixth served by a physician’s assistant. The school-based clinics are a partnership between Healthy Futures (a Building Bright Futures partner), Omaha Public Schools, the Charles Drew Health Center and OneWorld Community Health Centers. Representatives from all the major health-care systems in Omaha serve on the organization’s advisory board. Each clinic has a waiting room, reception area, lab space and an examination room. Several have bathrooms. The new clinic at Northwest has two exam rooms. Space is available to provide behavioral health services, but staffing isn’t in place. Patients who need referrals for more extensive care are sent to Charles Drew, OneWorld or their own health-care provider. The two community health centers provide care on a sliding cost scale. 22 PHYSICIANS BULLETIN January/February 2012

Before selecting the OPS sites, Healthy Futures staffers did their homework, visiting school-based clinics as far away as New Mexico and as near as Grand Island. They discovered that ideal sites would have a student population of 700 or more students with strong early child-care programs. Pick the best sites and link with nearby schools whose students could also benefit from access to health care. Clinics are situated at Belvedere Elementary, Kellom Elementary, Indian Hill Elementary, Liberty Elementary, Spring Lake Magnet Elementary and King Science Magnet Middle. A clinic at Northwest High School opened in January. Sixty-three linked schools are part of the network. Weiss said placing the clinics in elementary schools makes the most sense. “We want to focus on prevention. Once they’re in high school, they’re a health-care train wreck. Multiple barriers to care. It’s reactive. We want to be proactive.” During the 2010-11 school year, the Building Bright Futures The McVea File Hometown: Omaha Undergraduate: Stanford University in American studies Medical School: UNMC Residency: University of North Carolina Chapel Hill in internal medicine and pediatrics Family: husband, Craig; sons, Patrick, Andrew and Jackson Why I joined MOMS: “At OneWorld, part of our mission is to become involved in the medical community. MOMS is a great way to meet other physicians.”

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School-Based Health Centers served children during 2,245 patient visits. Monthly patient population ranged from 103 visits in August (the opening month) to 273 in October. Visits increase by 22 percent from the first semester to the second. Well-child visits were the most common diagnoses throughout the school-based clinic system, followed by colds, sore throats and asthma. In addition, clinic staff administered 3,222 vaccinations during the school year. The numbers are impressive, but the stories of care provided are even more so, said Kristine McVea, M.D., medical director at OneWorld and a MOMS member. “The clinics are helping kids who don’t have access to care get connected to other sources. They’re staying healthy and remaining in school. That’s the whole point.” Dr. McVea spoke of a student at Indian Hill who was initially seen at the clinic for a vaccination, but was discovered to have a serious orthopedic issue. His family had previously been told that nothing more could be done for the boy. Clinic staff helped the family access Medicaid and received help. Her other story is about a boy at Spring Lake who was a daily visitor to the principal’s office for behavioral issues. The boy suffered from ADHD, but wasn’t taking his medication. “He needed to take medication, but the family had challenges – transportation, getting time off work.” The clinic’s nurse practitioner helped the boy get back on his meds. “And he was student-of-the-month. There are lots of little stories like this – helping people back into the system where they get the care they need.”

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Credit the limits of synthesizing cubane for Dr. Marvin Bittner’s entry into medicine. During his undergraduate years at the University of Chicago, Dr. Bittner interacted with a professor who was the first to synthesize cubane, which is a synthetic hydrocarbon molecule that consists of eight carbon atoms arranged at the corners of a cube, with one hydrogen atom attached to each carbon atom. “It’s a very interesting compound, and synthesizing it was a remarkable achievement in organic chemistry. “But there isn’t much more to it. When the game’s over, it’s essentially over.” Dr. Bittner, who discovered he had an interest in science

24 PHYSICIANS BULLETIN January/February 2012

while in high school, had considered pursuing a doctoral degree in chemistry. He realized he wanted a career that provided more opportunities to interact with people. He chose medicine. “Looking back, I think it was a great choice,” said MOMS’ new president. “I like seeing science applied to helping people.” Fast forward, and Dr. Bittner found his first job at Creighton University Medical Center, where he now serves as an associate professor of internal medicine and medical microbiology and immunology. Dr. Bittner said, in looking for a city to call home, he sought the architecture and orchestra found in Chicago, the compact layout of Boston, the easy access he found in Ann Arbor, Mich., and the 22 lakes to be

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found in Minneapolis. “That was an unrealistic goal.” “Omaha is a convenient place to live,” meaning he could avoid the challenges of getting around in Chicago, Boston’s crime, the limited opportunities in Ann Arbor and the higher cost of living in Minneapolis. “Omaha doesn’t have everything, but it has a lot.” At Creighton, Dr. Bittner said, he quickly discovered that he was impressed with the chairman of the Microbiology Department’s approach: “He had a vision for the department to do meaningful work. That sounds logical, but all too often people see work as meeting productivity targets. He saw it far beyond that. Determining how to treat infections more effectively is very important work. It’s

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important to patients and it’s important to educating students.” So he stayed. Some 30 years later, Dr. Bittner also serves as a staff physician at the VA, and as an adjunct associate professor of medicine at the University of Nebraska Medical Center. In January, he began a two-year term as president of the Metro Omaha Medical Society. During a recent conversation, Dr. Bittner discussed topics related to medicine: What’s wrong with medicine? “We’re trying to do the best for patients, but we’re hamstrung in our efforts to learn from our experiences because of restrictions on the use of information in the electronic medical records.” What’s right with medicine? “We have a very strong scientific base in medicine in spite of efforts to portray us as moneygrubbers. There is an incredibly strong sense of service among physicians.” Where does your passion lie? “Epidemiology, because it’s fascinating to go through a mass of data and come up with a pattern that makes sense.” What moment sticks out during your medical career so far? “There was an episode where I was tutoring students in physical diagnosis. They were advertised to me as low performers. They ultimately were performing at a high level, and that was rewarding.” Why should a new physician join MOMS? “MOMS and its partner, the Nebraska Medical Association, are important advocacy organizations. There are many forces working against the practice of medicine, against physicians, against patients. MOMS and the NMA are there to recognize threats, particularly in the political sphere and speak up for medicine.” Dr. Bittner listed his three priorities for his two-year term as MOMS president: • To encourage more physicians to become members. “This is most important and most challenging.” He’ll rely on input from past MOMS leadership in developing a strategy. • Getting them involved beyond paying their dues. That’s the next step. MOMS schedules events that are more social to bring the medical community together as a way to counteract efforts to keep them apart because of competition among providers.“It’s a challenge at a time when there are so many demands on a physician’s time.” • Communicating the message of medicine more effectively to the community. More of the public is demanding a voice in what is happening in medicine. It must be an informed voice. The challenge: physicians are busy and privacy regulations make it difficult, for example, to take state senators into hospitals so they can see what’s happening. Finally, Dr. Bittner said he’s honored to serve as MOMS president, which he views as a sign of respectability, similar to why he joined MOMS (See the Bittner File). And he enjoys working with the MOMS staff, which he described as strong and hard-working. “To me it’s been a treat to work for MOMS.”

The Bittner File:

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Hometown: Peoria, Ill. Undergraduate: University of Chicago in chemistry Medical Degree: Harvard University Medical School Master’s Degree: Harvard University Medical School Residency: University of Michigan in internal medicine Fellowship: University of Minnesota in infectious disease Hobbies: Travel, especially to meet distant relatives Why I joined MOMS: “Essentially, to look respectable to lawyers. I became aware, shortly after I moved to Omaha, that there are people who were filing lawsuits. Traditionally, joining the medical society was something that indicated you were socially acceptable. In the past, medical societies functioned as a credentialing or standards organization, and physicians who were not practicing properly were excluded. Traditionally, to be a member of the county medical society was to receive a stamp of approval as an acceptable practitioner.”

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Marcus Balters, M.D. doesn’t mind being “that guy.”

His wife, Sarah Beth, jokingly refers to him as the “Thank-Godversation be all about him. “The conversation needs to be about I’m-not-that-guy” guy. And understandably so. them.” He’s the guy who underwent four heart surgeries between 1975 He’s also not opposed to praying with his patients: “I don’t do it and 2006. He’s the guy who probably should have died in 1999 that often, but it’s based on the sense I have at the moment. Ten when blood began pouring out of his nose and mouth when a graft years ago, I never would have said a prayer with a patient. My faith inserted into his aorta ruptured. He’s the guy whose kidneys began (as a Christian) has evolved over the years.” to fail in late 2006. And he’s the guy who received a life-saving kidSo has his appreciation for his profession. In his younger days ney from his brother in 2010. while in private practice, Dr. Balters said, he never would have Dr. Balters, a surgeon at Creighton University Medical Center, said imagined himself working with students. Now that interaction is he isn’t the type to dwell on his past because life is, well, too short. among the best part of his day. “I’m always aware that I’m not going to have the career longevEven though he’s not one to be overly philosophical, Dr. Balters ity that someone without health issues will,” he said. “This is just said he can’t help wonder about life – especially when he walks another step in life. through the Intensive Care Unit at Creighton. When his aorta rup“But I can’t complain. My health problems inspired me to focus tured, he explained, he never should have made it alive to the hospimy life on medicine.” tal. Then, he never should have made it through surgery. Dr. Balters’ health challenges – which now also have included “But I did. bouts with infection and rejection with his new kidney – provide “There might be a reason I beat the odds in so many ways. him with insight that he is willing to share with his patients. Maybe I’m still around because I have more work to do.” “The kidney issue has been another reminder of the uncertainties of life. You never know what’s going to happen. You see (treat) people who woke up in the The Balters File: morning feeling fine – and by the end of the day they’re not.” Undergraduate: Texas Christian University in biology So when Dr. Balters tells patients and their families that he Medical degree: University of Nebraska Medical Center knows what they are going through, he does know what they Residency: St. Elizabeth’s Medical Center in Boston in general are going through. surgery “I’d like to think I can understand better than a lot of Fellowship: State University of New York at Syracuse people what it’s like to be sick. I know what it’s like to Practice site: Assistant professor of surgery at Creighton University sit with a physician and think: ‘Who is this person?’ and Medical Center ‘What are they doing?’” Family: wife, Sarah Beth; four sons, Jason, Justin, Joshua Dr. Balters said he doesn’t always share his life experi(deceased) and Jordan ence with his patients. His decision is based on a feeling Hobbies: Playing the guitar (although I never have time for it) he gets during their conversation. “I seem to especially and reading, especially Stephen King novels. share my experiences with people who are sad.” Why I joined MOMS: It seemed like a good way to start making connecWhen he does, he’s careful not to allow their contions in the Omaha Community. 28 PHYSICIANS BULLETIN January/February 2012

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Where is Health-care Reform? Massachusetts Family Physician Greg Bazylewicz Weighs In Some might say Greg Bazylewicz, M.D., can’t make up his mind. Ask him to weigh in about health-care reform in his home state, Massachusetts, and the country, and Dr. Bazylewicz can’t help himself. He talks about the good, the bad and the somewhere in between. First, some background information: After working in solo practice for his first 15 years, Dr. Bazylewicz formed a practice group with two other family practitioners. Their practice grew to nine, and they serve patients in three Massachusetts communities. He also serves as president of a 250-member physician’s health organization. Dr. Bazylewicz is a former classmate of Marvin Bittner, M.D., who asked him to share his thoughts about health-care reform. Massachusetts is a state with a high number of residents who have no health insurance, he said. “We know people avoided coming in for care because they didn’t have insurance.” His practice group did what it could and provided no-charge examinations when possible. “Access to health care is something I always support, especially as primary care prevention is so valuable. As you know, ‘An ounce of preven30 PHYSICIANS BULLETIN January/February 2012

memberbenefits It’s Time to Renew Your MOMS/NMA Memberships for 2012

If you are currently a member of the Metro Omaha Medical Society and the Nebraska Medical Association, you should have received your notice for 2012 membership renewal.

Why Join or Continue to Be a Member of MOMS/NMA? tion is worth a pound of cure.’ I still feel that way.” National programs that are providing access to health care are working. The trade-off is that these programs cost taxpayers. “You can’t take this out of context – what’s happening in the public sector.” In Massachusetts, smaller companies are tapping into government-backed programs to insure their employees. The negative: reduced reimbursement for physicians. Dr. Bazylewicz said he has seen the benefits of health-care reform first-hand: He has four children. A son was able to stay on Dr. Bazylewicz’ insurance at age 25 because of new health-care regulations. Another son has health insurance through a state-sponsored program – “all part of Massachusetts health-care reform. That’s been a positive thing for my family.” The private portion of health-care reform has been more of a mixed bag, Dr. Bazylewicz said. Private health insurers are, understandably, trying to develop programs that will keep costs in check. In Massachusetts, for example, Blue Cross Blue Shield has created programs that invite physicians to join in sharing the cost risks, but also sharing in the rewards

when costs are kept in check. For example, physicians are challenged to curb costs by improving their patients’ health by lowering their blood pressure and controlling diabetes. “Because of achieving budget goals, we received the return of our 20 percent withhold,” he explained. “In addition, because of achieving Quality Care goals, we received an additional bonus that amounted to approximately an added 35 percent.” The rewards come with a cost, Dr. Bazylewicz said. “Day to day, it’s a pain in the neck. You have to pay more attention to documenting your numbers. More secretarial time is needed. You don’t receive your feedback until a year later when they pull your results. “You’re still working the same hard schedule, minute to minute, day to day. You slug through it.” Dr. Bazylewicz said he has a beef with the fee schedules set for the new reform programs. “The system doesn’t have natural feedback system to improve its faults.” Which begs the question: “Massachusetts health-care reform is supposed to look to national reform. I don’t know any physicians in Massachusetts who were interviewed by the federal program.”

The Bazylewicz File Hometown: Manchester by the Sea, Mass. Undergraduate: Northeastern University in biology Medical degree: Harvard University Medical School Residency: University of North Carolina at Chapel Hill and Case Western Reserve University Hospital in Cleveland Fellowship: Robert Wood Johnson Fellowship in family medicine Specialty: Family medicine Why he joined the Massachusetts Medical Society: “I joined for the cultural support of other doctors in our area.” Health-care Reform: A Perspective from the East Coast

We keep you informed

Members receive the latest in local, regional and national health-care news through the MOMS eBulletin and NMA STAT email newsletters, as well as the Physicians Bulletin and Nebraska Medicine magazines, and the NMA News.

We keep you connected

Members have unique opportunities through local MOMS events to network with their peers, interact with local medical students and communicate with community leaders. Members also have a wide variety of opportunities to make a difference by serving on MOMS and NMA committees and through involvement with our many local health-care related partners.

We represent physicians and patients

MOMS and NMA work diligently to monitor state legislation that will impact the future of health care. Together, our cumulative voice is heard by those who make decisions impacting Medicaid, Medicare, professional liability, insurance, rural health and public health…just to name a few.

Other member benefits

• • • •

Access to the NMA Blue Cross Blue Shield health and dental plans for physicians, their family and staff. Premium reductions for all members utilizing COPIC. Access to services provided by Foster Group Wealth Management. Savings on your annual AAA membership renewals with no initiation fee for new members.

If you would like more information on MOMS membership, call (402) 393-1415 or email Laura@omahamedical.com. January/February 2012 PHYSICIANS BULLETIN 31

MOMSevents MOMSAlliance

CPTCoding

Members of the MOMS Alliance met in December at “The Designers,” an interior design shop. Owner Marilyn Hansen spoke about new trends in decorating. Following the program, attendees had lunch at Dolce Café.

The MOMS annual CPT Coding Seminar featured Cynthia Swanson from Seim Johnson.

Senatorbreakfast Senator breakfasts provide MOMS members with an opportunity to learn what issues will be addressed during the coming legislative session and provide lawmakers and legislative candidates with their thoughts on these matters. Hans Dethlefs, M.D.; Tom Tonniges, M.D.; David Filipi, M.D.; and John Peters, M.D. (far right) were among those attending breakfast with State Sen. Bob Krist (second from right).

Attending the Senator Breakfast with State Sen. Gwen Howard in October were (from left) Wesley Zeger, M.D.; Richard Baltaro, M.D.; Marvin Bittner, M.D.; John Peters, M.D.; and Dale Mahlman, NMA vice president. State Sen. Brenda Council discussed legislative issues in late November with (from left) Pierre Lavedan, M.D.; Richard Baltaro, M.D.; and Marvin Bittner, M.D.

Some of the participants in the November breakfast featuring State Sen. Steve Lathrop (second from right) were David Buntain, NMA lobbyist; David Filipi, M.D.; Peter Whitted, M.D.; and Pierre Lavedan, M.D.

Among those who attended the Senator Breakfast with State Sen. Heath Mello (fifth from left) were David Ingvoldstad, M.D.; George Hemstreet, M.D.; Quan Ly, M.D.; David Filipi, M.D.; John Peters, M.D.; Tom Tonniges, M.D.; and Sushma Rai, M.D. 32 PHYSICIANS BULLETIN January/February 2012

Among those meeting with State Sen. Beau McCoy (center) in December were Peter Whitted, M.D.; Jane Bailey, M.D.; John Peters, M.D.; and Rowen Zetterman, M.D.

Attending the breakfast with State Sen. Burke Harr (third from left) in early November were Dale Mahlman, NMA vice president; Jane Bailey, M.D.; John Peters, M.D.; Marvin Bittner, M.D.; and George Hemstreet, M.D.

membernews

Dr. Harold Maurer

Dr. Maurer Receives Development Service Award UNMC’s top fundraising team recently received a surprise honor from the University of Nebraska Foundation. UNMC Chancellor Harold M. Maurer, M.D., was honored with the Harlan J. Noddle Distinguished Development Service Award. John Niemann, Ed.D., senior vice president of the University of Nebraska Foundation also was honored. “Working with these two honorees has been a happy experience for us,” said longtime university benefactor Ruth Scott, who along with her husband, Bill, presented the awards at the foundation’s annual meeting of trustees. The Scotts have made multiple gifts to UNMC, including the lead gifts on new buildings for four UNMC colleges -- medicine, nursing, public health and pharmacy. The award is in memory of Noddle, a longtime University of Nebraska supporter who served in various volunteer roles for the foundation, including chairman of the board of directors. Noddle died in 2005. Chancellor for 13 years, Dr. Maurer’s vision and strategic plan has repositioned UNMC from a regional to a national center of excellence in the 21st century.

inmemoriam Harry W. McFadden, Jr., M.D. Dec. 9, 1919 – Dec. 12, 2011

Dr. James O’Dell

Dr. O’Dell Named 2012 President of American College of Rheumatology James O’Dell, M.D., a rheumatologist and professor at the University of Nebraska Medical Center, was appointed 2012 president of the American College of Rheumatology at the ACR’s annual business meeting held in Chicago. The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. Dr. O’Dell is the Bruce Professor of Internal Medicine, vice-chair of internal medicine, and chief of the Division of Rheumatology at UNMC. For the past 27 years, he has served as the director of the institution’s Internal Medicine Residence Training Program, directing the training of more than 600 residents. Dr. O’Dell graduated from the University of Nebraska in Lincoln, Neb., with a bachelor of science degree in electrical engineering. He earned his medical degree at UNMC and then completed a residency and chief residency in internal medicine at the institution. In 1984, he completed a clinical and research fellowship in rheumatology at the University of Colorado Health Sciences Center in Denver. In addition to his leadership role at UNMC, Dr. O’Dell is the founder and director of the Rheumatoid Arthritis Investigational Network (called RAIN) - a 22-year-old group of rheumatologists conducting exclusively investigator-initiated trials to find better treatments for rheumatoid arthritis.

January/February 2012 PHYSICIANS BULLETIN 33

campusupdates Creighton in good company Creighton University has joined an elite group of about 250 U.S. health organizations and seven organizations outside the United States that have been granted full accreditation by the Association for the Accreditation of Human Research Protection Programs, Inc. The 10-year-old nonprofit organization works with groups that conduct human research and provide safeguards that exceed U.S. federal standards. The accreditation process is voluntary and involves a thorough review by a panel of peers of written policies and procedures involving human research as well as extensive onsite interviews about how those procedures are implemented. “This is the accumulation of four years of hard work by 40 or more Creighton faculty and staff, including Creighton’s two institutional review boards (IRBs), IRB administration, school deans, legal counsel and 12-14 researchers. It demonstrates Creighton’s commitment to the sanctity of human life as well as the importance of research to improve health care for society as a whole,” said Kathleen Taggart, Creighton associate vice president for research and compliance.

UNMC dean part of landmark study A University of Nebraska Medical Center physician-scientist, Dr. Bradley Britigan, was one of the authors on a landmark study that has determined why bacteria are antibiotic resistant and how disrupting key bacterial functions could result in making antibiotics more effective. The study, which appears in a recent issue of Science, brought together researchers from three U.S. universities (Washington, Cincinnati and Northwestern), one Canadian university (McGill) and one Canadian research institution (INRS Armand Frappier). Dr. Britigan, who took over as dean of the UNMC College of Medicine in July, participated in the study while serving on the faculty of the University of Cincinnati. Nebraska Neuroscience Alliance is formed In an effort to better serve people with developmental and degenerative diseases of the nervous system, UNMC physicians, allied health practitioners and scientists have formed the Nebraska Neuroscience Alliance. The NNA will unite three of UNMC’s top neuroscience programs – the departments of neurological sciences and pharmacology and experimental neuroscience as well as the Munroe-Meyer Institute to facilitate cooper34 PHYSICIANS BULLETIN January/February 2012

CUMC Campus Update Creighton-led team reaches milestone in DR A Creighton-led medical team participating in its ninth annual trip to the Dominican Republic to repair hernias reached a special milestone when it completed its 1,000th patient surgery. Each year, the medical team, led by surgeon Charles Filipi, M.D., and anesthesiologist James Manion, M.D., both with Creighton Medical Associates, repairs about 125 hernias during a five-day period in November. The team of 40 to 50 people – about half of them from the Omaha metro area – includes physicians, nurses, medical students, technicians and others. They conduct a hernia clinic at a surgical center located at the Institute for Latin American Concern Center in Santiago. Using three operating rooms, the doctors perform hourlong operations beginning at 8 a.m. and ending about 5 p.m. each day. The effort is one of many Creighton and non-Creighton service trips coordinated annually through University Ministry’s Institute for Latin American Concern (ILAC) Office at Creighton University.

Dartmouth Atlas Report favorable for CUMC Creighton University Medical Center is a leader among academic medical centers in reducing readmission rates and scheduling primary- care follow-up appointments after being discharged from the hospital, according to a study recently released by Dartmouth Atlas Project. The study compares post-acute care for Medicare beneficiaries at 94 U.S. academic medical centers for the years 2004 and 2009. “Addressing readmission rates makes care safer. We no longer look at just an episode of care, but strive to keep patients well after they leave. We put in the systems to improve quality and safety, and then teach it to our medical students and resident physicians,” said Todd Carlon, chief executive officer of Creighton Medical Associates. In 2008, CUMC implemented The Care Trek Project in partnership with CIMRO, focusing on care transition and implementation of Project Re-Engineering Discharge to provide structure and insight to prevent readmissions. The hospital also began working with UniNet in 2009 on a program to reduce readmissions in partnership with Blue Cross and Blue Shield of Nebraska.

UNMC Campus Update

ative research activities, enhance recruitment and retention of UNMC physicians and scientists, and·develop novel, state-of-the-art patient diagnostics and therapeutics. The NNA will target neurodevelopment and disorders of cognition and movement. These include the spectrum of brain, nerve and spinal cord diseases such as Alzheimer’s and Parkinson’s disease, autism, epilepsy, multiple sclerosis, cancer, microbial infections, stroke and genetic disease. “One of the major attractions for me coming to Nebraska was the ‘can do’ team spirit,” said Dr. Bradley Britigan, dean of the UNMC College of Medicine. “Over the years, the progress being made in the neurosciences has been incredible. This alliance will bring together experts in research and clinical care with the shared goal of moving breakthroughs made in the laboratory to the patient bedside. “It will elevate our neurological programs to a whole new level. There’s no reason anybody with a neurological disorder should ever have to leave the state for their medical care.” Medical center participating in clinical trial for Alzheimer’s disease UNMC is one of 20 sites across the country participating in a clinical research trial to deter-

mine whether an investigational medication reduces the amount of amyloid in the brain of those with early-onset Alzheimer’s disease. Amyloid is a protein (like a waxy substance) that gathers in the brain and is thought to cause symptoms of Alzheimer’s disease such as memory loss and confusion. UNMC will enroll at least five people who have subjective memory problems, but who do not yet have a dementia diagnosis. Each study participant will undergo MRI and PET brain scans to determine if amyloid has accumulated. If determined eligible for study participation, the participant will begin a series of injections proposed to activate the immune system to remove or reduce the amount of brain amyloid. Subsequent brain scans will measure the amount of amyloid in the brain. “The study will help us better understand the relationship of amyloid in the brain and its effect on memory and other brain functions,” said Dr. William Burke, A.O. Stake Professor of Psychiatry at UNMC. “It appears that people who have a diagnosis of mild cognitive impairment and have amyloid visualized in their brain by PET scan are at highest risk to develop Alzheimer’s disease.”

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membersupdate New Members In Focus Thomas Brooks, M.D.

Katie Sagrero, D.O.

Dr. Brooks is happy to be back in Omaha after being away for 21 years. He looks forward to sampling Omaha’s fine dining as well as Creighton sports. His body has retired him from soccer, but he has taken up barefoot running for fitness (short distances only) and anticipates continuing to develop his skills as a trap shooter. He enjoys his time with his wife, daughter and two sons.

Dr. Sagrero recently moved back to Omaha after living in Southern California for the past 12 years. She, her husband and two children are adjusting to Omaha and learning about seasons. She enjoys bike riding and taking her children to community events, such as the zoo and the Omaha Children’s Museum.

Medical School: Creighton University Medical Center Specialty: Pain Management and Anesthesiology Location: Midwest Pain Clinics

James Harper, M.D.

Medical School: University of Nebraska Medical Center Specialty: Hematology and Oncology Location: UNMC and Children’s Hospital and Medical Center In his off-hours, Dr. Harper enjoys spending time with his wife. He also has obtained his ham radio license. In addition to becoming involved with a variety of ham radio-related charities, he and his wife have become storm spotters for the National Weather Service. Other interests include learning about Nebraska history and a recent interest in digital photography.

Medical School: Western University of Health Sciences-Pomona (Calif.) Specialty: Family Medicine Location: OneWorld Community Health Centers and Creighton University (OB)

NEW MEMBERS Ryan Arnold, M.D. Orthopedic Sports Medicine Surgery Samindla Deepthi Family Medicine So Yun Grace, M.D. Family Medicine Neil Hamill, M.D. Obstetrics and Gynecology M. Layne Jenson, M.D. Pediatric Orthopedics Francisco Machuca, M.D. Family Medicine Rebecca Runge, M.D. Internal Medicine

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January/February Alegent Health is a faith-based health ministry sponsored by Catholic Health Initiatives and Immanuel. 2012 PHYSICIANS BULLETIN 39

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