Sept/Oct 2014 - Metro Omaha Medical Society

Transcription

September/October 2014 • USA $1.95
‘We
need to
wake up’:
A Call for Action to Provide
Quality Early Childhood Care
ALSO INSIDE
Advocating for Children
Changing the Question for
Future Physicians:
‘Who Needs Me to Be a Physician?’
A Publication of the Metro Omaha Medical Society • www.OmahaMedical.com
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JU ST C A LL
A Publication of the
Metro Omaha Medical Society
7906 Davenport St. • Omaha, NE 68114
(402)393-1415 • www.omahamedical.com
OFFICERS
President | Debra L. Esser, M.D.
President-Elect | David D. Ingvoldstad, M.D.
Secretary-Treasurer | Lori Brunner-Buck, M.D.
Past President | Marvin J. Bittner, M.D.
Executive Director | Carol Wang
EXECUTIVE BOARD
Debra L. Esser, M.D.
David D. Ingvoldstad, M.D.
Lori Brunner-Buck, M.D.
Marvin J. Bittner, M.D.
Mohammad Al-Turk, M.D.
David Filipi, M.D.
Harris Frankel, M.D.
Jason Lambrecht, M.D.
Kris McVea, M.D.
Lindsay Northam, M.D.
William Orr, M.D.
Laurel Prestridge, M.D.
Jill Reel, M.D.
William Shiffermiller, M.D.
Gamini Soori, M.D.
Jeffry Strohmyer, M.D.
James Tracy, M.D.
David Watts, M.D.
EDITORIAL/ADVERTISING STAFF
Publisher | Omaha Magazine, LTD
Editor | Marvin Bittner, M.D.
Art Director | John Gawley
Director of Photography | Bill Sitzmann
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Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD,
P.O. Box 461208, Omaha NE 68046-1208. © 2014. 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.
4 Physicians Bulletin September/October 2014
Two Partners.
One Goal.
Methodist Health System and The Nebraska Medical Center
are proud to introduce the Nebraska Health Network.
The goal of this unique partnership is to improve the quality, accessibility and cost
of patient care within our community.
We are:
» The only network locally owned, led by the physicians and health systems based
in the community.
» A broad provider network with over 1,200 primary care physicians and specialists
located conveniently throughout the area.
» Recently recognized for national rankings by US News & World Report, #1 and #2
hospitals in Nebraska.
» The most affordable health systems in our community.
September/October 2014 Physicians Bulletin 5
THIS Issue
18
September/October 2014
20
FEATURES
18
20
Advocating for Children
Changing the Question for
Future Physicians:
25
D E PA RTM E NTS
8
10
16
MOMS Message
12
14
17
Addressing Common Questions
About Life Insurance
30
Member Benefits
Word of Praise for Our
Member Physicians
31
Member News
34
MOMS Events
35
Coming Events
36
Campus & Health
Systems Update
Risk Management
Young Physician Report
Why Can’t Things
Stay the Same?
Financial Update
NMA Message
Disaster Recovery Planning
for Medical Practices
15
Legal Update
Working Through the Medicare
Enrollment Revalidation Process
Autism: Early
Intervention is Key
COVER: ‘We Need to Wake Up’:
A Call for Action to Provide
Quality Early Childhood Care
Editor’s Desk
When Putting Patients First
Wasn’t the First Choice
‘Who Needs Me to Be a Physician?’
25
34
Patients with ID Problems?
We provide team-based care for:
• Infectious Diseases Inpatient/
Outpatient Consultations
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• Vaccine Management
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OR
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Robert G. Penn MD,
FACP, FSHEA, FIDSA
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Douglas Penington, APRN
Stacey Shinaut, APRN
Elizabeth Jacobsen, PA-C
Suzanne Feloney, PA-C
Heidi O’Connell, APRN
Maralyn Walko, APRN
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8111 Professional Building • 8111 Dodge Street, Suite 363 • Omaha, NE 68114
EDITOR’S desk
When Putting Patients First
Marvin Bittner, M.D.
Editor
Wasn’t the First Choice
Physicians Bulletin
B
ERTRAND MIGHT DID NOT develop normally
in infancy. Eventually his parents brought
him to Duke University. Duke researchers found
that Bertrand had a congenital disorder of glycosylation. The Duke researchers knew of no
other patients with this disorder.
Bertrand’s father recognized the value of
identifying other patients with this disorder. He
posted a description of it, “Hunting Down My
Son’s Killer” on the Internet. In little more than
a year, that description led to the identification
of nine more cases.
Bertrand’s condition generated two puzzles.
The first puzzle is the condition itself: What was
happening to Bertrand? The second puzzle is
the way his father identified additional cases:
Why didn’t the conventional communications
network of medical conferences and journals
identify the additional cases?
There is no complete solution to the first
puzzle. Scientists are still studying Bertrand’s
glycosylation disorder. However, there is a good
understanding of the second puzzle. The reasons
conventional medical communications failed to
assemble a series of cases – and why the Internet
succeeded, are explained in an article about
Bertrand that I saw in The New Yorker in July.
Consider the situation that the Duke researchers faced when they identified Bertrand as the
first case, to their knowledge, of a congenital
disorder of glycosylation. The researchers had
three choices:
First, they could publish Bertrand’s case as
a single case report. From the perspective of
patients, this would be the right thing to do. It
would promptly bring Bertrand’s case to the
attention of the medical community. From the
perspective of the Duke researchers, however,
publishing a report of a single case was unwise.
Single case reports are not valued highly by journal
editors – nor by university promotion committees.
The second option for the Duke researchers
would be to wait for more cases. Publishing a
larger series would give them more credit. Yet
that wait would delay help for patients.
The third option would be to collaborate with
other researchers on a joint paper. However, they
wouldn’t get much credit from being one of 10
groups of authors – even though the joint paper
would quickly bring important information to
the medical community.
The New Yorker article clearly explained the
conflict between maximizing academic credit
and doing the right thing for patients.
What is particularly puzzling about this
conflict is its existence. As physicians, we
talk about putting the patient first. Physicians,
through organizations like the American Medical
Association, publish journals. We write criteria
for medical school promotion committees.
Sometimes, we complain about external forces
that fail to put patients first. Malpractice attorneys
promote “defensive medicine,” such as testing
that patients don’t need. Medicare’s regulations
encourage hospitalizations that aren’t needed –
except to get a patient’s nursing home bill paid.
One role of a medical society is to speak up
for patients and against the perverse incentives
of the malpractice attorneys and Medicare. We
can also speak up for patients when our own
journals and medical schools forget that the
patient comes first.
Have you run across a situation where external
forces – or our own practices – are failing our
patients? Speak up, please. Get in touch. MOMS
and the Nebraska Medical Association can give
you a louder voice.
MOMS message
Autism:
Debra Esser, M.D.
President
Early Intervention is Key
T
HE CENTER FOR DISEASE CONTROL esti-
mates 1 in 68 children has autism. Autism
Spectrum Disorder (ASD) is found in all ethnic
and racial classes and socioeconomic groups.
ASD is five times more common in boys.
Developmental screening in infants and young
children is a cornerstone of care in the world of
pediatrics. Screening can identify hearing and
speech issues, attention disorders, behavioral
disorders, autism and vision problems, just to
name a few. Early identification of developmental
delays is critical in the care of young children and
their families. Prompt treatment for these conditions can improve outcomes for these children.
It is estimated less than one-half of these
problems are identified before the child reaches
school age. This delay in treatment means that
the problems may have worsened and critical
intervention opportunities have been missed
during the preschool years before the patterns
are set. Studies have shown that children who
receive early intervention and treatment for
developmental disorders are less likely to be
involved in the juvenile justice system and are
more likely to graduate from high school and
hold jobs as adults than those who do not receive
early intervention.
In April, Gov. Heineman signed into law
LB254 granting autism coverage for children in
the state of Nebraska. Nebraska became the 36th
state to approve autism coverage. Most insurance
plans do not currently cover autism. This bill
requires insurance policies and benefit plans to
provide coverage for the screening, diagnosis
and treatment of autism spectrum disorder in
an individual under 21 years of age.
Coverage for behavioral health treatment is
subject to a maximum limit and Insurers have the
right to review the treatment every six months.
Most insurance coverage will take effect with
new policies sold beginning Jan. 1. Nebraska
Medicaid will begin to cover Applied Behavioral
Analysis (ABA) therapy for its members later this
year, with coverage through Magellan.
Federal law requires state Medicaid programs
to offer Early and Periodic Screening, Diagnosis
and Treatment to all Medicaid-eligible children
under age 21. Commonly referred to as “EPSDT,”
these services are designed to foster childhood
growth and development so that children in low
income families receive the health check-ups and
treatments they need. EPSDT services ensure
that children do not needlessly suffer from health
conditions that may be treatable or preventable.
Nebraska Medicaid will begin to cover ABA
therapy for children diagnosed with autism due
to developmental delays identified at EPSDT
screenings in primary care offices.
The new law requires coverage of up to 25
hours per week of ABA therapy and covers to age
21 years old. Certain insurance plans are exempt,
such as policies sold under the individual and
small group plans under the federal marketplace
and some self funded plans.
Behavior analysis focuses on principles that
explain how learning takes place. Positive reinforcement is one such principle. Simplistically, when
a behavior is followed by some sort of reward,
the behavior is more likely to be repeated. The
field of behavior analysis has developed many
techniques for increasing useful behaviors and
reducing those that may cause harm or interfere
with learning. Applied behavioral analysis is
the use of these techniques and principles to
bring about meaningful and positive change in
behavior. Techniques are taught to parents so
the behaviors are reinforced at home and not
just in the therapist’s office setting. Therapists
will need to be ABA certified and credentialed
by insurance companies. There are only a few
ABA certified therapists in Nebraska at this time
but many more will be needed.
Literature has shown the earlier the child with
autism is exposed to ABA therapy, the better
the results. Early intervention is key in autism.
ABA techniques should also be followed with
occupational, physical and speech therapy when
these therapies are needed.
In this issue, we discuss early childhood education and its impact on health. We all understand
the importance of screenings within our primary
care offices. Autism is just one of the diagnostic
outcomes from EPSDT screenings and with the
passage of LB 254 the proper treatment of autism
becomes easier for us all.
Physician Referral Line
402-498-1234
Connect to all Boys Town Specialty Clinics:
• Allergy, Asthma and Pediatric
Pulmonology
• Behavioral-Developmental
Pediatrics
• Ear, Nose and Throat
• Child and Adolescent Psychiatry
• Pediatric Gastroenterology
• Pediatric Neurology
• Pediatric Ophthalmology
• Pediatric Orthopaedics and
Sports Medicine
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Hospital
boystownhospital.org
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14000 Boys Town Hospital Road • Boys Town, NE 68010
555 North 30th Street • Omaha, NE 68131
NMA message
Word of Praise
Dale Mahlman
Executive Vice President
for Our Member Physicians
Nebraska Medical Association
W
HERE HAS THE TIME GONE?!
It seems like only yesterday I became acquainted
with our 2014 Nebraska Medical Association
Young Physician of the Year, Lori Brunner-Buck,
M.D., while an NMA AMA resident delegate in
2003. I then had the pleasure of working with her
again as the resident member of the NMA Board
of Directors in 2006-07. As her nomination for
the award pointed out, Dr. Brunner-Buck has
been active in the community improving the
health of area youth and families, but she has
also been active in organized medicine serving in
many different roles with the NMA and MOMS,
where she currently serves as secretary/treasurer.
Like MOMS President-elect, David Ingvoldstad,
M.D., our 2012 Young Physician of the Year,
having young physicians interested and involved
in organized medicine and, better yet, in leadership positions, only makes our organization
stronger as we prepare and face the ever changing
health care system and payment delivery system.
Congratulations to Dr. Brunner-Buck. She is
well-deserving.
Our 2014 Physician of the Year is David Watts,
M.D., of Omaha. I first met Dr. Watts in 2005. He
had an interest in one of our legislative issues and
served as a great resource and active member.
Over the years, I have worked with Dr. Watts
on many legislative issues, and I have always
been impressed by his passion for the issues
and more importantly, his patients. No matter
the issue, Dr. Watts was present in Lincoln for
legislative hearings and senator breakfasts – just
as he’s been at MOMS functions. He certainly
walks the walk when it comes to “Advocating
for Physicians and the Health of all Nebraskans.”
Like Dr. Brunner-Buck, Dr. Watts is also a very
deserving winner.
Our 2014 Annual Session saw two tremendous
patient advocates, Tom Tonniges, M.D., of Omaha
and Ron Klutman, M.D., of Columbus recognized
as our Distinguished Service to Medicine winners. I was introduced to Dr. Tonniges when he
returned to Omaha from Chicago and the AAP
in 2005. I was vaguely familiar with his time in
Hastings, but his return confirmed for me that he
was a wonderful and passionate child advocate
like I had been told. Over the years, whether
it was through his work with Boys Town or
Building Bright Futures, I’d receive a call from
Dr. Tonniges highlighting issues that needed
further attention or correction, such as foster
children aging out of the system or Medicaid
Expansion. If we ever needed a letter to the
editor or response to the press, Dr. Tonniges was
just one phone call away. His recognition by his
peers, as one of this year’s two Distinguished
Service to Medicine winners, is much-deserved.
Our other winner of the Distinguished Service
to Medicine award is just a “poor, country doctor”
from Columbus, Dr. Klutman. That description
was his own way of introducing himself at AMA
activities over the years, and many laughs were
had at his expense over the introduction.
I first met Dr. Klutman in 2000 while an
employee of Midlands Choice, one of Dr.
Klutman’s favorites at the time. I attended an
NMA Health Care Insurance Claims Council
meeting and, much to my surprise, I was the main
course, mostly to the enjoyment of Dr. Klutman.
After the well-intentioned jabs at my employer
and our underperformance in his opinion, he at
least thanked me for attending. Little did I know
that he and I would reconnect just two short
years later when I came to work for the NMA in
October 2002. We became reacquainted at the
December 2002 AMA Interim Meeting in New
Orleans and, thankfully, he had a short memory.
Over the years, I saw Dr. Klutman active with
the NMA at the local, state and national level,
serving as an AMA delegate for 10 years, which
included attending two meetings a year, taking
time away from his practice at his expense to
represent physicians at the state level testifying
at the Legislature, serving on numerous committees, supporting local public health efforts and
state efforts, and being the only known physician
to be excused from the floor of the Legislature
while serving as Physician of the Day.
These award winners are representative of
many of MOMS and NMA physicians and it is
unfortunate that we cannot individually recognize
each and every one of you. Our winners represent
the urban and rural physicians, primary care
and specialty care and, as a staff member at the
NMA, I have been fortunate to get to know and
work with this deserving group.
We are a better association because of physicians like these, and the citizens of Nebraska
have been well-served by their expertise and
professionalism. We thank them for all they do
to improve organized medicine and the health
of all Nebraskans.
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RISK management
Disaster Recovery Planning
for Medical Practices:
An Ounce of Prevention is Worth
A Pound of Cure
Dan Rosenquist, M.D.
COPIC’s Patient Safety and
Risk Management Department
A
58-YEAR-OLD MALE PRESENTED TO the
emergency department with headache, neck
pain and fever. These symptoms were present
for three days. He had previously been healthy
(except for one drug hypertension).
The patient’s exam revealed a temperature of
100 degrees with a non-toxic appearance. His
exam was non-focal with a normal neurologic
exam and a supple neck. A CT of the brain was
interpreted as normal. A spinal tap was performed
and showed 125 WBCs (82 percent polys), normal
opening pressure, and normal glucose and protein
in the CSF. His CBC showed a WBC count of
14.3 with a left shift. The ED physician diagnosed
the patient with aseptic meningitis and ordered
broad spectrum antibiotics pending cultures.
The patient was admitted to the hospitalist team
and seen by the physician assistant (PA), who
had finished training six months before. The
PA agreed with the diagnosis and discussed the
case with the internist he was working with, Dr.
Smith. As the diagnosis was aseptic meningitis,
the antibiotics were stopped. During the next two
days, the low-grade fever and pain continued.
An MRI of the brain was performed, which was
normal. The PA continued to see the patient over
this period of time and the patient was never
seen by Dr. Smith.
The patient suddenly developed an altered
mental status and a temperature of 103 degrees.
An ID consult was ordered. Focal neurologic
changes were noted, broad antibiotics were
instituted, and the patient was transferred to
the ICU. A stat cervical MRI revealed a C4-5
epidural abscess. The culture grew out Group
A beta hemolytic streptococcus. Surgery was
performed. The patient had an extensive ICU
and then rehabilitation stay. He recovered, but
has permanent neurologic sequelae and is unable
to work again. A lawsuit was filed against Dr.
Smith and the PA for delay in diagnosis.
Evaluation and Care of Neurologic Illness:
The failure to diagnose an illness is the major
reason for litigation in the cognitive and primary
specialties. About 20 percent of these diagnostic
errors could be categorized under the specialty of
neurology. Medical liability claims against ED,
primary care, pediatrics and neurology physicians that are seen in neurologic presentations
include, but are not limited to:
• Failure to recognize a CVA.
• Failure to consider or transfer for t-PA
when indicated.
• Failure to diagnose herpes encephalitis.
• Failure to diagnose spinal fractures.
• Failure to diagnose epidural abscess.
• Failure to diagnose and timely treat carotid
or basilar artery dissection.
• Failure to diagnose meningitis.
• Failure to diagnose cerebral tumors.
• Failure to diagnose intracerebral, epidural
or subdural bleeds.
• Failure to recognize increased intracranial
pressure (ICP) prior to LP.
Newer imaging technology has allowed us to
become aware of more esoteric and hard-to-treat
lesions in the deeper parts of the brain and in
the posterior circulation. However, the threshold
for increased imaging, including CT, CTA, MR,
and MRA, remains less clear.
Supervising PAs: In this case, Dr. Smith never
actually saw the patient until the third day and
experts on both sides were critical of this level
of supervision, and the lack of supervision of a
PA relatively new to practice.
The Nebraska Department of Health and
Human Services (DHHS) regulations related
to PA supervision are in Title 172, Chapter
90 of the Nebraska Administrative Code:
www.sos.ne.gov/rules-and-regs/regsearch/Rules/
Health_and_Human_Services_System/Title-172/
Chapter-090.pdf
Providers and their PAs need to have frank
and clear discussions about who should be seen
independently by the PA, who should be seen by
the PA and discussed with the supervisor prior
to treatment or discharge, and what patients
need to be examined by both clinicians and have
documentation by both of that examination.
Cognitive Error – Anchoring or Diagnostic
Momentum: About one-half of the diagnostic
errors are system errors, and the other half are
cognitive errors. When one makes a cognitive
error, it typically relates to having an initial
diagnosis and then not reconsidering the diagnosis as more information becomes available.
There was an initial diagnosis of aseptic meningitis in this case. This can lead to a letdown
in clinical scrutiny due to the terminology of
this diagnosis, which might suggest there is
no serious infection. In fact, it is an umbrella
diagnosis that covers a long list of treatable and
non-treatable central nervous system illnesses.
The providers in this situation apparently felt
there was no treatable infectious cause for the
patient’s symptoms. Always reconsider a differential diagnosis in a patient with a potential
serious illness and avoid anchoring on the first
clinical impression. Documentation and discussion of your thought processes can greatly aid
in the defense of your care.
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ELL HOW DID THIS happen? I swear it
wasn’t all that long ago that I got the
acceptance letter for medical school. Now I’m
facing this business of trying to find my first “real”
job. This is certainly a change. Gone are the days
where the M.D. career fairs were for stocking
up on my annual cache of pens – I actually have
to talk to these people and try to figure out if I
want to work for them. What do I ask them? Do
they really think I have the slightest clue about
what I’m looking for in a job? No more do I get to
dodge their questions with “Gee, I’m just really
not sure where I want to end up to practice. Do
you mind if I take two of these pens?”
It has been extremely anxiety provoking to
get to this point, where I am finally leaving
academics. I remember first entering medical
school, and being in awe of doctors and what
seemed like their endless depths of wisdom.
How on earth would I ever be able to learn all
this information? Then on to residency, which I
believed was going to be just like the TV show
“ Scrubs” – which scared the Netter out of me.
You mean I’m expected to be able to diagnose
and treat someone? Now, just when I feel like I
was getting comfortable with my “House Officer”
title, I’m facing another monumental change.
With the end of each phase of this career path,
I’ve found myself feeling terrified by the changes
ahead. Soon to be gone is the protection of being
a resident, where there was always a safety net
underneath me. In not too long, it’s going to be
me, and me alone, making recommendations and
trying to keep up to date on the latest evidencebased medicine.
This final year in training seems like such
an awkward shifting of roles. On the one hand,
I am still a lowly resident, not so far removed
from my first days on service where I felt like
an imposter in a long white coat. This contrasts
with the months-away future of being “all grown
up,” graduated, and starting my own practice.
While on my last year of rotations, I’m trying my
best to think like an attending but minding my
place as the second-to-final word on decisions.
I’m very sure my “graduating senior” mentality
will quickly evaporate once I hit the real world.
And what of things even further off? Medicine,
be it the business or the science, is, and constantly
will be changing. We are continually learning
more and more about the human body, developing
new treatments, and identifying new disorders.
Reimbursement models change and new guidelines get adopted. With the movement towards
value-based and patient-centered medicine, the
role of the physician is going to be changing from
team leader to team member. There seems to be
little room for getting too comfortable in roles,
routines, and the way things are done.
So, for now, it’s looking ahead, and taking
things as they come. I’ve done this before, and
I’m going to be doing it again, and again. I guess
things really don’t change that much.
.
Each franchise independently owned and operated
[email protected]
LEGAL update
Working Through
Karen M. Shuler
Member of Koley Jessen P.C.’s
Health Law Practice Group
T
HE PATIENT PROTECTION AND Affordable
Care Act requires providers to “revalidate”
their Medicare enrollment every five years.
Revalidation means the completion of a new
CMS 855B as if enrolling for the first time. The
requirement to revalidate occurs upon notice
from WPS. The provider has 60 days from the
postmark of the WPS letter to submit the new
CMS-855B. Failure to revalidate may result in
deactivation of billing privileges. Several of our
clients have worked through the revalidation
process and we have identified a few recurring
issues that might be avoided by taking some
proactive measures.
TIN Confirmation: One of the supporting
documents required for the submission of a new
CMS-855B is written confirmation from the
IRS of the practice’s tax identification number
(TIN). This is accomplished by submitting the
IRS CP575 letter. The CP575 letter is the original
letter the provider received when it was formed
and initially applied for its TIN. If the practice
cannot find the CP575 letter (which is not uncommon), it will need to request the IRS to issue a
147C validation letter; a process that will need to
be accomplished within the 60 day turnaround
requirement for revalidation. It may make sense
for providers to proactively look for the CP575
letter now, and if not available, request a 147C
validation letter in advance of being notified of
the obligation to revalidate.
Legal Name: Another issue providers run
into is that the provider’s TIN may not always
match the legal name used by the provider. This
can happen if the provider does not use the correct legal name on CMS 855B or the legal name
used does not match the one on file with the IRS.
Maybe there was a change in the legal name and
the Medicare Enrollment
Revalidation Process
a failure to notify the IRS of the name change,
or maybe the provider submitted the IRS Form
SS 4 (which is the form used to apply for a TIN)
with a name that does not match the legal name
on file with the Nebraska Secretary of State’s
office. Sometimes these errors are as simple
as failing to add the “P.C.” or “LLC” after the
entity’s name when filling out the form. While
this may seem like a minor detail, an unmatched
name may result in a rejection of the revalidation
or a delay in the process, either of which could
cause deactivation of billing privileges. Again,
a proactive review of company documents to
verify accuracy could avoid unnecessary delays
in the revalidation process.
Common Form Questions: We also see
some consistent errors made in the completion
of the CMS-855B form itself. Two Sections
providers often fail to fill out correctly deal with
the disclosure of ownership interests (Sections
5 and 6). Some group practices are structured
whereby the individual physicians have their
own professional corporations which, in turn,
own stock in the provider. In this case, these
professional corporations that have a 5 percent
or greater ownership in the provider need to be
disclosed as direct owners in Section 5 and the
physicians as indirect owners in Section 6.
Section 6 also requires the provider to list
its managing employees (e.g., administrators),
Authorized and Delegated Officials, and if a corporation, its officers and directors. Determining
who should be the Authorized Official and
whether there should be a Delegated Official
can be confusing. The Authorized Official is
defined as an “appointed official” who has been
authorized to enroll the provider in the Medicare
program, to make changes to the CMS-855B,
and to commit the provider to fully comply with
the laws governing the Medicare program. The
instructions give examples of those who typically serve as Authorized Officials and include
officers, directors and owners. An Authorized
Official does not need to be a physician. A
Delegated Official is one whom the Authorized
Official has delegated the authority to report
changes and update CMS-855B. The Delegated
Official must be an employee of the provider.
Some groups have the President (which is usually a physician) serve as the Authorized Official
with the office administrator serving as the
Delegated Official while others have the practice
administrator serve as the Authorized Official
with no Delegated Official. The better practice
is to have a physician, who has a leadership role,
be the Authorized Official and, if appropriate,
to have the office administrator serve as the
Delegated Official.
Keep Form Updated: Finally, and regardless
of whether you receive a revalidation notice, providers cannot overlook the ongoing requirement
to keep CMS 855B up to date. The regulations
require the provider to notify WPS within 30 days
of a change in ownership, adverse legal action or
change in practice location. All other changes are
required to be reported within 90 days. While
providers do a good job when it comes time to
adding physicians (due to the need to be able to
bill for same), they often forget to delete physicians who have retired or left the provider, as
well as report adverse legal actions, and changes
in the Authorized and Delegated Officials. The
revalidation process will obviously catch some
of these items, but, due to the current regulatory
environment, providers need to ensure they keep
the information on CMS 855B current.
FINANCIAL update
Addressing
Common Questions
About Life Insurance
W
HAT ARE THE DIFFERENT types of life
insurance policies? The two basic types
of life insurance are term life and permanent (cash
value) life. Term policies provide life insurance
protection for a specific period of time. If you
die during the coverage period, your beneficiary
receives the policy’s death benefit. If you live to
the end of the term, the policy simply terminates
unless it automatically renews for a new period.
Term policies are typically available for periods
of 1 to 30 years and may, in some cases, be
renewed until you reach age 95. With guaranteed
level term insurance, a popular type, both the
premium and the amount of coverage remain
level for a specific period of time.
Permanent insurance policies offer protection
for your entire life, regardless of your health,
provided you pay the premium to keep the policy
in force. As you pay your premiums, a portion
of each payment is placed in the cash value
account. During the early years of the policy,
the cash value contribution is a large portion of
each premium payment. As you get older, and
the true cost of your insurance increases, the
portion of your premium payment devoted to the
cash value decreases. The cash value continues
to grow – tax deferred – as long as the policy is
in force. You can borrow against the cash value,
but unpaid policy loans will reduce the death
benefit that your beneficiary will receive and
may create an adverse tax result in the event of
a lapse or policy surrender. If you surrender the
policy before you die (i.e., cancel your coverage),
you’ll be entitled to receive the cash value, minus
any loans and surrender charges.
Many different types of cash value life insurance are available. The most recognizable may
be Whole Life. There is also Universal Life,
which can be divided into three types: fixed,
indexed and variable.
How much life insurance do I need? Since
the amount of insurance you need depends on
your specific financial goals and circumstances,
there is no simple formula to help determine the
amount that is right for you. When you consider
all the things that life insurance proceeds need
to fund and how long the money will be needed,
it is easy to see that your true need for coverage
could be more than 10-15 times your gross income.
What should I consider in naming beneficiaries? There are several key considerations in
naming a contingent or secondary beneficiary
just in case you outlive your first beneficiary.
You should select a specific beneficiary rather
than having the proceeds of your life insurance
paid to your estate. One of the great advantages
of life insurance is that it can be paid to your
family immediately. If it is payable to your estate,
however, it will have to go through probate with
the rest of your assets.
Be very specific in working beneficiary designations. Saying “wife of the insured” could result
in an ex-spouse getting the proceeds. Naming
specific children may exclude those born later.
Changing the beneficiary designation is easy,
but you have to remember to do it.
Aaron Ostler
Financial Advisor
Heritage Financial Services
What type of insurance is right for you? Before
deciding whether to buy term or permanent life
insurance, consider policy cost and potential
savings that may be available. Also keep in mind
that your insurance needs will likely change as
your family, job, health and financial picture
changes, so you’ll want to build some flexibility
into the decision-making process. In any case,
here are some common reasons for buying life
insurance and which type of insurance may
best fit the need.
Once you purchase a life insurance policy,
make sure to periodically review your coverage – over time your needs will change. An
insurance agent or financial adviser can help
you with your review.
Here’s some fine print: Life insurance products contain fees, such as mortality and expense
charges, and may contain restrictions, such as
surrender periods. Administrative and insurance
charges are deducted every month regardless of
whether premium outlays are made. Depending
upon actual policy experience, the Owner may
need to increase premium payments. Any policy
loans and partial surrenders will affect policy
values and may require additional premiums to
avoid policy termination.
Securities and investment advisory services
offered through Securian Financial Services,
Inc., Member FINRA/SIPC. Securities dealer
and registered investment advisor. Heritage
Financial Services, LLC is independently owned
and operated.
feature
Photography by Bill Sitzmann
Photo: John Cavanaugh, COO of Holland Children’s Institute and Holland Children’s Movement.
feature
Advocating
for Children
T
WO ORGANIZATIONS BEARING A familiar
name are tackling issues that affect children
and their early development.
The Holland Children’s Institute focuses on
gathering data on best practices for ways to
reduce the number of Nebraska families living
in poverty and to make Nebraska the best place
in the country to raise children by identifying the
most effective practices in education, health care
and economic development, said John Cavanaugh,
who serves as chief operating officer of the
institute and the Holland Children’s Movement.
The institute, for example, shares with visitors to its website the “Getting Ready: 2013-14
Maryland School Readiness Report.” Maryland
has increased its rate of school readiness among
kindergarteners to 83 percent, up from 49 percent
in 2001-02. In addition, 80 percent of Maryland’s
African-American children and 73 percent of
Hispanic children are fully school-ready.
The Holland Children’s Movement is committed to advocating for public policies in Nebraska
that will have positive impacts on children in low
income families. Its top priorities are increasing
family income and improving early learning.
Cavanaugh said the Holland Children’s
Movement is part of the Nebraskans for Better
Wages coalition, which is intent on raising the
minimum wage in Nebraska to $9 per hour by
2016. The movement helped garner signatures to
get an initiative to raise the minimum wage on
the ballot for the General Election in November.
Backers of the petition drive turned in 134,899
signatures to the Secretary of State’s Office in
July, according to the World-Herald. The office
reported 89,817 signatures had been verified by
county election officials – with 80,386 needed.
That total had to include at least 5 percent of
registered voters from each of 38 counties (twothirds of Nebraska’s 93 counties).
If approved by voters, the state’s minimum
wage would rise from $7.25 an hour to $8 an
hour next year, and to $9 an hour on Jan. 1, 2016.
Cavanaugh said raising the minimum wage from
the current $7.25 could add $3,000 to a person’s
annual income. “The people at the bottom of the
income ladder have the greatest challenges to
daily life,” Cavanaugh said. “They must make
adjustments for housing, transportation, medical, nutrition – all this impacts the children in
the household and their opportunities to learn.”
The current $7.25 hourly wage provides $290
of income for a person working full-time, which
equates to an annual salary of $15,080 before
taxes – which is $4,700 below the poverty level
for a parent with two children.
Cavanaugh said the Holland Children’s
Movement will continue to promote the
proposed wage increase and work to increase
awareness – through such communication avenues
as providing op-ed pieces to the media – about
the importance of passing the initiative.
The Holland Children’s Movement also is
committed to supporting policies that directly
impact children and their families. This begins
with access to prenatal care for all women,
Cavanaugh said.
By reviewing the long form of birth certificates
filed in Nebraska, the data reveals that mothers accounting for 25 percent of the births did
not receive adequate care – although the state
provides universal access to prenatal care for all
women. “Our goal is to engage with the health
community to reach out to mothers not accessing
care, primarily in the earliest trimester. We’d like
to see 100 percent of all women receive prenatal
care,” Cavanaugh said.
The Movement looks to collaborate with other
health and educational organizations, including
school districts, UNMC, Creighton University
Medical Center, the Urban League and Boys Town.
The two organizations are funded primarily
by Omaha philanthropist Dick Holland and were
founded in August 2013.
feature
Changing the Question
for New Physicians:
‘Who Needs Me to
Be a Physician?’
T
HE REV. MICHAEL ROZIER hopes his essay –
which calls for physicians to provide genuine
moral leadership and future physicians to question
why they have chosen the profession – will lead
to conversation.
“I hope they (physicians who read the essay)
take it as an invitation to have deeper conversations with students about who needs medical care
and isn’t currently getting it,” Rozier said. “I hope
some people who sit on medical school admissions
committees also read it and wonder if we could be
asking better questions of our applicants.”
Rozier’s essay, “Why Do You Want to be a
Physician?” appeared in the Dec. 9 edition of The
Jesuit Post, (www.thejesuitpost.org) He starts the
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essay with strong words: “The landscape of
American health care is shifting beneath our
feet. And if anyone pretends to know where it
is going, they’re fooling themselves.”
Rozier, who served on the pre-med evaluation
committee for letters of recommendation while he
served as faculty at St. Louis University, initially
dwells on a question asked of medical school
hopefuls: Why do you want to be a physician? The
responses received typically focus on service. In
his essay, Rozier suggests that another be asked:
Who needs me to be a physician?
Rozier, in an interview, described the answers
he heard from medical school prospects in response
to the question: “They were rehearsed, certainly,
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but that doesn’t mean they were disingenuous.
I was more concerned that the central question
we were asking them - why do you want to be
a physician - was the wrong question. I wanted
us to ask a question that told me more about how
they saw their place in the world.”
The essay also focuses on the contradiction
caused by Medicaid – which he describes as
essential for the poor and disabled, but notorious in the medical community for its low and
slow reimbursement for services. He notes, for
example, that only 40 percent of physicians in
New Jersey will see new patients covered by
insurance for the poor and disabled.
Other challenges for accessing health care,
as outlined in his essay, include:
• The workforce for preventive medicine and
primary care has yet to be adequately expanded.
• We have yet to crack the code about how to
maintain quality care in rural areas.
• The disparity in compensation between
specialties is well-established, which means
health care will be even more difficult for
Medicaid patients to access.
“The sad truth is that we have a very dispiriting history of physicians and health care reform,”
Rozier wrote. He suggests reading Paul Starr’s “The
Social Transformation of American Medicine.”
“One takeaway of Starr’s history is that the
physician community has a great track record
of looking out for itself rather than the patients
it serves,” he wrote. “It has regularly used its
power of advocacy to ensure its social status
and financial compensation were protected
above all else.”
Rozier, in his essay, commends those who
have sacrificed much to become physicians. He
calls on physicians to effect change. “But for
those who feel stuck in a system that they think
prevents them from seeing the poor, I believe
that physicians might be the only ones capable
of changing it.”
Rozier said the response he has received to
his essay has been positive. He said he received
several emails from physicians who were complimentary and grateful that he challenged the
existing process. “The ones who disagreed with
me, and they are certainly out there, probably
wouldn’t waste their time contacting me.”
Editor’s Note: Rozier is a Jesuit with a degree in international
health systems from Johns Hopkins University. He was an ethics
fellow at the World Health Organization in Geneva. He also taught
global health and public health ethics as he served as the founding
director of undergraduate education at Saint Louis University
School of Public Health. Having completed a degree in moral
theology at Boston College, he is currently a doctoral student
in health management and policy at the University of Michigan.
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feature
‘We Need to Wake Up’:
Photography by Bill Sitzmann
A Call for Action to Provide Quality
Early Childhood Care
T
HEY MAY TAKE SLIGHTLY different approaches
when sharing their opinions about the importance of quality childhood care and education.
Their expertise may reside in different areas.
But their message is clear: Children are more
likely to thrive when their care givers, especially
and including their parents, provide them with
a stable, nurturing environment.
Physicians Bulletin asked five local experts in
early childhood care and education to bring this
topic to light. They first were asked to list the
critical components of high quality and successful
early childhood care and education programs.
Here is a summary of their responses:
• Parent engagement, which means that parents
are active participants in promoting their
child’s healthy growth and development,
and they become effective advocates for
their child’s learning.
• A safe, child-friendly, language-rich, nurturing environment with caregivers who
are trained to respond and be engaged with
children, encouraging them, stimulating
their sense of curiosity, comforting them
and helping them to identify their emotions.
• Developmentally stimulating curriculum
that is age appropriate, and incorporates
elements of math, language, science, art and
music, and the development of social skills.
• Highly effective teaching practices, small
class sizes, and low teacher-child ratios and
intentional implementation of research-based
curriculum that is focused on the whole child.
• Highly qualified early childhood educators
with embedded professional development
directly connected to practice and not done
in isolation through one-and-done training.
• Educational program data utilization, which
means that observations and assessments
are used to continuously improve practice
and achieve better child outcomes.
feature
One of our experts, Cynthia Ellis, M.D.,
associate professor of pediatrics and psychiatry
at the Munroe Meyer Institute for Genetics and
Rehabilitation, added that it is also important
to consider early childhood care and education
from a neuroscience and brain development
perspective. Brain development is an ongoing
and interactive process between biology and
experience (nature vs. nurture) that begins before
birth and continues into adulthood, she said.
“The first few years of life are especially
important because, as the brain evolves to be more
efficient, brain (neural) connections that are not
being used are eliminated through the process
of pruning. Thus, early experiences determine
which brain circuits (the foundations for later
learning and skill development) are being used
and reinforced and which are pruned through
lack of use.”
Our experts also described the progress being
made in the community and the challenges that
still must be addressed:
GINA DIRENZOCOFFEY, M.D.
Pediatrics
Boys Town Pediatrics,
Pacific Street
What evidence do we have that our approach
to providing quality early childhood education is working?
There are several studies, including the Perry
Preschool Project and Abecedarian Project, that
demonstrate that children in high-risk communities who attend high-quality nurturing early
childhood programs are better prepared on Day
1 of kindergarten, have better reading scores
in grade school, are more likely to complete
high school and less likely to be involved in the
juvenile justice system. The research of Nobel
economist James Heckman shows investment in
the first 3 to 5 years of life has the highest rate
of return of any period in the lifespan. This is
because investment at this age prepares children
for life and prevents the need for expensive
remediation later.
What keeps you up at night (meaning where
are we falling short)?
The fact that due to cost, high-quality early
childhood programs are not accessible to the
children who most need these programs. We live
in one of the most developed countries in the
world, but we lag behind almost every country
in the developed world in supporting young
families and early child development. I believe
this is why the U.S. is seeing rapid increases in
mental illness and criminal behavior in our youth
when compared with other developing nations.
What helps you sleep at night (meaning
what are we, as a community, doing well)?
What helps me to sleep at night is that people
in our community, including businessmen and
philanthropists, recognize that early childhood
programs and child development are vital not only
to the emotional and physical health of children
and families, but also to a strong workforce and
economic success of our state.
Please share a personal success story regarding early childhood care:
Years ago, I had a mother present with her
3-year-old daughter. The mother clearly suffered
from severe anxiety and her relationship with
her daughter had caused her daughter to develop
very maladaptive behaviors around sleeping and
eating, leading to very poor growth and delays
in development. We were able to get her into
child care with a high-quality early development
program and the effects were very rapid. Almost
immediately, the encouragement of her teachers
and peer modeling resulted in a reversal of her
poor eating and growth improved. With time,
her developmental delays also resolved and she
entered kindergarten ready to learn. She has
done well in school ever since.
CYNTHIA ELLIS, M.D.
Associate Professor of
Pediatrics and Psychiatry
Munroe Meyer
Institute for Genetics
and Rehabilitation
What keeps you up at night?
There is a relatively short time over someone’s
life span (i.e., early childhood) when the brain
is molding and rewiring itself in response to the
environment, and this is the only opportunity to
establish a solid foundation for future learning,
behavior and health. I see this window closing
on many children who don’t get a chance to
experience the “right” environment and then
thinking they have missed their early childhood
opportunity. This is especially concerning for
at-risk children or those with developmental disabilities who are already behind from the start.
I think of a little boy with autism who really
needed specialized and intensive early intervention
because of his disability. Although he qualified for
early intervention through the school system, this
was not sufficient to meet his needs. His family
did not have the financial means to obtain private
services or access to any appropriate program
for him. The ACT (Autism Care for Toddlers)
Clinic was initiated last fall as a collaborative
program between the Munroe-Meyer Institute
and Autism Center of Nebraska. This program
serves infants and toddlers with autism, regardless
of their ability to pay. This little boy was one of
the first children accepted into this program and
he has made remarkable developmental progress
over the course of this year. Hopefully, he now
has the skills to continue to make progress as he
moves into a school-based preschool program.
This would not have happened without the effort
of the professionals who put this new program
together and the grants and nonprofit funding
that has supported it.
BARB JACKSON
Professor
Munroe-Meyer Institute
What evidence do we have that our efforts
are working?
The are several well-known studies, High/
Scope Perry Preschool Study and The Abecedarian
Project, that demonstrate that quality early childhood programs not only have immediate academic
and social emotional benefits for the children,
there are also long-term benefits academically
(fewer students in special education, increased
high school graduation rates) and economic benefits (higher earnings, less trouble with the law).
Although great strides in early education
and care have been made across many sectors,
the majority of child-care centers in the private
sector are not of high quality, especially those
that serve the working poor or those families in
poverty. There are not simple solutions as it is
as much an economic issue as a training issue.
In order for child care to be affordable, teacher
pay is often low (frequently at minimum wage),
which results in teachers with less education and
frequent turnover.
Secondly, there has been an expansion of
school-funded programs, which is good. However,
it has resulted in a workforce shortage of teachers
with early childhood training. This currently is
being addressed with higher education.
feature
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OneWorld Community
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What helps you sleep at night?
Nationally and in Nebraska, there has been
an increasing awareness on the importance of
the early years, which has created a momentum
to build systems and programs to address the
needs of these young children and their families.
In Nebraska, a public-private partnership has
emerged that is supporting both higher education
and programs at the community level, which
has contributed greatly to expansion of high
quality opportunities for young children and
their families.
A teenage mother was able to stay enrolled
in high school, while the school provided her
child with high-quality early childhood education experiences. The mother was 14 when she
was pregnant and was just a freshman in high
school. In addition to going to typical high school
classes, she also took parenting classes and
interacted with her baby throughout the day, as
well as participating in home visits. The childcare teachers provided her with “a lot of hope.”
In her parenting classes, there was a lot to
learn because, as a teenager, she had limited
knowledge of child development and how to
help her daughter learn.
The mother continues to be intensely focused
on her child and her future. Her child is 4 now
and is continuing in the program, while her
mother is on the path to graduation and is
entering her senior year. Her daughter is doing
well in school, and she and her mother have a
wonderful relationship.
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feature
crime rates, increased job skills and income.
For the rest of society this translates into less
money spent on public education, criminal justice
and welfare.
There is still a significant education achievement gap for Omaha minority children. Only
12 percent of black graduates met the ACT’s
standards for college readiness in reading. The
same gap is there for math and science. Dropout
rates are improving, but nearly one-quarter of
OPS kids do not complete high school. Nebraska
has the fourth worst graduation rate for black
males in the country – just 44 percent. Many of
those kids who drop out are destined for a life
of poverty, and many end up in jail. It’s sad, and
the human cost is just huge. Unfortunately, I still
see us focusing a lot on trying to fix problems
late in the game. We need to wake up and focus
on how to help families in a more proactive way.
There are a growing number of benefactors
and legislators who have chosen to invest in
our children. I think we are moving in the right
direction by looking carefully at the science
behind education programs – the Buffett Early
Childhood Institute is just one example of that.
Taking that information about the benefits of early
childhood care and putting them into practice
is the next step. I am really excited about some
of the cutting edge ways Nebraska is looking to
do that, like the Sixpence Early Learning Fund.
This is a public, private partnership that provides
dollars for early childhood education and training across the state. The Learning Community
Center of South Omaha is another great example
of a program that helps immigrant families learn
English and build stronger relationships with their
children to support their educational success.
I had a patient who became pregnant while
she was in high school, and had very little support from her family. Although she had dreams
for her own education, her family just figured,
“Hey, you are an adult now, this is your responsibility.” Her boyfriend was not in the picture at
all, and she was faced with a very challenging
future. I remember when she brought her baby
in to see me for the first time, I was worried for
her future too. She was only able to take about
10 days off for maternity leave before she had
to get back into class. She also was planning to
continue working at Burger King because she
needed money to pay for day care and diapers,
and everything else. Fortunately, she was able to
eventually get her daughter into Educare, which
just has such a great reputation as a high quality
day care. She also received a lot of mentoring
and parenting support along the way, and she
has really done well. She participated in a home
visitation program and that helped to build her
confidence as a teen parent. They helped her to
keep exclusively breastfeeding for over 18 months,
and taught her a lot about how to create a developmentally stimulating home environment. She
is now working part-time in a bank and is going
to college. He daughter is just delightful, very
bright and active. When she brings her daughter
in for appointments, it is really great to see them
interacting. She is a very pro-active parent and
brings in a lot of written notes and questions
about her daughter’s health and development. I
am very proud of what she has accomplished.
She could have been just another teen mom, but
she has been able to create something new for her
daughter. She is breaking the cycle of poverty.
JESSIE RASMUSSEN
President
Buffett Early
Childhood Fund
are working?
I see three examples:
• More than 150 studies nationwide conclude
that what happens in the earliest months
and years matters – big time. The science
is clear: Children with strong foundations
feature
in their first five years are more successful
in school and later in life.
• The independent evaluation of the Educare
Learning Network, a national network of
20 high quality early childhood programs
that serve the most at-risk children, reflects
that Educare graduates are arriving at
kindergarten on par with their peers from
resourced families, instead of being one to
two years behind.
• The Educare Omaha follow-up study shows
that Educare graduates who had more than
two years at Educare are performing in
third and fifth grades on state math and
reading assessments not only significantly
higher than their peers from low-income
families, but also within the expected range
for all children – regardless of their socioeconomic status.
There are still thousands of children in Omaha
and Nebraska – especially the youngest and most
vulnerable children – who are not getting a great
start in life. There is still a huge opportunity gap
in the first five years that is leading to failure in
school for these children.
We’re getting traction. There is broad-based
recognition of the importance of the early years.
Educators, business leaders and philanthropists are
promoting smart investments in early childhood
education. There is the real possibility that we
can succeed in leveling the playing field through
quality early childhood education for all children.
Please share a personal success story:
I think of a boy, whom I will call Harrison.
I observed Harrison when he first arrived, just
before age three, in a high quality community
based child care program. His mother became
a single mom when she got out of a domestic
violent relationship. She was working two jobs
and going to school, doing her best to make ends
meet. When Harrison entered the child care program, he was 12 to 18 months behind in language
development. He expressed his frustration through
kicking, biting and hitting. While other children
were engaged in activities, he was usually running around, literally climbing the walls. The
teacher understood how important routines and
consistency were to help Harrison grow socially
and emotionally. And she not only provided that
for him while in her care, she also worked with
his mom to establish routines and consistency in
Harrison’s home life. The teacher used Harrison’s
interests to engage him in meaningful play; she
modeled appropriate ways to interact with other
children; and she intentionally gave him more
attention when he was behaving appropriately,
than when he was not. Furthermore, this teacher
provided Harrison with well-designed activities
that expanded his language and thinking. By the
time Harrison entered kindergarten, his language
development had caught up, as had his social
and development skills – he was ready to take
full advantage of what formal education had to
offer. The bottom line: This quality child-care
program had a highly competent teacher who
included parents as partners in the early care and
education of Harrison. And as a result, this early
childhood program changed the life trajectory
for Harrison by setting him up for success in
school and later in life.
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Medical Association (NMA). I hereby consent and authorize MOMS to use my application information that has been
provided to the MOMS credentialing program, referred to as the Nebraska Credentials Verification Organization (NCVO),
in order to complete the MOMS membership process.
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(If you answer “Yes” to any of these questions, please attach a letter giving full details for each.)

Have you ever been convicted of a fraud or felony?

Have you ever been the subject of any disciplinary action by any medical society, hospital medical staff
or a State Board of Medical Examiners?
Has any action, in any jurisdiction, ever been taken regarding your license to practice medicine?
(Including revocation, suspension, limitation, probation or any other imposed sanctions or conditions.)
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I certify that the information provided in this application is accurate and complete to the best of my knowledge.
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MEMBER news
Dr. Thomas Tonniges (right), receives the
Dr. Kevin Nohner (left) presents the Physician
Dr. Lori Bruner-Buck receives the Young Physician of
NMA Distinguished Service to Medicine award,
of the Year award to Dr. David Watts.
the Year award from NMA President Dr. Kevin Nohner.
presented by NMA President Dr. Kevin Nohner.
Drs. Tonniges, Watts and Brunner-Buck
Recognized by NMA
T
HE NEBRASKA MEDICAL ASSOCIATION
honored three MOMS members at its annual
meeting in September.
Thomas Tonniges, M.D. received the NMA
Distinguished Service to Medicine. This award
recognizes lifelong distinguished service to the
patients and the people of Nebraska and the
Nebraska Medical Association.
For decades, Dr. Tonniges, a Nebraska
pediatrician and patient advocate, has worked
tirelessly to battle childhood obesity, promote
literacy, expand access to quality health care and
improve the overall lives of Nebraska’s children.
Beginning his career as the first pediatrician
with neonatal intensive care training in Hastings,
Dr. Tonniges immediately began to leave his
mark. His passion for prevention and education
led him to start the town’s Healthy Beginnings
and Head Start programs.
After 18 years in Hastings, Dr. Tonniges was
appointed to head the Department of Community
Pediatrics at the American Academy of Pediatrics
(AAP) in Chicago where he oversaw all of the
AAP’s community health programs, enacting grassroots change in schools and medical
clinics worldwide.
After a decade in Chicago, he returned to
Omaha to work with Boys Town continuing
his tireless efforts on behalf of Nebraska’s
children. In the last 15 years, he has served
on numerous local, statewide and national
community organization boards and committees, including membership in both MOMS
and the NMA, as well as holding more than
20 committee and board positions within the
American Academy of Pediatrics, including
president and vice-president.
David Watts, M.D., was awarded the NMA
Physician of the Year. This award recognizes a
practicing physician for their medical contributions to the community.
Dr. Watts is a board-certified dermatologist,
fellowship-trained in Mohs surgery. He is a fellow
of the American College of Mohs Surgery and of
the American Society for Dermatologic Surgery
and specializes in Mohs Micrographic Surgery
for high-risk skin cancers, and post-operative
reconstruction. He advocates for skin cancer
prevention, especially for children, and patient
protection through truth in advertising.
Dr. Watts, as a member and current vice president of the Nebraska Cancer Coalition (NC2),
plays an active role in the efforts to emphasize
cancer prevention, address the needs of cancer
survivors, promote early detection and screening
and increase access to cancer care.
He is a champion of “The Bed is Dead,” a
cooperative campaign focusing on educating
Nebraska girls ages 18 and under, and their parents,
on the dangers of indoor tanning. Community
organizations, student groups and the Nebraska
Cancer Coalition (NC2) are working together to
spread the message with the goal of changing
the behavior of young women who tan indoors.
Dr. Watts advocated for the Nebraska Skin
Cancer Prevention Act, no doubt playing an
integral part in its passage. His efforts included
testifying before the Nebraska State Legislature,
speaking face-to-face with lawmakers, creating
awareness through local and national media
and educating patients – earning him national
recognition with the 2013 American Academy
of Dermatology Advocate of the Year award.
Co-founding the “Aim for the Cure for
Melanoma” charity walk in 2012, Dr. Watts found
yet another avenue to build public awareness of
Melanoma while raising money to help find a cure.
He continues his involvement with this event.
Lori Brunner-Buck, M.D., was named Young
Physician of the Year. This award honors a physician
whose contributions to the NMA and the community
are examples of the finest in a young physician.
Dr. Brunner-Buck is dual boarded in internal
medicine and pediatrics. She began practice serving pediatric patients and has since transitioned
into hospital medicine seeking out positions
where she can utilize both skill sets and care for
patients throughout their lifespan.
Beginning in medical school, continuing through
residency and into practice, Dr. Brunner-Buck
has taken an interest and played an active role
in organized medicine, the health of Nebraskans
and in shaping the future of health care.
As a medical student and member of the
UNMC Pediatric Interest Group, she served as
the program volunteer coordinator for the “House
Calls for Kids” program. “House Calls for Kids”
is a collaborative venture with UNMC and the
Children’s Hospital & Medical Center. This
program allows first- and second-year medical
students to give a presentation to Head Start
Programs and daycare centers. The purpose of the
presentations is to familiarize children to visiting
their doctor and to dispel some of their fears.
In addition, through the National Health
Service Corps: SEARCH Program, Dr. BrunnerBuck researched, designed and implemented
a project proposal to help start an adolescent
health care clinic for the underserved Hispanic
population in Omaha, Nebraska.
At various stages in her training and practice,
Dr. Brunner-Buck has held membership in the
AMA, AMPAC, American Academy of Pediatrics,
American College of Physicians – American
Society of Internal Medicine, National Medicine/
Pediatrics Resident Association and the Society
of Hospital Medicine. She has served as the
MOMS Membership Committee chair and on
the board of directors of the NMA. She currently
holds the position of secretary-treasurer on the
MOMS board of directors
MEMBER benefits
FINANCIAL EXPERTISE
FOR THE HEALTH CARE INDUSTRY.
To speak with a dedicated speciallist
from our Health Care Banking Diviision
call Ed Finan at 402-399-5028.
XXXBOCBOLDPNtMPDBUJPOTJO/FCSBTLBBOE*PXB$BMMPS
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Why Join or Continue to Be
a Member of MOMS/NMA?
We keep you informed:
Members receive the latest in local,
regional and national healthcare news through the MOMS
eBulletin and NMA STAT email
newsletters, as well as the Physicians
Bulletin and Nebraska Medicine
magazines and the NMA News.
If your patients suffer from swollen, achy, painful, discolored legs
We can help!
We keep you connected:
Members have the opportunity to
network with their peers, interact
with local medical students and
communicate with community
leaders. Members also have the
option of serving on MOMS and
NMA committees and through
involvement with our local
health care-related partners.
We represent physicians
and patients:
MOMS and NMA diligently monitor
state legislation that will impact the
future of health care. Together, our
cumulative voice is heard by those
who make decisions impacting the
practice of medicine and the health
of all Nebraskans, including Medicaid,
Medicare, professional liability
insurance, scope of practice, and
public health – just to name a few.
Call (402) 298-5727 to further
relieve your patient’s condition
Make sure your
voice is heard.
If you would like more information on
Revealing God’s Love Through Excellence in Healthcare
ree
12702 Westport Parkway, Ste. 101 LaVista, NE 68138
www.heartlandvein.com
MOMS membership, call (402) 393-1415
Thomas
h
B. Whittle,
h l M.D.
Vascular Surgeon
or email [email protected].
MEMBER news
Dr. Feilmeier
Dr. Filipi
Honored by
Receives National
Nebraska Wesleyan AAFP Award
M
ICHAEL FEILMEIER, M.D., HAS been
honored by Nebraska Weslyan University
as the recipient of its Young Alumni Achievement
Award 2014.
After graduating from NWU in 2001, Dr.
Michael Feilmeier earned his medical degree
as a Regent’s Scholar at University of Nebraska
Medical Center, where he graduated with highest distinction. Following medical school, Dr.
Feilmeier continued his medical education with an
internship in internal medicine at the University
of California San Diego and an ophthalmology
residency at Bascom Palmer Eye Institute at the
University of Miami. Dr. Feilmeier then finished
his formal medical education as the first fellow
in the country in advanced global blindness prevention and corneal surgery at the John Moran
Eye Center, University of Utah.
In 2010, Dr. Feilmeier accepted a position at
Midwest Eye Care, where he currently practices as
a board certified corneal, cataract and refractive
surgeon. Following his dream to cure blindness
throughout the developing world, Dr. Feilmeier
and his wife, Jessica, founded the division of
global blindness prevention and community
outreach at UNMC in 2011.
In the past three years Feilmeier and his team
at UNMC have restored sight to more than 1,000
blind patients in Haiti and Africa. Additionally he
assisted in training surgeons throughout Nepal,
India, Haiti, Ethiopia and Ghana.
As assistant professor and medical director
of the Division of Global Blindness Prevention,
Dr. Feilmeier is also fellowship director for fellowship positions in global blindness prevention.
Locally, Dr. Feilmeier and his team provide much
needed eye care to the Native American Indian
population of Nebraska.
D
AVID FILIPI, M.D., VICE PRESIDENT, qual-
ity advancement and medical director
for Blue Cross and Blue Shield of Nebraska,
has been presented the American Academy of
Family Physicians 2014 Robert Graham Physician
Executive Award.
This national award is given annually to
recognize an outstanding family physician and
academy member whose executive skills in
health-care organizations have contributed to
excellence in the provision of high quality health
care, and demonstrated that family physicians
can have an impact on improving the overall
health of the nation.
This award is named in honor of Robert
Graham, M.D., executive vice president from
1985 to 2000. Dr. Graham dedicated his career
to improving health-care access and fostering
the tenets of family medicine.
Prior to joining BCBSNE, Dr. Filipi was vice
president of medical affairs and chief medical
officer for Methodist Physicians Clinic in Omaha.
Dr. Filipi serves on the Douglas County
Board of Health and has served as president of
the Nebraska Academy of Family Physicians,
the Nebraska Medical Association and the
Metro Omaha Medical Society (MOMS). He
currently serves as chairman of the MOMS
Public Health Committee. He served on both
the American Academy of Family Physicians
(AAFP) Commissions on Socio-Economics
and Quality, was the AAFP liaison to NCQA,
the American Academy of Pediatrics and the
American College of Pathology Laboratory
Reference Committee. He volunteers as medical
director of Hope Medical Outreach Coalition.
He graduated from the University of Nebraska
Medical Center, where he also completed a
family practice residency, becoming chief resident. He earned an MBA from the University of
Nebraska Omaha.
MOMS events
MEMBER NETWORKING
1
Filled to capacity, a member networking
event on Aug. 7 at Cantina Laredo provided an
opportunity for 40+ physicians and their spouses
to join their peers for an evening of Mexico City
style cuisine followed by Jazz on the Green.
1. (From left) Dr. Jane Bailey, Lori Gigantelli
and Dr. James Gigantelli enjoy the evening
2. New MOMS member, Dr. Jai Bikhchandani
(left) introduces himself to Dr. Nirmal Raj,
who also recently joined MOMS.
3. The event was a great opportunity for residents and practicing physicians to interact.
RETIRED PHYSICIANS
MOMS retired physician members met on
Aug. 20 to learn about early childhood education efforts in the metro area. Jessie Rasmussen,
president of the Buffett Early Childhood Fund,
addressed the group.
4. Dr. William Orr, chair of the retired physicians group, welcomes keynote speaker Jessie
Rasmussen.
5. Jessie Rasmussen discusses the role of the
Buffett Early Childhood Fund.
2
3
5
4
COMING events
Metro
maha
Medical Society
COMMUNITY INTERNSHIP
OCT. 21 – WELCOME RECEPTION
OCT. 22 & 23 – INTERN SHADOWING
OCT. 23 – BANQUET DINNER
MOMS invites lawmakers, members of the media, community
leaders and business representatives who work closely with
the heath care community to shadow physicians and witness
all aspects of care including patient examinations and
procedures, consultations and even behind the scenes.
Physicians willing to be shadowed and participate
in the program should contact MOMS.
Metro
maha
Medical Society
STRATEGIC PARTNERS
The Metro Omaha Medical Society Strategic Partners
offer a variety of expertise, products and services
to assist physicians and practices in addressing
their needs and achieving success.
We encourage you to talk with our Strategic Partners when
making decisions for yourself or your practice.
PLATINUM PARTNERS
www.CallCopic.com
MEMBER NIGHT AT UNO MAVS HOCKEY
(HOSTED BY MOMS AND FOSTER GROUP)
FRIDAY, NOV. 21
UNO MAVS VS. MINNESOTA DULUTH
GATES OPEN AT 6:30 PM
PUCK DROPS AT 7:37 PM
CENTURY LINK CENTER
MOMS members and their immediate family are
invited to attend this fun, family event.
Reservations required - contact the MOMS office for details.
www.FosterGrp.com
www.corebank.com
http://tmsassocgen.com
GOLD PARTNERS
www.YourFutureCounts.com
www.nebraskamed.com
www.nebraskaspinehospital.com
MOMS ANNUAL MEETING
SILVER PARTNERS
TUESDAY, JAN 27
HAPPY HOLLOW COUNTRY CLUB
Plan to join your fellow members for a reception and dinner followed
by a recap of the past year at MOMS, recognition and award
presentations, and hear what is planned for the coming year at MOMS.
www.chihealth.com
www.ClineWilliams.com
www.KoleyJessen.com
www.BestCare.org
MARK YOUR CALENDAR
MARCH 5
MEDICAL LEGAL DINNER
APRIL 17
MEDICAL MESS CLUB
www.SeimJohnson.com
BRONZE PARTNERS
MAY 1 & 2
MOMS DOCBUILD HABITAT FOR HUMANITY BUILD EVENT
www.GoNines.com
Call (402) 393-1415 or email
[email protected] for more information
or to RSVP for any of these events.
www.LutzCPA.com
www.NebMed.org
For more information on our Strategic Partners
visit www.omahamedical.com
CAMPUS & HEALTH SYSTEMS update
Camp keeps visually
impaired youths busy
C
AMP ABILITIES NEBRASKA, A week-long
sports camp for children, ages 9 to 19,
who are blind or visually impaired, provides
campers with a variety of activities. The camp is
co-sponsored by Boys Town National Research
Hospital and Outlook Nebraska.
This summer, campers participated in swimming, yoga, tandem cycling, beep baseball and
kickball, archery, bowling, ballroom and hip hop
dance, bocce ball and other yard games – activities
they are not typically able to do outside of camp.
Each evening, the youth shared their adventures
with friends and camp leaders during a “care to
share” activity.
Camp Abilities Nebraska explores sports and
recreational activities in a safe environment with
instructors from the University of Nebraska
Omaha, who are highly trained in adaptive
physical education.
One parent wrote, “I wanted to thank Boys
Town once again for the awesome experiences
that my son had at camp. I know he loved the rock
wall climbing, the bowling for sure, swimming
and cheese pizza! There is no way I could afford
for him to do these things and it means so much
to me that this special camp was available for
him and the other children.”
“Children who are blind or visually impaired
are often the only child in their school with a
visual impairment,” said Kristal Platt, Vision
Program coordinator at Boys Town National
Research Hospital. “This is a great way to teach
independence and self-determination to children
who are blind, and have fun while instilling these
life-long skills.”
Alegent Creighton Health and the other CHI
facilities in Nebraska are now CHI Health.
“Our new name is a signal that we are moving
forward and positioned incredibly well, not only
to be able to improve the health of the communities we serve, but to change how health
care is delivered,” said Cliff Robertson, M.D.,
chief executive officer for CHI Health. “Patients
can expect the expert care that they’ve always
received with the same compassion right in their
own community.”
CHI Health is made up of nearly 15,900
employees, 15 acute-care hospitals, an academic
medical center, Level I trauma center, two
freestanding inpatient psychiatric facilities, a
Commission on Accreditation of Rehabilitation
Facilities (CARF) certified rehabilitation center,
an American College of Surgeons (ACS) verified
burn center and two networks of multi-specialty
clinics with nearly 200 locations in Nebraska,
southwest Iowa and northern Kansas.
Plans new for medical
complex unveiled
T
OGETHER WITH CREIGHTON UNIVERSITY
and community partners, CHI Health (formerly Alegent Creighton Health) unveiled plans
for a new medical complex where health care,
education and community will come together at
24th and Cuming streets.
“This is the future of health care,” said Cliff
Robertson, M.D., chief executive officer of CHI
Health. “The future demands that we work very
closely with our communities to design a model
of care that will meet their needs and keep people
healthy while educating providers of the future.”
The new 90,000-sq. ft. building will be a
medical home to people from across the metro
area offering outpatient, emergency and many of
the diagnostic services currently at CUMC.
New ophthalmology service
at Children’s
CHI Health is the new name
for regional health system
T
HE LARGEST HEALTH CARE network that
covers the Nebraska and southwest Iowa
region has come together under a new name.
C
HILDREN’S HOSPITAL & MEDICAL Center
has launched a new Ophthalmology
Clinic specializing in pediatric eye disorders.
Led by Donny Suh, M.D., clinical service chief
of Ophthalmology, the Children’s team will
screen and treat a wide range of pediatric eye
disorders including amblyopia, chalazion, congenital cataracts and glaucoma, conjunctivitis,
corneal abrasions, ocular injuries, strabismus
(pediatric and adult), and tear duct obstructions.
Dr. Suh is an associate professor with the
Truhlsen Eye Institute at the University of
Nebraska Medical Center. He completed his
pediatric ophthalmology and strabismus fellowship at The Wilmer Eye Institute at the Johns
Hopkins University School of Medicine and his
ophthalmology residency at The Eye Institute
at Medical College of Wisconsin. He received
his medical doctorate from Baylor College of
Medicine in Houston, Texas.
In addition to Dr. Suh, Children’s ophthalmology service includes an optometrist, an orthoptist,
an ophthalmic technician, and a pediatric nurse.
Surgery, when needed, will be performed on site
at Children’s Hospital & Medical Center. A newly
constructed, full-service optical shop is now
available in the Children’s Specialty Pediatric
Center at 84th Street and West Dodge Road.
Dr. Suh is actively involved with the Pediatric
Eye Disease Investigation Group (PEDIG),
which is sponsored by the National Eye Institute
(NIH). Some research studies are open for patient
enrollment.
New urology residency
announced
C
REIGHTON UNIVERSITY AND CHI Health
Alegent Creighton Clinic announced the
establishment of a urology residency program at
the university’s School of Medicine. The Urology
Residency Review Committee of the Accreditation
Council for Graduate Medical Education approved
the Creighton program in July.
Urology is a highly competitive specialty,
with currently 123 programs across the country
producing about 280 urologists a year. Currently,
the fact that more urologists are retiring than are
being trained and that the population is aging, it
is predicted that the U.S. will be facing a shortage
of urologists by 2020.
The new residency program is the fi rst
Creighton has added since 2005 and becomes the
16th medical specialty or subspecialty residency
or fellowship the University offers. The urology
program was approved for one resident each year
CAMPUS & HEALTH SYSTEMS update
for the four-year program. The director of the
program is urologist Larry Siref, M.D., and the
first resident will match in January 2015.
This is the fi rst residency to be located
primarily at the CHI Health Bergan Medical
Center, the future flagship teaching hospital in
the CHI network.
Robert Dunlay, M.D., dean of the School of
Medicine, said the urology residency brings
together the common goals of the University
and CHI Health in the areas of clinical, research
and educational excellence. “Urology is among
the top two or three most competitive residency
slots in the nation,” Dunlay said. “Creighton and
Alegent Creighton Clinic are excited to be among
that elite number and to be helping alleviate the
great need for urologists.”
This is the first major joint academic achievement at the School of Medicine in conjunction
with CHI Health Alegent Creighton Clinic.
Methodist earns 3-Star
rating from Society of
Thoracic Surgeons
M
ETHODIST HEALTH SYSTEM HAS been
recognized by the Society of Thoracic
Surgeons (STS) with a 3-Star rating for the outcomes of the open-heart program at Methodist
Hospital and Methodist Jennie Edmundson
Hospital.
The Society of Thoracic Surgeons has a
comprehensive rating system that allows for
comparisons regarding the quality of cardiac
surgery among hospitals across the country.
Approximately 10 percent of hospitals receive
the 3-Star rating, which denotes the highest
category of quality for the more than 1,000
programs that submit data.
The open-heart surgery performance of MHS
hospitals, known as the “STS CABG Composite
Quality Rating,” was found to lie in the highest
quality tier, earning MHS the 3-Star rating for
the period covering January – December 2013.
CABG stands for coronary artery bypass
grafting, a procedure to treat coronary artery
disease by improving blood flow to the heart.
According to the National Heart, Lung, and
Blood Institute, CABG is the most common
type of open-heart surgery in the United States.
“The 3-Star rating is the highest ranking given
by the STS to hospitals who submit data,” said
John Batter, MD, medical director of the cardiothoracic program Methodist Hospital. “These
outcomes give us feedback on our performance
and help us identify areas where we can improve.
Earning this rating is very much a team effort.
From the surgical team to the care teams on
the inpatient units, we all have to perform at a
very high level – resulting in excellent patient
outcomes and quality care.”
Founded in 1964, The Society of Thoracic
Surgeons is a not-for-profit organization representing over 6,800 surgeons, researchers
and allied health care professionals worldwide
who are dedicated to ensuring the best possible
outcomes for surgeries of the heart, lung, and
esophagus, as well as other surgical procedures
within the chest.
U.S. News again lauds The
Nebraska Medical Center
U
.S. NEWS & WORLD Report surveyed nearly
5,000 hospitals nationwide to come up with
this year’s list of Best Hospitals. For 2014-15, U.S.
News evaluated hospitals in 16 adult specialties
and ranked the top 50 in most of the specialties.
Just 3 percent of the hospitals analyzed for Best
Hospitals earned national ranking in even one
specialty.
The Nebraska Medical Center is ranked 36th
nationally for its cancer care, 29th for gastroenterology and GI surgery, 29th in nephrology, 31st in
neurology and neurosurgery, 41st in pulmonology
and 25th in urology. This is the best performance
for the hospital in terms of national recognition
in these rankings. The Nebraska Medical Center
was also high performing in six other specialties: cardiology and heart surgery, diabetes and
endocrinology, ear, nose and throat, geriatrics,
gynecology and orthopedics.
In addition to these rankings, U.S. News &
World Report ranked The Nebraska Medical
Center as the top hospital in the state.
“We are truly honored to be recognized as
a leader in so many different areas,” said Bill
Dinsmoor, CEO of the clinical enterprise that
includes The Nebraska Medical Center. “It’s a
reflection of the serious medicine and extraor-
dinary care our physicians and staff provide to
our patients every day.”
UNMC to join national
implant registry
M
ORE THAN SEVEN MILLION people in
the United States are living with an
artificial hip or knee according to a report given
at the annual meeting of the American Academy
of Orthopaedic Surgeons this year.
“Americans are living longer, more active
lifestyles and seek out ways to continue to do
so when faced with joint problems that a hip or
knee implant can solve,” said Curtis Hartman,
M.D., associate professor of orthopaedic surgery
and rehabilitation in the University of Nebraska
Medical Center College of Medicine.
In order to ensure the best clinical outcomes
for patients, national implant registries have
sprung up around the world to track surgical
techniques, which implants work and which
ones don’t, Dr. Hartman said.
UNMC and its hospital partner, The Nebraska
Medical Center, is in the process of joining the
American Joint Replacement Registry to begin
tracking how well implants placed in patients
are performing.
There are new implants coming onto the
market all the time, Dr. Hartman said. The
advantage of a registry is in knowing as soon
as possible which product performs the best or
has the highest failure rates.
“They all sound good and have promising
preliminary data or the FDA wouldn’t approve
them, but sometimes the best ideas don’t always
work,” Dr. Hartman said. “This really will help
orthopedic surgeons and patients understand which
implant is best for them on an individual basis.”
The most common causes for implant failure,
Dr. Hartman said, are loosening, infections,
dislocation and soft tissue damage due to an
immune reaction by the body to the materials
used to make the implant.
“In one case of a metal on metal hip implant,
it took ten years to figure out before a trend
emerged that led surgeons to cease using that
particular type of implant,” he said. “If we had a
registry we would have seen this happen sooner
and responded much more quickly.”
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