The Doctor is Deployed
Transcription
The Doctor is Deployed
MEDICINE in Oregon A publication of the Oregon Medical Association Policy • Community • Practice Spring 2010 The Doctor is Deployed Hack through the Regulatory Jungle with the Help of OMA Resources Special Message: Health Care Reform and the OMA Volume 3, Number 2 Spring 2010 POLICY COMMUNITY PRACTICE 14 Deployed PAGE The Doctor is By Carla McKelvey, MD 16 Healing the By Ryan James PAGE of Our Returning Heroes Also Inside 4 FROM THE PRESIDENT MEMBERSHIP MATTERS 6 SPECIAL MESSAGE Health Care Reform and the OMA By Peter A. Bernardo, MD 12 OMA ALLIANCE Alliance Aids Returning Vets 14 FEATURE The Doctor is Deployed By Carla McKelvey, MD 16 FEATURE Healing the Invisible Wounds of Returning Heroes By Ryan James Plus Diagnosing TBI in a PTS World 5 Upcoming events 7 New and reinstated members 8Hack through the regulatory jungle with the help of OMA resources By Jennifer Nordgaard 10 Committee Updates 21 IN THE OFFICE Smaller Clinics Are First in Line for HITEC Help By Ruby Haughton-Pitts 23 LEGAL BRIEFING RAC – It’s Here! By Gwen Dayton, JD By TriWest Healthcare Alliance 28 SPOTLIGHT ON Cooperation between Military and Civilian Forces in Disaster Response By Douglas Eliason, DO in Oregon Published quarterly by Oregon Medical Association 11740 SW 68th Pkwy, Ste 100 Portland, OR 97223 (503) 619-8000 • fax (503) 619-0609 www.theOMA.org • [email protected] Editorial Advisory Board Carla McKelvey, Physician Editor Monica Wehby Peter Bernardo John Evans Evelyn Ford Mike Crew (of counsel) OMA Staff Military and Medicine A Profile in Service MEDICINE Jo Bryson Betsy Boyd-Flynn Jennifer Nordgaard Ryan James Reina O’Beck Submissions We welcome and encourage our members to contribute to Medicine in Oregon. For more information, contact Betsy Boyd-Flynn at (503) 619-8000 or [email protected] Advertising & Design by LLM Publications, Inc. 8201 SE 17th Ave, Portland OR 97202 (503) 445-2220 • (800) 647-1511 fax (503) 655-0778 www.llm.com PLUS President | Linda Pope 3 0 3 1 3 6 Advertising Sales | John Garbett Snow Blackwood Joseph Madigan OMA MEDICAL-LEGAL HANDBOOK STAT NEWSLETTER CLASSIFIEDS On the Cover... This photo by Daniel Laury, MD, is of a palm tree fruiting in El Yunque Rainforest National Park in Puerto Rico. Graphic Design | Heather White © 2010 by the Oregon Medical Association. All rights reserved. No part of this publication may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopy, recording, any information storage or retrieval system, without permission from the publisher. From the President D John Evans, III, MD A Profile in Service Deployment to Iraq to serve, care for and resuscitate the men and women fighting for our country is an honor and a privilege to Lieutenant Colonel Michael “Mickey” Moneta, who R. MONETA’S FIRST DEPLOYMENT was in 1991, when he was sent to Saudi Arabia during the Gulf War. Most recently in Iraq from April– July 2009, Dr. Moneta served as a fight surgeon with the Indiana National Guard. On this deployment, Dr. Moneta moved closer to the front lines as an air ambulance flight surgeon. The air ambulance for Oregon Army National Guard is a Blackhawk Helicopter. The program is fairly new over the last few years, and it remains the decision of the flight surgeon to accompany or have the medic ride with the patient. Dr. Moneta participated in approximately a dozen evacuations where he determined that the life of the soldier would be best served by actively performing the resuscitation efforts himself. The crew of a Blackhawk consists of two pilots, a crew chief, a medic and a flight surgeon. The medic is a soldier trained in field resuscitation and can—under appropriate circumstances— intubate, administer fluids, resuscitate, apply compressive dressings and place chest tubes when indicated. The overriding goal for these crews is to improve the survivability of wartime trauma with aggressive treatment within the ‘golden hour’ after a trauma occurs. concluded his second deployment in 2009. John Evans, III, MD, is an anesthesiologist in private practice in Portland. 4 • Medicine in Oregon Dr. Moneta, with his nephew, who also served. Moneta was stationed at Camp Boehring where the population fluxuated from 5,000 to 25,000. His primary responsibility was to the injured soldiers being rescued. After that, he was the primary care physician for the flight crew and flight personnel. In the few moments of downtime, he pursued his lifelong passion: running. This was quite challenging since the daily temperature in April was around 100˚F, and in July, temperatures routinely were in the 130s. When going out on any mission, he would always be in full, long-sleeved combat gear. He and the other soldiers were constantly drenched in sweat, and drinking water to stay hydrated. Dr. Moneta is modest of his service, but unabashedly proud about the courage and dedication of the men and women he cared for in service to our country. Dr. Moneta has returned to the Orthopedic & Fracture Clinic in Portland. Upon his return, he had an Officer Evaluation Report and will be receiving a new title and assignment with the Oregon Army National Guard—he will become a full Colonel. Upon the retirement of the current Flight Surgeon (William Gutheim, MD, a urologist in Eugene), Dr. Moneta will accept the assignment of State Flight Surgeon. As such, he will supervise 12 MDs, 30 nurses and 200 medics. “Yes, we had a Starbucks.” UPCOMING events OMA Executive Committee Retreat May 22–23, Sisters This Oregon Army National Guard has seen action in Oregon in recent years. When the Nehalem River flooded in December 2007, Vernonia was isolated, running out of supplies, and the medical workers were exhausted. The Guard provided medical assistance for the Providence outpatient center. Dr. Moneta is just one of many Oregon physicians who serve in the Oregon Army National Guard. Among them are Lt. Col. Scott McAtee, MD, an orthopedic surgeon based in Salem; Major Mark Maddox, MD, is a surgeon in Bend who will be deployed to Iraq later this year (and is the incoming OMA Secretary-Treasurer); Col. Seth Izenberg, MD, is a trauma surgeon who has also been deployed to Iraq; Lt. Col. Jon Park, a family physician from Coos Bay, has been deployed to Afghanistan three times (see his story on p. 14). Dr. Moneta encourages all Oregon physicians to consider signing up for service to the men and women of the Oregon Army National Guard. OMA Board of Trustees Meeting June 5, 9am, OMA Headquarters OMA Executive Committee Meeting July 8, 4pm, OMA Headquarters OMA Alliance Retreat June 24–24, Village Green, Cottage Grove AMA House of Delegates/ AMA Alliance House of Delegates June 12–16, Chicago OMA Roster Inquiries Due June 15 Non-OMA Events OMA Headquarters 11740 SW 68th Pkwy, Ste 100, Portland (503) 619-8000 • www.theOMA.org Loss Prevention Course schedule and online registration are available at www.theOMA.org/lossprevention. Workshops For details, additional courses and online registration, visit www.theOMA.org/workshops. EHR Best Practice Series: EHR Selection and Implementation July 15, Noon–2:30pm, OMA Headquarters Medical Collections Workshop May 5, 9am–noon, OMA Headquarters May 7, 9am–noon, Bend Webinars Recover Audit Contractor Educational Webinar May 12, 1:30pm–noon Office for Civil Rights Auditing and Enforcement Webinar June 2, 10–11:30am Lane County Medical Society General Membership Meeting May 4, Hilton Eugene & Conference Center Oregon Academy of Family Physicians Annual Spring CME Weekend May 6–8, Embassy Suites, Downtown Portland Moneta’s “room” at his base. Spring 2010 • 5 Special Message Health Care Reform and the OMA March 30, 2010 Dear Colleague, Peter A. Bernardo, MD Immediate Past President, Oregon Medical Association The Oregon Medical Association is a decidedly non-partisan organization. We have to be. “Health care reform” has been a major local and national issue over the last three years. The Oregon Medical Association has been deeply involved in the discussion. The OMA has not supported any one proposal or bill. Rather, we have supported key principles including health insurance coverage for all Americans, supported broadly by society in a fiscally sound manner. We have pushed hard for resolution of the Medicare geographic disparities and correction of the SGR formula, as well as increased Medicaid reimbursement for all physicians. Covering the uninsured is important, but 35% of Oregon citizens already have difficulty accessing care in spite of having government-sponsored insurance. The OMA has highlighted the physician shortage in Oregon. Inadequate insurance coverage will not guarantee patients timely access to care, especially if we do not have enough doctors to provide the care. And finally, we have talked extensively about the costs of defensive medicine and the need for medical liability reform. The OMA has had plenty of opportunity to bring these principles to our political leaders. The state of Oregon has been working on many of the same issues that have been discussed in the national forum. The Oregon Health Fund Board, formed as a result of 2007 legislation, developed a plan for insuring all Oregonians. That plan came to the 2009 Legislature as HB2009. The formation of the Oregon Health Authority, the taxes on hospitals and insurers, and the expansion of the Oregon Health Plan coverage for children and the working poor are all a direct outgrowth of health care reform activity in Oregon. At the national level, we have had close interaction with our delegation. Senator Wyden has been working on national health reform legislation for over four years. We consistently partnered with him, providing input, particularly on workforce issues. Our Federal Delegation has been well educated by the OMA on the Oregon health care system. OMA leadership even met with each of them in Washington, D.C., the week before the final health care vote. Our message nationally has been clear: reform must be fiscally prudent, broadly supported by all of society, and must not disadvantage Oregonians. In particular, the Medicare reimbursement system must be fixed, and Medicaid cannot be expanded without infusion of additional federal dollars. There is no comprehensive fix of the Medicare system in the current legislation, though it does address one of our most important priorities, the fixing of the geographic payment disparities. We were working with our Congressional delegation to secure this important provision up until the day of the vote. As to the larger problem of the sustainable growth rate, there is no certainty of change. Most distressing, there is no substantive liability reform, only support for projects to test solutions. 6 • Medicine in Oregon Joining the Circle OMA thanks those members who have paid their dues, and welcomes the following new members and those who have reinstated their membership with the OMA. The Health care debate has been heavily politicized; it is hard not to view this issue in terms of Democrats vs. Republicans. The Oregon Medical Association is a decidedly non-partisan organization. We have to be. As an association, we must try to represent the wishes of our members. Yet we recognize that the passage of the health insurance reform legislation has divided the house of medicine. We have members who are hugely disappointed by the national reform because they feel it didn’t go far enough, and who would like to see a single payer or a national health care system. At the other end of the spectrum are those who see the current reform as a threat to private medicine and the first step on the road to socialism. In the middle is excitement over insurance for 32 million citizens, tempered by concerns about the size of this bill, the cost, and the unintended consequences arising from it. Many of our members are upset that we did not vigorously support, or oppose, health care reform. In deference to this lack of consensus, we chose to be neutral. It’s important to recognize: neutrality does not equate with inactivity. Our legislators understand our position, and also understand that we have, without fail, advocated for reforms that are good for all Oregonians. I hope that our position, and the work that the OMA has done remains important to our members no matter what their views on the final health care product. Politics is rarely pretty, but reforming our health care system is a political process. Through your membership you have a voice in the association and, in turn, a hand in crafting reform. Your participation in the Oregon Medical Association is needed, now more than ever. Sincerely, Peter A. Bernardo, MD Eric Adler, MD Fadi H. Akoum, MD Christopher L. Amling, MD Candye R. Andrus, MD Amaryllis Ar Raut, MD Jeanette A. Ardans, MD Fayez Bader, MD Tarunpreet Bains, MD Katherine A. Banker, MD Diana V. Barron, MD Sara Schleimer Batya, MD Naveen D. Bhandarkar, MD Gregory Blaschke, MD Amela Blekic, MD Rosanne L. Botha, MD Nathaniel Brigham, MD George A. Brown, MD Jennifer Burmeister, PA Florence B. Cappleman, MD Misty L. Carlson, MD Marty L. Caudle, PA James Chan, MD Kevin M. Chatham-Stephens, MD Andy Chen, MD E. Richard Clark, MD Gregory E. Conway, MD Nicholas D. Coppa, MD Elise K. Crockford, PA-C Jerry D. Crum, MD Kurtus Dafford, MD Rachel C. Danczyk, MD Kim-Hien Dao, DO Lara E. Davis, MD Scott Deaton, PA Matthew G. Drake, MD Daniel Dugi, Iii, MD Todd W. Ellingson, MD Alison J. Erde, MD Jeremy D. Fields, MD Jennifer File, DO Paul W. Flint, MD Graeme N. Forrest, MD Joel A. Friedlander, DO Brett Ian Gingold, MD Johanna R. Godell, PA Apoorva Gogna, MD Charles T. Gonsowski, MD Steven G. Gordon, MD Jennifer Anne Graslie, PA Anna Greschner, MD Gregory S. Grunwald, DO David L. Guarraia, MD Morgan Hakki, MD Kenneth R. Hanington, MD Steven L. Hersch, MD Andreanna J. Holmberg, PA Carissa L. Honeycutt, PA Vaishali Hotanalli, MD Saleh A. Ismail, MD Deani K. Iversen, MD Peter M. Jessel, MD Farahnaz Joarder, MD Christina Joseph, PA Brendan Kelly, MD Antony Kim, MD Valerie J. King, MD Virginia G. King, MD Laszlo N. Kiraly, MD Elena K. Korngold, MD Jeffrey La Rochelle, MD Michael P. Lang, MD Eric Langewisch, MD Michael Lavrsen, MD Haidy L. Lee, MD Kristen D. Lentell, PA-C Christine Li, PA David A. Lieberman, MD Hsinchen Jean Lin, MD Catherine J. Livingston, MD Cynthia Lodding, MD Lorinna H. Lombardi, MD Barbara Long, MD Alyssa Luddy, MD Kelvin Macdonald, MD Alessandro C. Mangili, MD Teresa M. Mangin, MD Babith J. Mankidy, MD Michael Lee Mara, MD Elizabeth Mccormick, MD Erin M. Mccune, DO Logan M. Mcdaneld, MD James S. Mcguire, MD Brayn M. Mcvay, MD Justin Meuse, MD Michael E. Mills, MD Karen E. Minzer-Conzetti, MD Andrea R. Moore, PA Jill Moore, MD Srinivas Morampudi, MD Jesus Moreno, MD Elizabeth Munro, MD Preetha Nair, MD Rahel Nardos, MD Eugene P. Nicholson, IV, MD Stephen L. Noble, MD Kathleen A. O’connell, PA Amanda E. Olson, MD Molly L. Osborne, MD Mansi Parikh, MD Anisha Patel, MD Jeanette C. Paysse, MD Richard Pierce, Jr., MD Idalee P.C. Posa, MD Kelly Probst, DO Samantha Quilici, PA Brian T. Ragel, MD Akhil Raghuram, MD Patrick H. Rask, MD Gerard S. Rebagliati, MD Regina-Maria Renner, MD Joel D. Rice, MD Robert L. Roberts, DO Jonathan Rogers, MD Kate M. Ropp, MD Andrew P. Rose-Innes, MD Kristina M. Ruybalid, MD Michael G. Ryan, MD David Wayne Sander, PA Robert L. Schelonka, MD Andrew Seaman, MD Raj T. Sehgal, MD Tatyana E. Shaw, MD Harry Sirounian, DO Stefan O. Spann, MD Pete H. Spitellie, MD Lynette Spjut, PA Stephen E. Spurgeon, MD Christian L. Stallworth, MD Christina L. Stroup, MD Kathleen Sullivan, MD Joselin D.L. Tacastacas, MD Robert L. Tatsumi, MD Esther Teo, MD Frederick Tibayan, MD Joanna Toews, MD Tamara E. Tuttle, PA-C Thomas Valvano, MD Philbert Y. Van, MD Roger D. Walker, MD Cara E. Walther, MD Ryanne Walther, MD Ajay Wanchu, MD Amy Wang, MD W. Kenneth Ward, MD Tammara L. Watts, MD Stephen Michael Weber, MD Stephen E. Whorrall, PA Metta Elizabeth Willey, MD Paula F. Wilson, PA Carmel Diane Wimber, PA Trisha Wong, MD Daisuke Yamashita, MD Kimberly K. Young, MD Katharine Zuckerman, MD Spring 2010 • 7 Membership Matters OMA Resources Can Help You By Jennifer Nordgaard HIPAA and Red Flags Rule Online Resources: The OMA has HIPAA policies, procedures and templates and Red Flags Rule resources available exclusively to members online. These free tools provide an overview of HIPAA policies and the Red Flags Rule requirements, as well as customizable templates and forms for physician offices. These tools help medical practices ensure they meet the HIPAA and Red Flags Rule requirements. OMA Education “To Go” The OMA offers recorded versions of some of our most critical education focused on regulatory updates. OMA members and staff can order audio or webinar recordings regarding HIPAA, Red Flags Rule, the new HITECH Act provisions and other recent regulatory updates to get the latest education at a time and location that’s most convenient for them. S EVERAL IMPORTANT REGULATORY REQUIREMENTS and programs went into effect in 2009 and early 2010, or will do so soon. These include: the HITECH Act (part of the American Recovery and Reinvestment Act of 2009), Red Flags Rule, HIPAA rule changes, and electronic health record incentives. New requirements have already had a significant impact on medical practices, and will continue to influence the practice of medicine over the next several years. To help physicians and their staff manage these changes, OMA offers a variety of resources and tools. See the sidebar below for contact information and how to access these and other resources. 99 New Member Benefit! Privacy and Security Compliance Audits and “Virtual Compliance Officer” Services OMA’s newest endorsed member benefit provider, Apgar and Associates, LLC, conducts customized privacy and security compliance audits for OMA member organizations at a discounted rate. These specialized assessments help practices comply with mandatory HIPAA Privacy and Security provisions, the new HITECH privacy and security requirements, appropriate industry privacy and security practices, Contact Information and Important Numbers 99Online HIPAA and Red Flags Rule Resources www.theOMA.org/hipaa • www.theOMA.org/redflagresources (Members need to login to access these pages; for login instructions, visit www.theOMA.org/Login.asp, or contact Jenn Webster at [email protected] or (503) 619-8000. 99OMA Education “To Go” Descriptions and order form available at www.theOMA.org/edtogo 99Chris Apgar, Apgar and Associates, LLC [email protected] • (503) 977-9432 • www.apgarandassoc.com 99OMA Webinar Information and Registration www.theOMA.org/workshops 99OMA Practice Roundtable For more information on upcoming Roundtables and to register, visit www.theOMA.org/practiceroundtable 8 • Medicine in Oregon and other federal and state privacy laws. Assessments also help practices reduce their legal and financial risk and adopt appropriate privacy and security safeguards based on the unique needs of the practice. For each audit, an expert from Apgar & Associates spends time getting to know the practice and delivers a complete report with findings and recommended actions. “Audits include interviewing practice staff, completing a short questionnaire and providing practice documentation, such as policies and procedures,” explains Chris Apgar, CISSP. “The hours vary depending on the size of the practice, but the tasks performed do not. Once the audit is completed, we will review the report and recommendations with the practice, and assist in prioritizing any outstanding compliance deficiencies.” See STAT for details about upcoming compliance auditor trips around the state. OMA member organizations are entitled to an eight percent discount for these privacy and security audits and “virtual compliance officer” services. 99 New OMA Webinars! 99 New Member Service! 99 New Member Resource! The OMA is Hosting Two Live Educational Webinars The first webinar will be held Wednesday, May 12, from 1:30–3 pm regarding the Recovery Audit Contractor program. This webinar will cover the RAC basics, CMS-approved issues up for RAC review, how to respond to a RAC audit, and one physician’s experience with a RAC audit. OMA Practice Roundtable Gwen Dayton, JD, OMA’s new General Counsel, will staff an OMA Practice Roundtable group composed of practice managers and others who wish to attend to talk about challenging legal and regulatory issues managers and physicians face every day. OMA Legal/Regulatory Briefings Developed in response to the numerous challenges physicians face when navigating through the many laws and regulations that affect the practice of medicine, OMA has created OMA Legal/Regulatory Briefings, an electronic publication designed to inform OMA members about recurring legal issues in the day-to-day practice of medicine. The second webinar, regarding the Office for Civil Rights Auditing and Enforcement: What to Expect, will be scheduled for later this summer. It will review audit and enforcement requirements, what to expect from the OCR, and who may be on the list to be audited. The webinar will also cover strategies practices can use to demonstrate compliance with the HIPAA Privacy, Security and Breach Notification Rules. See future issues of STAT for the date and time. Topics will include issues such as: managing a difficult patient; best practices related to disclosure of minor patient records; practical tips on how practices handle drug seeking patients and anything else on your mind. Legal briefings will be provided to support the discussion. These informal gatherings will occur approximately every six weeks, to be decided by the group. Don’t miss these briefings; be sure the OMA has your current e-mail address. Please send it to [email protected], and make sure “theoma.org” is on your safe senders list so our e-mails get through! Spring 2010 • 9 Membership Matters Committee Update IT’S VOLUNTEER SEASON AND WE NEED YOUR HELP. OMA has several committees that focus on specific tasks throughout the year. Access Committee Community Health Committee CONTACT Joy Conklin: [email protected] CONTACT Betsy Boyd-Flynn: [email protected] The OMA worked with the Oregon Health Care Workforce Institute on the Physician Economic Impact Study which estimates the economic impact that a single physician has on a local county’s economy in Oregon, which will reinforce the need to recruit and retain Oregon’s physician workforce. The Committee is anticipating the release of the 2009 Oregon Physician Workforce study, which is a combined effort with the Division of Medical Assistance Programs, the OMA and the Office for Oregon Health Policy and Research. The Committee also developed several new goals to pursue this year, which include advocating for: an increased supply of physicians (both primary care and specialty); interdisciplinary training; physician re-entry; and loan repayment (including funding the current initiatives or grants for future initiatives). This committee has helped with the effort to ban BPA from baby bottles, had members and staff advising public health planning groups during the H1N1 outbreak, and is working to advise physicians how to plan for and engage in disaster response efforts. Bylaws Committee CONTACT Gwen Dayton: [email protected] The Bylaws Committee is charged with making recommendations regarding changes to the OMA Bylaws and Functions Manual. In March, the committee recommended that the Board of Trustees consider amendments to the bylaws and the Functions Manual that are intended to streamline the bylaws and make the Functions Manual the document where day to day operational matters are discussed. The Bylaws Committee also voted to recommend revision of the Functions Manual to change the methodology for selection of the OMA Nominating Committee. 10 • Medicine in Oregon Finance and Audit Committee CONTACT Jo Bryson: [email protected] This committee is charged with reviewing the financial affairs of the OMA and providing recommendations to the OMA Executive Committee and Board of Trustees. Based on the committee’s recommendations, the OMA entered into a new relationship with Ferguson Wellman Capital Management to manage the OMA Employees’ Pension and Retirement Savings Plans beginning January 2010. In February, the committee began working with Ferguson Wellman on a new investment policy statement which was finalized in April. The annual audit of the association was just completed and the committee is scheduled to meet with auditors at Bashar and Johnson, P.C., to review the audit in May. Health Care Finance Committee CONTACT Joy Conklin: [email protected] This committee formed a prior authorization subcommittee to address issues with third party prior authorization organizations and will interface with the Health Leadership Task Force Evidence-Based Practices subgroup to address AIM operational issues affecting physicians and their staff; review AIM appropriateness criteria; look into the Independent Physician Review Board mentioned in AIM documentation; conduct a survey of OMA practice managers, if necessary; and review specific AIM data. The government affairs staff will continue to work with the HCFC on legislative concepts for the 2011 session; reviewing what did not pass in 2009 and determining what to prioritize for the next session. Institutional Accreditation Committee CONTACT Gwen Dayton: [email protected] The Institutional Accreditation Committee oversees the OMA’s accreditation of community hospitals, health systems, state specialty societies and other organizations serving primarily Oregon physicians as sponsors of continuing medical education under the Essentials Areas, Elements, Updated Accreditation Criteria and Policies approved by the Accreditation Council for Continuing Medical Education. Recently the committee approved initial accreditation for one new provider, Providence Medford Medical Center. Legislative Committee CONTACT Bryan Boehringer: [email protected] The committee has been busy with the February Special session, reviewing legislation and providing testimony on OMA’s agenda items. The committee is also working on compiling items for the 2011 legislative agenda, and will be following the implementation of health reform at the state and federal levels. Loss Prevention and Education Committee CONTACT Gwen Dayton: [email protected] The committee oversees the Loss Prevention Program. 2010 is the second in a three-year series of loss prevention workshops for the program. The Committee agreed to look at the curriculum and faculty to determine what changes we might make to further To help with one of these committees, please contact the staff person affiliated with that committee. E-mail the staff contact shown below or call the OMA office at (503) 619-8000. improve the program and best meet the needs of physicians, their allied medical providers and office staff. The committee is considering such ideas as offering specialty-oriented loss prevention programs. Membership Committee CONTACT Jen Nordgaard: [email protected] The committee reviewed sections of the OMA Bylaws related to membership and recommended language revisions around the definition and criteria for Life and Physician Assistant membership. The committee also helped develop a volunteer recognition and committee evaluation process for the OMA, and is exploring ways to better address the needs of hospital medical staff and employed physicians. In the coming year, the committee will be involved in developing and executing an overall membership recruitment and retention plan for the Association, and exploring ways to encourage member engagement and leadership development. Office Sedation Accreditation Committee CONTACT Gwen Dayton: [email protected] Effective August 1, 2007, an office or facility in which office-based surgeries are being performed was required to become accredited by August 1, 2009. When a physician starts performing office-based procedures in a new office or facility, the new office or facility must be accredited within one year of the start date of the office-based procedures being performed. The Oregon Medical Board recognizes the OMA Office Based Surgery Accreditation Program as an approved accrediting body for compliance. Since October of 2009, the committee has reviewed and approved accreditation status for four facilities providing conscious sedation. Two additional facilities are in the process of undergoing the accreditation review and three more have indicated an interest. Patient Safety Committee CONTACT Gwen Dayton: [email protected] This committee provides direction to the OMA regarding its patient safety and quality initiatives. The committee is considering ways to further engage physicians in patient safety and quality efforts, including participation in quality processes and systems. As a first step toward that goal, the committee is planning a workshop to occur commensurate with the OMA Fall Forum that will focus on physician leadership in patient safety and quality. Professional Consultation Committee CONTACT Gwen Dayton: [email protected] The committee is responsible for overseeing and monitoring the OMA Physicians Protection Program (the sponsored professional liability insurance program underwritten by CNA Insurance). Rates for the program will remain flat for 2010, and the program returned over $1.6 million in profit sharing to physicians in 2009. Technology Committee CONTACT Betsy Boyd-Flynn: [email protected] The committee is charged with addressing the OMA’s electronic connectivity with members and the public, the new and emerging issue of electronic health/medical records. As EHRs become an increasing focus on both the state and federal level, future committee work will focus on assessing and addressing the needs of members related to the adoption of health information technology. Spring 2010 • 11 OMA Alliance By Beth Irish, OMA Alliance President Alliance Aids Returning Vets I N MY FIRST COLUMN, I would like to share with you some of the areas of focus for community outreach that have engaged the Alliance throughout the past couple years, and will continue through the coming year. To engage with the considerations of the military and medicine in this issue, the starting point would be 2008– 2009. Our Alliance president at that time, Eva Germaine-Shimotakahara, began to promote awareness and education about issues surrounding our returning war veterans, especially concerns relating to post traumatic stress disorder and traumatic brain injury. A forum looking at “The Veteran Experience” was held in Coos Bay in conjunction with the Alliance Fall Session, 2008. In collaboration with Bay Area Hospital in Coos County, Eva organized a program filled with experts who educated us on subjects ranging from diagnosis and treatment of PTSD and TBI, as well as about local and regional resources for family support. Presenters included Dr. Scott Babe (OHSU), Dr. Lynn Van Male (Portland VA Medical Center), and Dr. James Calvert (2008 Oregon Doctor Citizen of the Year), who practices medicine in Klamath County. (See p. 16 for more on this topic). Through the ‘Adopt a US Soldier’ program, individuals, county alliances, and families adopted soldiers, with one school class in Coos County assuming responsibility for an entire unit in Iraq. Cards, letters, magazines, books and over 40 boxes of goodies were sent to Beth Irish is a retired critical care RN, living in Portland, sharing life and a home with husband Ed Irish, MD, a general surgeon. 12 • Medicine in Oregon soldiers who had no friends or family back home. Realizing that we all are motivated by that which touches us in a personal way, Eva and her husband Steven are the proud and honored parents of daughter Danielle, who serves along with her husband, McKenzie, in the U.S. Coast Guard. Being the parents of a soldier can be both a very proud and frightening time as my husband Ed and I (our son served in the US Army infantry in the 90s) and OMA Alliance Executive Director Pat Webster and her husband Monty (who currently have son in the U.S. Navy) can confirm. Regardless of our stand on war and/ or politics, we need to support our returning military men and women. This is, in fact, crucial to the very health of our society. Three very reliable web sites to consider in exploring resources for veterans and their families are: the VA home page at www.va.gov/portland which will allow for movement into the regional, as well as the national system; www.supportyourvet.org was founded by the Iraq and Afghanistan Veterans of America, in 2004 to enable one to “navigate the VA”, research “invisible injuries” (PTSD, TBI and related mental health issues) and information about the new, comprehensive “GI Bill”; www.woundedwarriorproject.org, has evolved into America’s foremost advocate for those who come home with physical, psychological and spiritual wounds from today’s wars. To learn more about the OMA Alliance visit www.theOMA.org or e-mail Pat Webster [email protected]. The Doctor is d e y o l Dep By Carla McKelvey, MD W HEN YOU SIT IN Dr. Jonathon Park’s office there is no doubt where his loyalty lies. His office—and also his big red pickup truck—is decorated with the symbols and memorabilia of the Army National Guard. He wears his pride in the military on his sleeve. Fort Drum, NY; Fort Pickett, VA; and Indian Town Gap, PA, to name a few. In the middle of it all, he completed his family practice residency in Erie, Pennsylvania. In September 2001, the world changed and the troops in the National Guard began playing a role that many had never anticipated. Lt. Col. Park though, never questioned the commitment he made. “I knew what I signed up for,” he says. He knew when he joined that he might be called into active duty, so when the first call came in 2004, he went without question. Park was born in South Korea and immigrated to the United States when he was six years old. His commitment to the military is a reflection of the debt of gratitude he feels for his adopted country. He joined as a fourth year medical student in Puerto Rico, also finding the financial assistance a boon. Life “over there” He initially enlisted with the anticipation of being out in a few years, but each time he re-enlisted. He enjoyed being the physician for other National Guard troops as they did their training and assignments at He was assigned to Patrol Base Volunteer which covered Sadr City in Baghdad and the Rusafa District. He was the only physician on the base and was responsible for maintaining the health of the troops—American, Iraqi, 14 • Medicine in Oregon and Coalition forces—and also was available to help local citizens. He was on call 24 hours a day for three and half months. The troops under his care were a “quick reaction force”. They responded to any attacks in the area they covered. Park says he would hear the trucks start up and “wonder and pray that they [would] come back.” Sometimes they would be gone for hours and sometimes for days. It was an emotionally stressful situation, according to Park, but eventually you “get used to it” and become conditioned to it. Routinely he would see facial trauma and barotraumas from the explosions of the IEDs. The worst situation he faced was when nine Iraqi soldiers were hit by an IED and brought to their patrol base. His job was to supervise a physician assistant and several medics to stabilize them. Medevac helicopters were able to transfer patients within five minutes to the main military hospital in Baghdad. “Military triage has gotten better with each war,” states Park. The mortality rate is significantly less than any other war but the morbidity is significantly higher. The body armor of the soldiers is a life saver, but the number of amputations is much higher. Stateside Support Back home, Park’s family practice at North Bend Medical Center is typical: elderly patients with multiple medical problems. His day is not filled with trauma or procedures like his time in Iraq or Afghanistan, where his patients in general were young and healthy. When asked about the contrast between his military and private practice, Park says, “in civilian medicine, you are limited by your training and the specialists available to you. But in military medicine you are expected to do it all. It is life and death for soldiers.” he returned, she was afraid of him and didn’t recognize him. With new video phone technology such as Skype, however, he feels he will be able to keep in touch better with her and his newborn son. The hardest part of the deployment is leaving his wife behind to worry about his safety, to take care of the bills, and raise the children. Robert Gerber, MD, one of Park’s family practice colleagues, states that when Park is deployed, in general his own call days are busier. Also he believes Park’s patients are more complicated and tend to take more time. However, Gerber states, “The greatest impact on my life with Jon gone is [simply] that he is gone! If ever I am busy with my kids, stressed out, over worked, out of time, Jon will step in without a moment’s hesitation and take some of my load…can’t replace a partner like that easily.” Park feels it takes a few weeks to get back to the routine when he returns home. “I initially feel out of place and detached— a certain estrangement,” said Park. He agrees that PTSD is a bigger issue but he believes that is a cultural difference. “Previous generations did not feel comfortable talking about it.” Now, screenings are done before and after each deployment. “Battle buddies” are encouraged to communicate with each other and to let commanding officers know of any issues. As he gets ready to deploy, he emphasizes that public support has made a huge difference to the troops. When overseas they receive cards and gifts. The support helps encourage soldiers to re-enlist, as he has. Even though he says that fighting an “asymmetric war where there are no fronts and the enemy is hiding in public” is extremely stressful, the satisfaction he receives from serving is adequate compensation. Carla McKelvey, MD, is a pediatrician in private practice in Coos Bay. She is the President-Elect of the OMA. Park was assigned to a second tour of duty for another three and a half months in Afghanistan in 2006. His practice was covered by his fellow family practice doctors as well as locum tenens physicians. This maintained his practice, and kept his employees paid. The military tries to compensate physicians by paying them a base salary, combat pay and additional pay based upon years of service and board certification. For a primary care physician, he felt the pay was sufficient. However, for a specialist such as an orthopedic surgeon, it might not be. In general, his patients have been loyal and supportive of his commitment. Every time he leaves for a deployment, he does lose patients, but not a significant number. As of April 10, Park was back in Baghdad providing care at a detention center. He has a daughter who is now almost four years old. The first time Spring 2010 • 15 Healing the Invisible Wounds of Our Returning Heroes By Ryan James O VER 1.7 MILLION U.S. SOLDIERS have been deployed in Afghanistan and Iraq since October 2001. While the nature of war means some troops will return home with physical wounds and scars, improvements in body armor and medical technology have led more service members to survive situations that would have been fatal in previous wars. In addition, today’s service members face an increased prevalence of “invisible” wounds in the form of mental health conditions and cognitive impairments resulting from combat trauma. PTSD and TBI The most common mental health and cognitive conditions identified in returning service members are post-traumatic stress disorder, severe depression and traumatic brain injury. The symptoms of PTSD, an anxiety disorder that often occurs after traumatic experiences, include flashbacks to terrifying events, hyper-anxiety, uncontrollable anger, severe depression and withdrawal. A comprehensive 2008 study by the Rand Center for Military Health Policy Research found that approximately 18.5 percent of troops returning from Iraq and Afghanistan report symptoms consistent with those of PTSD or depression, and the Department of Defense Task Force on Mental Health found that 38 percent of soldiers and 31 percent of Marines returning from 16 • Medicine in Oregon Iraq and Afghanistan have some level of psychological symptoms. Traumatic brain injury refers to an injury, blow or jolt to the head, caused by blast exposure, for example, that disrupts brain function. Mild cases of TBI can cause brief changes in consciousness or amnesia, while more severe cases can have a prolonged impact on cognitive function. Data from the Defense and Veterans Brain Injury Center indicates that 33 percent of patients needing medical evacuation to Walter Reed Medical Center for battle-related injuries in 2008 had TBI. Besides the immediate consequences of PTSD and TBI, these disorders can also impair productivity and be detrimental to relationships, and they have been linked to other psychiatric diagnoses, substance abuse and suicide. Barriers to Treatment The Department of Defense and the Department of Veterans Affairs have shown a commitment in recent years to better understanding and treating these conditions. The VA has nearly 200 specialized PTSD treatment programs, and every VA medical center treats veterans with PTSD. Nonetheless, while these conditions are becoming more common among our troops, they often go untreated. According to the Rand study, 57 percent of service members reporting a probable traumatic brain injury had not seen a physician for evaluation, and only about 53 percent of those meeting criteria for PTSD or major depression had sought treatment from a physician or mental health provider. Diagnosing TBI in a PTS World By TriWest Healthcare Alliance Diagnosing traumatic brain injuries can be complex, especially when some symptoms overlap with those of posttraumatic stress. Russell Jenna, MD, a medical director at TriWest Healthcare Alliance, notes that taking a thorough history of the patient could mean the difference between a proper TBI diagnosis and a misdiagnosis. “If a patient is complaining about feelings of agitation and isolation, but also mentions headaches, you could ask: ’Since you mentioned you served, did you suffer any injuries while deployed, or were you near an explosion?’” Jenna said. “You can’t necessarily put a stamp on TBI, but if you ask the right questions, the answers may be very good indicators that the patient may be suffering from TBI, as opposed to PTS.” Connection between TBI and PTS The Defense Centers of Excellence outlined the similarities and differences between PTS and TBI. According to the DCoE website, overlapping symptoms of the two include: • Insomnia, fatigue • Irritability, anger • Problems thinking and remembering • Mood swings, personality changes • Hypersensitivity to noise • Withdrawal from social and family activities However reports from the Center indicated that a TBI patient will also exhibit headaches, dizziness and vertigo, reduced alcohol tolerance and sensitivity to light. In a study published Jan. 31, 2008 in the New England Journal of Medicine, Dr. Charles W. Hoge, concluded PTS is strongly associated with mild TBI. In fact, about 44 percent of study participant soldiers who reported loss of consciousness from their injury also met the criteria for PTS. Dr. Blake Chaffee, vice-president of Integrated Health Services at TriWest, emphasizes that often, a patient may have both. TriWest TBI Program TriWest has a TBI Program specifically to help active duty TBI patients and their families. After diagnosing a patient with a TBI, a referral to this program in addition to the provider’s recommended treatment may greatly help the patient and their family. Anyone may refer a TBI patient to TriWest’s program by completing the TBI Program Referral Form. A fact sheet about the program is also available. For more information, visit http://tinyurl.com/TriWest-TBI. Resources, Continuing Education Two PTS continuing education opportunities are also available: • University of North Texas Posttraumatic Stress Disorder Seminar—A free online course (two CEU credits) in cooperation with the University of North Texas (UNT) Health Science Center at Fort Worth. It is offered for providers to better help TRICARE beneficiaries deal with post-deployment behavioral health issues. For more information, visit http://tinyurl.com/UNT-PTSD • PTS 101—A web-based PTS/trauma-related curriculum presented by the U.S. Department of Veterans Affairs. It is available on-demand for professionals who provide services to individuals who have experienced trauma. CE Credits are now available free of charge. Visit www.ptsd.va.gov and click on the ‘Providers and Researchers’ link Contact the TriWest TBI team at (866) 209-0390 or [email protected]. Spring 2010 • 17 This undertreatment has multiple causes. For one, service members—like the general population—often feel that having a mental health problem is a sign of weakness and may avoid seeking treatment. Furthermore, active duty soldiers may fear that seeking mental health services will have negative repercussions on their careers. Skepticism about the effectiveness of treatment and concerns about the side effects of medication also deter many from seeking help. Inadequate access to care is another leading reason that these disorders go untreated. The workforce shortage endemic in our health care system means there are not enough properlytrained mental health professionals to meet demand, and most of these professionals are concentrated in urban areas. This is true of the civilian health care system in addition to those operated by the DoD and the VA. Helping Our Heroes Get the Help They Need All of these barriers to treatment are complicated by our limited knowledge of PTSD and TBI. These conditions often go unrecognized by patients and health care providers alike, and lack of understanding is largely responsible for the stigma attached to these disorders. A better understanding of PTSD and TBI among health care and mental health providers, service members and the general public will begin to address this problem. The VA, various branches of the armed forces, and other groups have resources available online that identify the main causes, symptoms and treatment options for these disorders. Information is available for soldiers and their families as well as physicians and other health care providers. Soldiers inflicted with these “invisible” wounds should be encouraged to seek treatment, and until our health care systems can provide adequate access to care, other resources must be readily available for service members and their families when help is needed. Non-profit organizations, religious groups and community partnerships have stepped in to fill some of the void by providing support and counseling services to soldiers and their families. Thanks to these groups, resources are available throughout Oregon and across the country for service members suffering from depression, PTSD or TBI, as well as those needing other post-deployment support. Each new resource or program brings us closer to providing the men and women who have so bravely served our country with the level of support and treatment that they deserve. Ryan James is the Research and Projects Specialist for the Oregon Medical Association. He can be reached at [email protected]. Resources Available to Vets, Service Members, Families and Physicians Department of Veterans Affairs National Center for PTSD The VA provides service members, veterans and the general public fact sheets, videos and more to answer questions about PTSD, including information on VA treatment programs. Materials are also available to help health care providers assess and treat PTSD. For details, visit www.ptsd.va.gov. The Oregon Department of Veterans Affairs also has post-deployment resources at www.oregon.gov/ODVA/index.shtml. Point Man International Ministries PMIM, run by veterans from various conflicts, has focused on healing PTSD since 1984. PMIM offers counseling, group meetings, hospital visits, welcome home projects, community support and more free of charge. PMIM has a regional director in Newberg and Outposts all over Oregon. For details, visit www.pmim.org or call (800) 877-VETS (8387). Returning Veterans Resource Project NW The Returning Veterans Project is comprised of health care practitioners who offer free and confidential services to veterans, active duty service members and their families. Their website, http://returningveterans.org/providers.php, has information for service members and their families to help them select a health care provider as well as information to help providers get involved and volunteer their services. 18 • Medicine in Oregon Southwestern Oregon Veterans Outreach SOVO offers veteran-to-veteran PTSD counseling as well as referrals to professional counseling for veterans, service members and their families. SOVO also offers assistance and referrals for job training, housing, substance abuse and more. For details, visit www.sovo1.org. References For Further Reading Department of Defense Task Force on Mental Health. An achievable vision: Report of the Department of Defense Task Force on Mental Health. 2007. Falls Church, VA: Defense Health Board. Available at: www.health.mil/dhb/mhtf/ MHTF-Report-Final.pdf. Accessed March 15, 2010. Jaycox, Lisa H and Terri Tanielian, eds. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.2008. Arlington, VA: Rand Corporation. Available at: www.rand.org/ pubs/monographs/2008/RAND_MG720.sum.pdf. Accessed March 12, 2010. Rand Center for Military Health Policy Research. Improving Mental Health Care for Returning Veterans. 2009. Available at: www.rand.org/pubs/research_ briefs/2009/RAND_RB9451.pdf. Accessed March 12, 2010. U.S. Army Medical Department. Frequently Asked Questions: Traumatic Brain Injury. Army Medicine Website. 2009. Available at: www.armymedicine.army. mil/news/releases/20090225FAQtbi.cfm. Accessed March 15, 2010. In the Office Smaller Clinics Are First in Line for HITEC Help By Ruby Haughton-Pitts I N FEBRUARY 2010, OCHIN, Inc. was awarded $13.2 million in federal stimulus funds that will support Oregon’s Health Information Technology Extension Center. The center will be called O-HITEC with the purpose of providing qualifying Oregon primary care providers with education, outreach, and technical assistance to facilitate the successful implementation, and meaningful use of certified electronic health record technology. All of these efforts will be designed to improve the quality and value of health care delivered to Oregonians. Public and Critical Access Hospitals Community Health Centers and Rural Health Clinics Other settings that predominantly serve uninsured, underinsured, and medically underserved populations To achieve its goals, O-HITEC will leverage the proven abilities of its two lead partners—OCHIN, the lead grant applicant, and the Oregon Health & Sciences University, the foundational partner. They will also benefit from the combined experience of several independent provider associations, rural research networks, academic institutions, and technical partners. Partners OCHIN and OHSU were very fortunate to have professionals in their organizations who were ready to serve O-HITEC will work collaboratively with stakeholders throughout the state to provide and coordinate technical assistance and field support services to ensure that target providers meet the federal definition for “meaningful use” of their EHR system—required to receive up to $64,000 in federal incentives per provider. Priority will be given to primarycare providers (physicians and/ or other health care professionals with prescriptive privileges, such as physician assistants and nurse practitioners) in any of the following settings: Individual and small group practices (ten or fewer professionals with prescriptive privileges) primarily focused on primary care Spring 2010 • 21 HITEC Help, cont. O-HITEC will work collaboratively with stakeholders throughout the state as the key leaders of the O-HITEC effort. Clayton Gillett and Chip Taylor, MD will head the organization. Clayton Gillett, OCHIN’s past COO is serving as the Interim Director of O-HITEC. Prior to working for OCHIN, he was the project director for the implementation of EpicCare at Group Health Cooperative of Puget Sound, then worked as a consultant for a large independent firm providing strategic advice, implementation assistance and general consulting services to integrated delivery systems, MSOs, hospitals and large group practices. Clayton is certified in a number of EHR products and has worked with a variety of other practice management and EMR systems. Dr. Harry “Chip” Taylor was appointed medical director for O-HITEC in March. In this capacity, he works to implement electronic health records in primary care practices across Oregon and to assist those practices in transformation to meaningful use of their electronic health record. Dr. Taylor has an active inpatient and outpatient clinical practice. He joined the Department of Family Medicine at OHSU in 2008, and has extensive experience in quality improvement and practice transformation having implemented primary care teams, teambased patient safety training, open access appointing, clinical practice guidelines, telemedicine and EHRs in two regional health systems; first as the evidence-based healthcare coordinator at the headquarters for Navy Medicine, then as medical director for Naval Clinics Command Northeast United States and finally as executive officer, second in command, for the U.S. Naval Hospital in Sigonella Sicily. Chip and Clayton are pleased to serve as the leaders of O-HITEC and will be introducing new staff members very soon. to provide and coordinate technical assistance and field support services to ensure that target providers meet the federal definition for “meaningful use” of their EHR system—required to receive up to $64,000 in federal incentives per provider. The O-HITEC vision is to use health information technology as a catalyst to transform the delivery of primary care services to patients across the State of Oregon. Over the life of the grant, O-HITEC will focus on three overarching goals: Bringing EHR technology to providers in small clinics still using paper charts Helping those who have “adopted” EHR systems achieve true meaningful use Transforming the delivery of primary care In addition to bringing EHR technologies to providers, the O-HITEC will participate in the development of interoperable health IT and Health Information Exchange systems and services to provide clinicians, health systems, and policymakers the information pivotal to advancing the state of Oregon’s healthcare systems and infrastructure. O-HITEC will also collaborate closely with universities and community colleges to develop workforce-training programs designed to prepare more Oregonians for careers in this high growth sector of our economy. For additional information about O-HITEC, call (503) 943-2617 or e-mail [email protected]. Updates from O-HITEC will appear frequently in Medicine in Oregon and other OMA publications, as part of our efforts to keep members informed about the significant impacts of technology on their practices. 22 • Medicine in Oregon RAC T HE LONG AWAITED TIME is finally here: The Recovery Audit Contractors program has hit Oregon physicians. This article will discuss the legal parameters of the program, what the RACs may require of physicians and what recourse physicians have if they disagree with either the process or the conclusions of the RAC. Background The RAC program is part of the Medicare Modernization Act and seeks to identify and recoup Medicare underpayments and overpayments. To accomplish this goal, CMS has engaged private Recovery Audit Contractors for each region of the country. Oregon is part of Region D and our RAC is a company called HealthDataInsight, Inc. Legal Briefing It’s Here! by Gwen Dayton, JD improper payments among federal programs surpassed only by the Earned Income Tax Credit and Medicaid programs. It is also estimated that 3.9% of the Medicare dollars paid did not comply with one or more Medicare coverage, coding, billing, or payment rules. This equates to $10.8 billion in Medicare fee-for-service overpayments and underpayments. Of these numbers, 85% came from hospitals and 2% came from physicians. How are the RACs paid? RACS are paid a contingency fee for each overpayment and underpayment they find. The percentage varies across the country but in our region, Region D, HDI is paid a contingency fee of 9.49%. Many advocacy groups, including the AMA, have protested this contingency payment methodology, believing it imposes an improper incentive on the RACs to find overpayments. Indeed, at The RAC program began as a three year demonstration project involving just a few states. After this demonstration project ran its course, the program began to roll out across the country and reached Oregon last fall, when hospitals began receiving RAC inquiries. Physicians are next on the list and are now hearing from the RAC. CMS began the program because of concern that providers are receiving improper Medicare payments. Reportedly, $10.8 billion in improper Medicare payments were made in 2007, the third highest amount of Spring 2010 • 23 RAC, cont. the beginning of the program, the contingency fee applied only to overpayments but, due in large part of the protest from the AMA and others, this was changed to allow a contingency fee payment for underpayment as well. The RAC must return the contingency fee if the assessment is overturned on appeal. What claims are (and are not) subject to review? HDI may only review Medicare fee-forservice claims. They may not review improper payments that involve: 99 Services provided under Medicare Managed Care and prescription drug programs 99 Claims more than three years past the date of initial determination 99 Any claim paid on a date earlier than October 1, 2007 99 Claims where the patient is liable for an overpayment 99 Cost report settlement process 99 Prepayment review 99 Random claim selection, except in limited circumstances 99 Claims identified with a special processing number (i.e., claims involved with a Medicare payment demonstration) Types of reviews There are two types of review: automated and complex. An automated review is one where the overpayment is straight forward and does not involve a need for a person to review claims data or medical records in order to determine that an overpayment or underpayment has occurred. Complex medical reviews are less clear cut and require a manual review of the medical record. In Oregon, we are only seeing automated reviews at this point. 24 • Medicine in Oregon What this means is the RAC is not requesting medical records from physicians. That can be a good thing, but it also means physicians may not know that they are being reviewed by the RAC until they receive a demand letter indicating that the RAC has found an overpayment or underpayment. Complex reviews involving medical records requests will begin at a later date. For automated reviews (not involving a medical record review), the RAC uses proprietary automated review software algorithms to detect overpayments or underpayments. How many records may the RAC request? The limit for Oregon physicians has not yet been set for 2010. For 2009, the limits were: 99 Sole Practitioner: 10 records in a 45 day period 99 Partnership of 2–5 individuals: 20 medical records in a 45 day period 99 Group of 6–15 individuals: 30 records in a 45 day period 99 Large group (over 15): 50 records in a 45 day period How long do physicians have to respond to request for records? Physicians must respond within 45 calendar days to a RAC request for medical records, and may request an extension at any time prior to the 45th day by contacting the RAC. Can I charge for photocopying the records? It does not appear that physicians may charge for copying records. CMS has published Frequently Asked Questions on RAC, which identifies only inpatient settings and long term care as eligible for reimbursement for copying charges. When must the RAC complete review of medical records? The RAC will typically complete its review within 60 days of receipt of the records. What is the RAC reviewing for? In general, the RACs are allowed to look for the following type of improper payment: 99 Incorrect payment amounts 99 Non-covered services (including services that are deemed not medically necessary) 99 Incorrectly coded services 99 Duplicate services Within these generalized categories, the RAC will decide to focus on specific, targeted issues to review. Physicians may find a list of the issues on the “targeted” list on the HDI website at www.healthdatainsights.com. New issues must first be approved by CMS. Hospitals have found that certain issues on the list have received particular scrutiny. As of the date of this publication, the RAC has not identified specific physician issues that rise to the top of the list for review and indicates it is actively reviewing for all issues on the list referenced above. OMA will provide further information to physicians regarding any issues that are identified as priority issues as that information becomes available. What standards will the RAC apply? The RAC must adhere to Medicare regulation, policies, national and local coverage determinations and manual instructions when determining an overpayment or underpayment. If there is no clear regulation or policy, the RAC will look to accepted clinical standards of medicine that were in place at the time the claim was made. The RAC is bound by any Medicare RAC, cont. coverage, coding or billing policies and cannot develop their own standards. What is my recourse if I am assessed an overpayment that I do not believe is owed? During the demonstration period and as the program has rolled out across the country, many providers have appealed overpayment findings. Pay close attention to the timeframes discussed below; they are critical to a successful appeal. While it is not required by law, the OMA recommends that all appeal communications be done by certified registered mail to ensure documentation of the dates that appeal requests are sent and received. 15 Day Rebuttal Period. Contact the RAC within 15 days of the date of the demand letter to discuss the overpayment determination. Remember that this discussion does not qualify as a formal appeal and the timeframes discussed below continue to run. Formal Appeal Steps 1. Redetermination. Appeal to the fiscal intermediary within 120 days of the RAC’s initial decision. The FI will have 60 days to determine if the RAC findings should be sustained. Make this appeal within 30 days to avoid recoupment of the overpayment. Note that the appeal must be received and date stamped within 30 days, not just postmarked. 2. Reconsideration. Submit a request for reconsideration to the Qualified Independent Contractor within 180 days of the redetermination decision. In Oregon, the Qualified Independent Contractor is First Coast Service Options, Inc. The QIC has 60 days to make a decision. Note that the RAC will begin recoupment of the overpayment 60 days after the initial redetermination decision unless the physician first submits a request for reconsideration. 26 • Medicine in Oregon 3. Administrative Law Judge Hearing: File request within 60 days of receipt of reconsideration decision. The ALJ must issue a written opinion within 90 days of the date the hearing request is received. Minimum amount in dispute: $120 4. Medicare Appeals Council. Appeal to Departmental Appeals Board within 60 days of notice of the ALJ’s decision. 5. Federal Court Review. File within 60 days of receipt of the Departmental Appeals Board decision. Minimum amount in dispute: $1,130. When and how will the RAC take the money back? The RAC will first request that the physician provide a refund of the overpayment. If the physician is unable to provide a complete refund, a repayment plan can be created to repay the amount over time. If a physician does not repay the amount owing within 30 days, interest will accrue going back to the date of the demand letter. After 40 days, Medicare will begin withholding amounts from current and future claims until the full overpayment plus interest is recouped, or an extended payment plan is implemented. How to Contact HDI PHONE (866) 376-2319 Physicians may stop recoupment of an overpayment at several points in the process: 99 Send a request for redetermination within 30 days of the date on the demand letter 99 If the redetermination is not favorable, send a request for reconsideration within 60 days of the redetermination finding. What steps should I be taking now to get ready for a RAC audit? 99 Identify a person to be primarily responsible for responding to the RAC. 99 Go to the HDI website to give them the primary contact person for your clinic. 99 Be watchful for RAC demand letters. For an example of the demand letter, go to the RAC website at www.healthdatainsights.com. If the letter is not yet posted, expect it soon. 99 Develop a tracking system for responding to the RAC and appealing any overpayments. 99 Review existing charting to ensure are coding/documenting correctly. 99 Review available data to identify any patterns of errors. OMA is Here to Help Attend the upcoming OMA Recovery Audit Contractor Educational Webinar scheduled for May 12 from 1:30–3pm. [email protected] The webinar will cover: • RAC: The basics • The CMS approved issues up for RAC review • How to respond to a RAC audit: appeals and recoupment • One physician’s experience with a RAC audit ADDRESS To register, please contact Jenn Webster at the OMA at (503) 619-8000. 7501 Trinity Peak St Suite 210 Las Vegas, NV 89128 You can also contact Gwen Dayton, JD, OMA General Counsel, with questions or concerns about the RAC program or interactions with the RAC. Reach her at [email protected] or (503) 619-8117. FAX (702) 240-5510 E-MAIL In the Spotlight... Here Comes the Cavalry Cooperation between Military and Civilian Forces in Disaster Response By Douglas Eliason, DO L OCAL, LOCAL, LOCAL. All disasters begin and end locally. All communities and local officials are responsible before, during and after a disaster to ensure their communities are taken care of. This doesn’t mean that individual communities have no help available—indeed, they don’t have all the resources you might need in the case of a major disaster. Mobilizing Materials In the late 1990s the federal government recognized that disaster response was somewhat fragmented, and without a common language to ensure that we all responded in a similar way to disasters. Hence, the federal government developed the National Response Framework. The National Response defines how communities, States, Tribes and the Nation would respond in disasters, and develops a common language about resources needed in disasters, to ensure that a local responder gets what he needs. In a disaster, the response starts with a local incident commander at the site taking charge. When all available resources are utilized and still more are needed, the incident commander takes it to the next level and calls the governor, who issues a state disaster declaration. This allows the governor to reach into all the resources of the state to support the local disaster response. If the state is overwhelmed, the governor has the option to ask adjacent states to provide support 28 • Medicine in Oregon under the Emergency Management Compact. In the case of a large disaster that overwhelms the abilities of the state and adjoining states, the federal government will be called in to assist. The federal government, mostly through FEMA, can organize and provide many of the resources required by an incident commander. One of the most important resources that the federal government brings to a disaster is money. Once the President has declared a federal disaster, it opens up the purse of FEMA and all the resources of the federal government. Among those federal resources are the Armed Forces of the United States. Boots on the Ground So where is the cavalry? One of the resources that a state can use during a disaster is the National Guard of the state, which is the “well-ordered militia” referenced in the Constitution. Those who serve in the guard are under the command and control of the governor of the state, and come in at the state-level response. When the federal government mobilizes to provide support in a disaster, the Department of Defense, which regulates the uniform services of the United States, can call other armed forces up to support a local disaster. Where do the medical resources that we need in a disaster come from? Under the National Response Framework, medical response falls under emergency support function eight (ESF 8-Health and Medical Services). Emergency support functions are essentially a way to organize resources under common groupings. In Oregon, ESF 8 belongs to the Department of Human Services, and at the Federal level, ESF 8 falls under health and human services. At every level, these agencies are responsible for finding the medical resources the incident commander needs. So let’s put this all together: An earthquake and resulting tsunami rocks the town of Lincoln City. As the city and county responds, it becomes apparent that the hospital will not be able to function due to severe damage. Community physicians start helping out in whatever shelter they can find, but it’s clear to the county health department that they will need additional resources and an immediate call goes to the state. The governor, realizing the extent of the damage, declares a state emergency. The county health officer communicates the need to evacuate patients from the hospital to DHS at the State Emergency Operations Center. As there is now a declared disaster, the Oregon National Guard is mobilized and medical personnel begin to evacuate the Lincoln City hospital and long-term care facilities. Medevac helicopters start the immediate evacuation of intensive care patients to unaffected facilities in the Willamette Valley. Field ambulances from the 41st Infantry Brigade begin Community Health Disaster Preparedness Task Force In a disaster, the response starts with a local incident commander at the site taking charge. When all available resources are utilized and still more are needed, the incident commander takes it to the next level and calls the governor, who issues a state disaster declaration. evacuating noncritical patients along with ambulatory patients in any vehicle that can serve the purpose. The state health department remains in charge of the evacuation effort with the Guard, as the state agency supporting the emergency support function eight. If at any point the disaster exceeds the resources of Oregon, our governor can call the state of Washington under EMAC and asked for additional resources to help the evacuation. If these resources are not enough, the governor of Oregon can call the president to ask for a federal disaster declaration and then medical assets from Fort Lewis, Washington could be sent in support of an Oregon disaster and a Combat Support Hospital will be set up to provide for the medical needs of Lincoln City. What I did not describe in detail may be most critical: the local response. During the first several hours and days after an event, a local community is on its own. So it is incumbent on each of us to help our communities prepare to respond to a local disaster. This is an example of how a disaster response would work through integrating local, state and federal resources to include the National Guard of the State of Oregon and federal Department of Defense forces. Douglas Eliason, DO, is the leader of the Community Health Committee Disaster Preparedness Task Force. A family physician based in Salem, Eliason has also served as Deputy Surgeon for NORTHCOM, which integrates all branches of the uniform military to respond to domestic disasters, since 2006. Spring 2010 • 29 “How long should I keep patients’ medical records?” “How do I terminate the physician-patient relationship?” “What is ‘informed consent’?” These are just a few of the many medical-legal questions that doctors and their practice staff face every day. OMA has a resource that can help … the Medical-Legal Handbook! Updated every two years after the adjournment of the Oregon Legislative Session, the 2010–11 MedicalLegal Handbook is now available. It is an indispensable resource for physicians, medical office staff and others working within the health care field, answering important medical-legal questions about litigation and legal issues, records and privacy, office practice guidelines and more. Cost: $74.95 for OMA members $649.95 for non-members Order: www.theOMA.org/publications For more information, or if you have any questions regarding this resource, contact D’arcy Renhard at darcy@ theOMA.org or (503) 619-8000. STAT May 2010 • Volume 40, No. 5 INSIDE THIS ISSUE Special Legislative Session Report New OMA Officers Announced, OMA Alliance President Installed OMA Committee Volunteer Opportunities Available for Members Reminder to Prescribers and Pharmacies Updated 2010 PQRI and E-Prescribing Educational Products Now Available Online Got RAC questions? The OMA is Here to Help! Is Your Practice HIPAA Compliant? Is Your Practice Manager Receiving OMA E-mail Updates? Don’t Miss Out on Essential Education in Your Area this Spring It’s Not too Late to Order 2010 Coding Books 2010 Loss Prevention Schedule Available Online 2010-11 MedicalLegal Handbook Now Available Need a Venue for Your Summer Meeting or Special Event? March Drug Turn-In Event a Huge Success The Oregon Clinic Recognized by MGMA as a “Better Performer” in National Report Latest AMA Therapeutic Insights Covers Alzheimer’s Disease Member News In Memoriam Special Legislative Session Report On Thursday, Feb. 25, the Oregon Legislature adjourned Sine Die to mark the end of the 2010 special legislative session. The Legislators plugged a $183 million revenue shortfall without major cuts to programs. Adjustments to the budget included “fund sweeps” from agency reserves that totaled $51.7 million and reforming the state’s Business Energy Tax Credits program to find another $55 million. The Finance and Revenue co-chairs also identified an additional $20.8 million in budget requirements that they covered with $10 million from the “rainy day” fund and $23.5 million from an expected tobacco tax revenue increase to leave the state with a $12.7 million ending balance. While Legislators convened during the special session with the primary purpose of addressing the state’s budgetary concerns, over 200 bills were introduced and many were considered in just under four weeks. One of the most significant policy decisions to come out of this legislature was the constitutional referral of legislation to require annual legislative sessions. Legislation was introduced that would provide for annual sessions with preset limits on the length of the sessions; sessions during even-numbered years would be limited to 35 days, and those during odd-numbered years would be limited to 160 days. As this policy would require an amendment to the state constitution, it will be referred to voters. Other bills of note include: BPA Ban (SB 1032) The OMA supported a ban on Bisphenol A, an ingredient in some plastics shown to disrupt endocrine function, in products for children age three and under. The bill failed on the Senate floor on a split vote of 15-15. OMA and our various partner organizations will reintroduce similar legislation in 2011. Primary Care Loan Repayment (HB 3639) This bill, which established the Primary Care Student Loan Repayment Fund, passed with OMA support. Ultimately, given the current dire budget climate, there were no funds provided for the program, and details regarding funding still need to be addressed in future sessions. Noneconomic Damages Cap (SJR 46) The OMA supported this proposed constitutional amendment that would limit awards on noneconomic damages against health care providers, nonprofit corporations and public bodies to $1 million. No hearings were held for this proposal, and the bill remained in committee upon adjournment. The Judiciary Committee will hold hearings in May on the Rural Medical Liability Fund. Psychologists Prescriptive Authority (SB 1046) This bill sought to create a program for prescribing psychologists under the Oregon Medical Board. A task force made up of an equal number of members appointed by the OMB and the Board of Psychologist Examiners was created to design and set the standards for the program. Despite opposition from the OMA and other medical professional groups based on the training and oversight provisions in the bill and concerns for patient safety, the bill passed. However, the Governor announced on April 8 that he had vetoed the bill. The OMA would like to thank the many OMA members who traveled to Salem to testify, sent e-mail messages, made phone calls, and sent letters to newspapers in opposition to the bill. Physician Assistant Supervision Panels (HB 3642) This bill creates an alternative supervisory panel for larger groups of physician assistants. The OMA worked to include an amendment that requires the supervising physician organization to include the names of the panel and to name the primary supervising physicians in the practice plan. This bill passed and has been signed by the Governor. continues 31 STAT New OMA Officers Announced, OMA Alliance President Installed On Saturday, April 24, John Evans, MD, was installed as the 136th President of the OMA. Other officers of the OMA for 2010–11 are: Carla McKelvey, MD, Coos Bay, PresidentElect; William “Bud” Pierce, MD, Salem, Vice President; Mark Maddox, MD, Bend, Secretary-Treasurer; Peter Bernardo, MD, Salem, Immediate Past President; Mary McCarthy, MD, Portland, Speaker of the House; Frances Biagioli, MD, Portland, Vice Speaker of the House; David Shute, MD, Portland, Member-at-Large; Nancy Hutnak, DO, Baker City, Member-at-Large. Beth Irish, wife of Portland surgeon Ed Irish, MD, was installed as the 2010 OMA Alliance President. OMA Committee Volunteer Opportunities Available for Members OMA committees tackle tough issues ranging from health care finance to public health to legislative affairs—and much more. Committee participation is a great way to help shape the organization you belong to, while you build leadership skills. Members from anywhere in Oregon are welcome to participate in person or by phone. Here’s how to take the first step to get involved in the OMA: 1.Visit www.theOMA.org/OMAcommittees 2.Review the committee descriptions and find a committee on which you’d like to serve 3.Complete the online Committee Interest Form The OMA President will review interest forms and appoint members in May, and letters will be sent out in June confirming committee assignments. Reminder to Prescribers and Pharmacies OHP fee-for-service prescriptions now require prior authorization for non-preferred drugs On Jan. 1 of this year, DHS implemented an enforceable Preferred Drug List for physical health drugs and a voluntary PDL for mental health drugs that will affect Oregon Health Plan fee-for-service prescriptions. Prescriptions for drugs not included on the OHP’s physical health PDL require prior authorization, and on April 13, the OHP claims system began denying claims for non-preferred drugs without prior authorization. This requirement does not apply to mental 32 health drugs. Also effective April 13, the OHP claims system is denying claims for prescriptions that exceed a 34-day supply, except in circumstances where DMAP allows a 100day supply. An announcement from DHS with more details is available at www.theOMA.org/files/Preferred_Drug_List.pdf. A PDL pocket guide is also available for reference at www.oregon.gov/DHS/healthplan/tools_prov/pocket-guide. pdf. To submit a prior authorization request, call the Oregon Pharmacy Call Center at (888) 202-2126, fax your request to (888) 346-0178, or submit your request via the secure Provider Portal at https://www.or-medicaid.gov. Updated 2010 PQRI and E-Prescribing Educational Products Now Available Online CMS has announced the release of updated 2010 PQRI educational products, which are available at www.cms. hhs.gov/PQRI. CMS has recently updated or added PQRI Educational Resource Documents, EHR-Based Reporting Documents, PQRI Measures Documents, Qualified Registries, Qualified EHR Vendors and more. For a complete list of what’s new, visit http://tinyurl.com/ybxg5d9. Electronic Prescribing Incentive Program educational products have been updated as well and are available at www.cms.hhs.gov/ERxIncentive. Updates include 2010 eRx Educational Resource Documents and EHR-Based Reporting Documents. Details about these updates are available at http://tinyurl.com/ycxgzdr. Got RAC questions? The OMA is Here to Help! The OMA has received multiple member inquiries regarding the Recovery Audit Contractor program that ramped up in Oregon last August. Because it is important to address audit findings, the OMA’s Payment Advocacy department is available to assist members with RAC questions. Please contact Reina O’Beck at [email protected] or (503) 619-8000 with RAC inquiries. The OMA is also hosting a RAC educational webinar on May 12 from 1:30–3 pm that will cover: • RAC basics • CMS approved issues up for RAC review • How to respond to a RAC audit, including appeals and recoupment • One physician’s first-hand experience with a RAC audit To register, visit www.theOMA.org/workshops. STAT Noridian Administrative Services, Oregon’s Medicare Part B carrier, also has a recently-updated RAC information sheet available at www.noridianmedicare.com/provider/updates/ docs/RAC_information_sheet_B.pdf. The article was revised on March 9 to adhere to current CMS verbiage on the RAC program and includes clarification of the discussion period and the rebuttal process. Is Your Practice HIPAA Compliant? New OMA member benefit can help Apgar & Associates, LLC, the OMA’s newly-endorsed member benefit provider, is conducting privacy and security compliance assessments this spring for medical practices throughout the state. The assessments will help practices comply with the HIPAA Privacy and Security rules, the new HITECH privacy and security requirements, and other federal and state privacy laws, as well as help practices reduce their legal and financial risk. Assessments are being scheduled for the following areas: • Roseburg/Grants Pass/Medford: The week of May 3 • Pendleton/Baker City/La Grande: The week of May 17 Appointment slots are limited, so schedule your assessment today! OMA member organizations are entitled to an eight percent discount on these assessment services. Discounted packages are available for smaller practices, and custom pricing is available at a per-hour rate for practices with 10 or more practitioners and/or 45 or more employees. For more information and to schedule an assessment, contact Chris Apgar, CISSP, at [email protected] or (503) 977-9432. Is Your Practice Manager Receiving OMA E-mail Updates? Did you know that your practice manager can receive the same electronic communications as you? If not, they may be missing crucial information on regulatory issues, HIPAA rules, educational programs and much more! Be sure to inform your practice manager about this service and ask them to visit www.theOMA.org/pmdistribution to fill out a form to begin receiving OMA news. Contact Jennifer Quisenberry at [email protected] or (503) 619-8000 if you have any questions. Don’t Miss Out on Essential Education in Your Area this Spring Details about the OMA’s 2010 workshops as well as webinars and “Education to Go” programs are available online at www.theOMA.org/workshops. Don’t miss out on these valuable learning opportunities taking place around the state this spring. It’s Not too Late to Order 2010 Coding Books 2010 Coding books and other AMA publications are available to OMA members and their staff at discounted prices. Visit www.theOMA.org/publications and scroll to the bottom of the page for an order form. If you have any questions, please contact Jennifer Quisenberry at [email protected] or (503) 619-8000. 2010 Loss Prevention Schedule Available Online The OMA’s Loss Prevention programs are open to all physicians and allied health care professionals to provide training and resources to help avoid malpractice claims and to provide assistance in case such a claim should arise. The Loss Prevention workshop schedule for 2010 is now available on the OMA website. Visit www.theOMA.org/lossprevention for course details and online registration. 2010-11 Medical-Legal Handbook Now Available The latest edition of OMA’s Medical-Legal Handbook is now available! Updated every two years after the adjournment of the Oregon Legislative Session, the Medical-Legal Handbook is an indispensable resource for physicians, medical office staff and others working within the health care field. This guide answers important medical-legal questions about litigation and legal issues, records and privacy, office practice guidelines and more. The handbook is $74.95 for OMA members and $649.95 for non-members. An order form is available at www.theOMA.org/publications. For more information, or if you have any questions regarding this resource, contact D’arcy Renhard at [email protected] or (503) 619-8000. continues 33 STAT Need a Venue for Your Summer Meeting or Special Event? Host your event at the OMEF Conference Center and receive a discount! Planning a board meeting, staff retreat or special occasion this summer? Consider hosting your next event at the OMEF Conference Center! Our full-service facility features outstanding cuisine; professional, friendly catering staff; excellent multi-media equipment and expert assistance with catering options, room set-up and technological needs. OMA members who hold a meeting or event at the Conference Center during the months of June and July will receive a 50 percent discount on their room rental. To schedule your next meeting or event, contact Ron Costa, Executive Chef, at [email protected] or Steven Waggoner at steven@theOMA. org, or call (503) 619-8111. March Drug Turn-In Event a Huge Success On March 13, sites around the state took part in a drug turn in event organized and sponsored by the OMA Alliance, under the leadership of Leanna Lindquist, who was the Alliance President at the time, along with Community Action to Reduce Substance Abuse, Oregon Partnership and other community groups. The event was very successful with 29 collection sites statewide. All told, approximately 2,400 people turned in nearly two tons of expired or unwanted medications from as far back as 1936. The street value of controlled substances collected in Portland alone is estimated to be $57,540. The collection and proper disposal of these drugs will greatly reduce the impact of drug abuse and improper drug disposal on our communities and the environment. A similar nationwide event is currently in the works for November. The Oregon Clinic Recognized by MGMA as a “Better Performer” in National Report The Oregon Clinic, one of the largest private specialty physician practices in the state, has been recognized as a “better performer” in the Medical Group Management Association’s Performance and Practices of Successful Medical Groups, a 2009 report based on 2008 data. The Oregon Clinic was recognized for superior operational performance compared to similar medical group practices nationwide in several categories, including productivity, capacity, and staffing for surgical and non-surgical specialties. 34 Latest AMA Therapeutic Insights Covers Alzheimer’s Disease The American Medical Association has announced the release of “Management of Alzheimer’s Disease,” the latest AMA Therapeutic Insights newsletter. AMA Therapeutic Insights is a free online newsletter written by top disease experts in collaboration with the AMA. One disease condition is highlighted each issue, featuring state and national prescribing data and evidence-based treatment guidelines. AMA PRA category 1 credit™ is also available. This issue looks at the use of memory enhancing medications on patients suffering from Alzheimer’s disease, which affects approximately 5 million Americans, accounting for 60–80 percent of all dementias in the United States. Visit www. ama-assn.org/go/therapeuticinsights to read this issue and previous newsletters. Member News Jonathan Hill, MD, and Dana Gray, PA-C, one of the founding members of the OMA’s Physician Assistant Section, have won the Physician-PA Partnership 2010 Paragon Award. This is a national award from the American Academy of Physician Assistants and is the highest recognition given to AAPA members who have distinguished themselves in service to patients, the community and the PA profession. An awards ceremony will take place in late May. Brad Bryan, MD, has received a three-year appointment as Cancer Liaison Physician for the cancer program at St. Charles Medical Center in Bend. An integral part of cancer programs accredited by the American College of Surgeons’ Commission on Cancer, Cancer Liaison Physicians spearhead CoC initiatives in their respective cancer programs and facilitate quality improvement initiatives, among other duties. In Memoriam The OMA offers its condolences to the families of members who have passed away: Roy L. Swank, MD, Portland, Nov. 16, 2008, member since Oct. 1955. STAT 35 OMA Classifieds Physician Openings VIEW THESE CLASSIFIEDS ONLINE or PURCHASE AN AD at: www.OMAclassifieds.org Physician Openings FAMILY PRACTICE INTERNAL MEDICINE GRANTS PASS, OREGON Seeking 2 BC/BE Family Practice physicians to join 3-physician FP Department. Physician-owned, financially strong, multi-specialty group of 26 providers with a 60 year history. 4 day work week and 1:8 weekday and weekend call. Obstetrics is optional. First year salary guarantee, plus an incentive bonus and moving allowance, with partner consideration after first year; located on hospital campus. There are many cultural events and recreational activities in this beautiful community and region that serves 85,000. (Not a J-1 Opportunity) Send CV and letter of interest to: Grants Pass Clinic, Attn: Susan Sartain, Human Resources Director, 495 SW Ramsey Ave., Grants Pass, OR 97527. Ph 541-472-5500 Fax 541-472-5671 Email [email protected]. Visit www.grantspassclinic.com GRANTS PASS, OREGON Seeking 2 BC/BE Internists to join 12-physician IM department. 4-day work week and a 1:6 weekend call. Physician owned, financially strong, multi-specialty group of 26 providers with a 60 year history. First year salary guarantee, plus an incentive bonus and moving allowance, with partner consideration after first year. Newly constructed clinic located across from hospital. There are many cultural events and recreational activities in this beautiful community and region that serves 85,000. (Not a J-1 Opportunity). Send CV and letter of interest to: Grants Pass Clinic, Attn: Susan Sartain, Human Resources Director, 495 SW Ramsey Ave., Grants Pass, OR 97527. Ph 541-472-5500; Fax 541-4725671; Email [email protected]; www.grantspassclinic.com ZOOMCARE IS EXPANDING! Do you love medicine but are tired of the dysfunction and diminishing returns? If so, ZoomCare is offering a new future. ZoomCare may be the perfect position for the outstanding, experienced Physician. We practice a scope of care called Everyday Care focused on illnesses, injuries and preventive care. We operate a sophisticated modern environment with strong technical tools and an excellent clinical support structure. ZoomCare Physicians build neighborhood practices in a sustainable environment supported by a high-performance organization. ZoomCare offers Physicians compelling economic and quality of life opportunities: no call, no late nights, and a healthy pace building up to three patients per hour. ZoomCare is expanding. Full-time available; limited part-time available. Email [email protected] to submit your CV or to learn more about this opportunity. Neighborhood locations include Alberta, Sellwood/Westmoreland, PDX Airport area, and Tualatin/Tigard. GREAT FAMILY MEDICINE OPPORTUNITY for BE/BC physician to join a non-OB independent group practice in the desirable AlamedaIrvington area of Portland, Oregon. Well established 4 doctor/1 NP single specialty group with Electronic Medical Records, Lab and digital Xray on-site. Four day work week, 100% office based with excellent professional staff, facilities and light call. Very collegial and supportive atmosphere; group practice experience is a plus. Competitive salary, future partnership available if desired, and excellent benefits. Inquire by contacting our Administrator, Keirene Adams, at our office, 503-288-0083; her cell phone, 360-772-2734; or email at Keirene@ comcast.net. GENERAL PRACTICE PURE PATIENT CARE AT CHAS— At Community Health Association of Spokane (CHAS), we believe doctors should practice what they are passionate about: serving patients and the community. We are looking for physicians to join our great team! Enjoy a quality life/ work balance in Spokane, Washington and excellent benefits including: competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment site and more. Experience pure patient care at CHAS. To learn more about physician employment opportunities, contact April Gleason at 509-710-8046 or [email protected]. IT’S POSSIBLE TO make a good living AND a good life! Kittitas Valley Community Hospital in Ellensburg, Washington is located in a beautiful university town on the sunny side of the Cascade Range, easy driving distance to Seattle, with excellent recreational access. Well established IM hospital owned clinic offers competitive salary, outstanding productivity bonus, CME allowance, relocation, negotiable loan repayment program & great benefit pkg, including 10% Pension Plan! Hybrid position available for candidates interested in outpatient and Hospitalist combo! BE/BC send CV to Julie Johnson, [email protected]; fax 509-933-7529. OCCUPATIONAL MEDICINE CHAIR NEUROBIOLOGY RESEARCH LEGACY RESEARCH, part of Legacy Health in Portland Oregon, is currently recruiting for the Director and Chair for the Robert. S. Dow Neurobiology Laboratories. The Chair will be responsible for providing the leadership to ensure the development and support of the program, within the neurobiology areas of expertise and interest that also achieves and maintains national and international recognition and is supported by extramural grants and contracts. The endowed Robert S. Dow Neurobiology Laboratories were established in 1999 and have a current focus on the molecular and cellular mechanisms of neuronal injury and repair and includes a multi-disciplinary team of scientists with expertise in neuroscience, molecular biology, physiology, pharmacology and proteonomics. Led by P. Ashley Wackym, MD, Clinical Vice President of Research, Legacy Research supports clinical research and outcomes research across most medical disciplines. There is a more focused discovery-based basic research effort in the areas of vision research (glaucoma and retina), neurotology (hearing and balance), stroke, epilepsy, biomechanics, and oncology. There are also surgical education and research programs in the areas of endoscopic surgery, robotic surgery, and microsurgery within the fields of burn care, cancer, diabetes, neurotology, otolaryngology, ophthalmology, orthopedics, surgery, transplantation, trauma and women’s health. The Legacy Clinical Research and Technology Center is based in a 158,000 sq. ft. facility where surgical education and a wide range of clinical, laboratory-based and pre-clinical research activity are concentrated. The Research Center is committed to an ambitious agenda that will lead to improving the health and quality of life of our patients and the community at large. The ideal candidate should have a doctoral degree (MD, PhD, or equivalent) and 10 to 15 years of leadership experience in a neurobiology research program with broad international and peer recognition; leadership VIEW THESE CLASSIFIEDS ONLINE or PURCHASE AN AD at: www.OMAclassifieds.org Physician Openings OCCUPATIONAL MEDICINE of a multidisciplinary team; and evidence of mentorship. For consideration for this position, please send a CV to Vicki Owen at vowen@ lhs.org. If you have questions, please contact Vicki at 866-888-4428, ext. 6. AA/EOE Other Opportunities PHYSICIAN ASSISTANTS LOOKING FOR A NURSE PRACTITIONER or Physician Assistant to work with three other providers in the Stayton/Jefferson areas–family practice clinic with no OB. This opportunity can be either full-time or part-time. Call is just phone calls every third week. Full-time is 4 days per week. Send resumes to msmith@ santiamhospital.com. PRACTICE ADMINISTRATORS BOOKKEEPER/MANAGEMENT BUSY DERMATOLOGY CLINIC: Southwest Portland area, looking for a full time A/R person with some management skills. Responsibilities: prepare and post daily insurance payments, appeals, batch credit cards, balance and run reports. Knowledge of CPT and ICD-9 codes helpful. Also must learn the daily routine of how the office runs and able to help the front desk when needed. There will also be some management when the office manager is not available. Benefits include 401K and Profit Share, Health Insurance and FSA. Please fax resume to 503-244-5963. Office Space SUB-LEASE AVAILABLE IN NW PORTLAND starting July 1st, 2010. GREAT PARKING! Two suites are available–main suite 4459 sq. feet, 2nd suite 2180 sq. feet. Both newly remodeled. Main suite used for clinical floor with 16 exam rooms, 7 offices, reception and wait area. 2nd suite used for administration. Please contact Kate Othus, MHA at kate@ portlanddermclinic.com or 503-445-2133. MEDICAL OFFICE OPPORTUNITIES: Lake Oswego, Beaverton, Providence Milwaukie Campus, Portland, Hillsboro, Tualatin; TIs, parking, and signage. Contact Marcele, KLM, 503-201-0833. EXCELLENT OPPORTUNITY FOR NEW or established psychiatrist in the NW area of Portland, Oregon. Collegial affiliation of seven independent psychiatrists practicing psychotherapy has office space available for like minded clinician. Benefits include referrals, support staff and reasonable overhead. Contact Dr. David Turner 503-276-1292. Seeking Employment PHYSICIANS SEEKING INTERNIST POSITION: I am a Harvard trained internist who has had a very successful career in the Boston area. I am active in the MMS and the AMA and am a past president of my district medical society. I have particular interests in clinical nutrition and men’s health. I am interested in relocating to the west for family reasons. I currently practice in a medium sized group affiliated with Partner’s Healthcare in Wellesley and am an assistant clinical professor at Tufts University. Email: [email protected], cell: 617-852-0854 MEDICINE in Oregon Volume 3, Number 2 • Spring 2010 11740 SW 68th Pkwy Portland, OR 97223 Address Service Requested