Post on 09-Mar-2016
description
A Publication of the Metro Omaha Medical Society bull wwwOmahaMedicalcom
MarchApril 2013 bull USA $195
When Nature Leaves Its Calling Card
ALSO INSIDEA Team EffortHow Bergan Staff Responded When 1975 Tornado Hit
Ready If Necessary OMMRS to React Should Disaster Strike
Minimizing Down TimeAccessing Patient Records after a Disaster
nebraskabluecomBlue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association
healthy NebraskaWorking with you for a
4 Physicians Bulletin MarchApril 2013
wwwsaint judehospiceorgWhere Love and Healing F low
ldquoLove one another as I have loved yourdquo John 1334
A Catholic Hospice serving all people according to the directives of the Church on end-of-life care
For More Information 4026094818 or 18889801226
member benefitsFOR THE PASSIONATE GOLFER
Pure air clear blue skies and endless grass covered sand dunes stretching unobstructed for miles in every direction Rugged serene untarnished The Nebraska Sand Hills is the finest golf country in the world This book tells you about the magnificent golf courses that have created a golf trail in the Nebraska Sand Hills
To Order Call (402) 884-5995 wwwGolfintheNebraskaSandHillscom
$2995
MarchApril 2013 Physicians Bulletin 5
Did you Know
MOmSNmA memberShip beNefitS phySiciANS in a variety of ways ndash
everything from legislative representation access to health and dental plans designed for physicians and access to a variety of personal and medical practice products and services to save you time and money
Here is one of our membership benefits
reduce your total cOpic
premium by up to 10 percentMembers with COPIC medical liabil-
ity insurance receive an automatic 5 percent premium reduction
Combine it with another 5 percent reduc-tion for participating in risk manage-ment education and save even more
Contact Kristin Stepien director of sales at COPIC at (800) 421-1834or kstepienCOPICcom for more
information on the premium credit or a premium indication
For a complete list of membership benefits
visit wwwomahamedicalcom
Not currently a MOMSNMA member but would like to start
taking advantage of our many membership benefits
Apply for membership online at wwwomahamedicalcom or
complete the membership applica-tion on page 36 and return it
Contact Laura Polak at the Metro Omaha Medical Society if you have any
questions ndash phone (402) 393-1415 or email lauraomahamedicalcom
MOMS Foundation
7906 Davenport St
Omaha NE 68114
402-393-1415
The Metro Omaha Medical Society
Foundation identifies and provides
support to community priorities where
physician involvement can
make a difference in improving the
health of the Metro Omaha Community
6 Physicians Bulletin MarchApril 2013
thiS issue Marchapril 2013
f e a t u r e s d e p a r t m e n t s 19 COVER When Nature Leaves
Its Calling Card
20 ldquoProud of the Medical Profession that Dayrdquo Bergan Mercy and the 1975 Tornado
22 Ready If Necessary
24 lsquoWill You be Readyrsquo HIPPA and Your Liability
27 Minimizing Down Time Accessing Patient Records After a Disaster
10 Editorrsquos Desk Community Leaders + Physicians = Greater Understanding
12 NMA Message Your Dues Your Association
14 Legal Update HIPPA Omnibus Rule Modifies What Constitutes A
Reportable Breach of Protected Health Information
15 Young Physician Report The Glamour of Medicine
16 Clinical Update Top Ten Tips for Prescribing Pain Medication
29 MOMS Coming Events
30 MOMS Events
32 Member News
34 Campus Update
37 New Member Update
MarchApril 2013 Physicians Bulletin 7
Wealth Management Personally Delivered
spend time with them
wwwbonnettwmcom
14710 West Dodge Road 203Omaha NE 68154
(402) 556-8858
Leave your wealthmanagement to usItrsquos what we do
Learn about our approach Call today
Securities offered through Securities America Inc member FINRASIPC Jerome P Bonnett Jr CFPreg ChFCreg Registered Representative Advisory services offered through BWM Advisors LLC Jerome P Bonnett Jr Investment Advisor Representative BWM Advisors LLC (dba Bonnett Wealth Management) and Securities America companies are unaffiliated
8 Physicians Bulletin MarchApril 2013
NOvemberDecember 2012 vOLUme 33 NUmber 6
A Publication of the
Metro Omaha Medical Society7906 Davenport St bull Omaha NE 68114
(402)393-1415 bull wwwomahamedicalcom
OfficerSPresident | Marvin J Bittner MD
President-Elect | Debra L Esser MDSecretary-Treasurer | David D Ingvoldstad MD
Past President | Pierre J Lavedan MDExecutive Director | Diane Parsons
eXecUtive bOArDMarvin Bittner MD Debra Esser MD
David Ingvoldstad MD Pierre Lavedan MD
Mohammad Al-Turk MD Jane Bailey MD
Lori Brunner-Buck MD David Filipi MD
Harris Frankel MD Sherrill Murphy MD James Newland MD
William Orr MD Laurel Prestridge MD
William Shiffermiller MD Gamini Soori MD
Jeffry Strohmyer MD
eDitOriALADvertiSiNG StAffPublisher | Omaha Magazine LTD
Editor | Marvin Bittner MDArt Director | John Gawley
Senior Graphic Designer | Katie AndersonJunior Graphic Designer | Paul Lukes
Director of Photography | Bill Sitzmann
advertising sales Todd Lemke bull Sandy Besch bull Greg BrunsGwen Lemke bull Gil Cohen bull Alicia Smith bull
Vicki Voet bull Paige Edwards bull Jessica Linhartfor advertising information
402-884-2000
Physicians Bulletin is published bi-monthly by Omaha Magazine
LTD PO Box 461208 Omaha NE 68046-1208 copy 2012 No whole
or part of contents herein may be reproduced without prior permission
of Omaha Magazine or the Metro Omaha Medical Society excepting
individually copyrighted articles and photographs Unsolicited
manuscripts are accepted however no responsibility will be assumed
for such solicitations Omaha Magazine and the Metro Omaha
Medical Society in no way endorse any opinions or statements in this
publication except those accurately reflecting official MOMS actions
B2B
Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WIN
NER bull 2012 bull WIN
NER
Des Moines | Kansas City | LeawooD
o M a h a
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
nebraskabluecomBlue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association
healthy NebraskaWorking with you for a
4 Physicians Bulletin MarchApril 2013
wwwsaint judehospiceorgWhere Love and Healing F low
ldquoLove one another as I have loved yourdquo John 1334
A Catholic Hospice serving all people according to the directives of the Church on end-of-life care
For More Information 4026094818 or 18889801226
member benefitsFOR THE PASSIONATE GOLFER
Pure air clear blue skies and endless grass covered sand dunes stretching unobstructed for miles in every direction Rugged serene untarnished The Nebraska Sand Hills is the finest golf country in the world This book tells you about the magnificent golf courses that have created a golf trail in the Nebraska Sand Hills
To Order Call (402) 884-5995 wwwGolfintheNebraskaSandHillscom
$2995
MarchApril 2013 Physicians Bulletin 5
Did you Know
MOmSNmA memberShip beNefitS phySiciANS in a variety of ways ndash
everything from legislative representation access to health and dental plans designed for physicians and access to a variety of personal and medical practice products and services to save you time and money
Here is one of our membership benefits
reduce your total cOpic
premium by up to 10 percentMembers with COPIC medical liabil-
ity insurance receive an automatic 5 percent premium reduction
Combine it with another 5 percent reduc-tion for participating in risk manage-ment education and save even more
Contact Kristin Stepien director of sales at COPIC at (800) 421-1834or kstepienCOPICcom for more
information on the premium credit or a premium indication
For a complete list of membership benefits
visit wwwomahamedicalcom
Not currently a MOMSNMA member but would like to start
taking advantage of our many membership benefits
Apply for membership online at wwwomahamedicalcom or
complete the membership applica-tion on page 36 and return it
Contact Laura Polak at the Metro Omaha Medical Society if you have any
questions ndash phone (402) 393-1415 or email lauraomahamedicalcom
MOMS Foundation
7906 Davenport St
Omaha NE 68114
402-393-1415
The Metro Omaha Medical Society
Foundation identifies and provides
support to community priorities where
physician involvement can
make a difference in improving the
health of the Metro Omaha Community
6 Physicians Bulletin MarchApril 2013
thiS issue Marchapril 2013
f e a t u r e s d e p a r t m e n t s 19 COVER When Nature Leaves
Its Calling Card
20 ldquoProud of the Medical Profession that Dayrdquo Bergan Mercy and the 1975 Tornado
22 Ready If Necessary
24 lsquoWill You be Readyrsquo HIPPA and Your Liability
27 Minimizing Down Time Accessing Patient Records After a Disaster
10 Editorrsquos Desk Community Leaders + Physicians = Greater Understanding
12 NMA Message Your Dues Your Association
14 Legal Update HIPPA Omnibus Rule Modifies What Constitutes A
Reportable Breach of Protected Health Information
15 Young Physician Report The Glamour of Medicine
16 Clinical Update Top Ten Tips for Prescribing Pain Medication
29 MOMS Coming Events
30 MOMS Events
32 Member News
34 Campus Update
37 New Member Update
MarchApril 2013 Physicians Bulletin 7
Wealth Management Personally Delivered
spend time with them
wwwbonnettwmcom
14710 West Dodge Road 203Omaha NE 68154
(402) 556-8858
Leave your wealthmanagement to usItrsquos what we do
Learn about our approach Call today
Securities offered through Securities America Inc member FINRASIPC Jerome P Bonnett Jr CFPreg ChFCreg Registered Representative Advisory services offered through BWM Advisors LLC Jerome P Bonnett Jr Investment Advisor Representative BWM Advisors LLC (dba Bonnett Wealth Management) and Securities America companies are unaffiliated
8 Physicians Bulletin MarchApril 2013
NOvemberDecember 2012 vOLUme 33 NUmber 6
A Publication of the
Metro Omaha Medical Society7906 Davenport St bull Omaha NE 68114
(402)393-1415 bull wwwomahamedicalcom
OfficerSPresident | Marvin J Bittner MD
President-Elect | Debra L Esser MDSecretary-Treasurer | David D Ingvoldstad MD
Past President | Pierre J Lavedan MDExecutive Director | Diane Parsons
eXecUtive bOArDMarvin Bittner MD Debra Esser MD
David Ingvoldstad MD Pierre Lavedan MD
Mohammad Al-Turk MD Jane Bailey MD
Lori Brunner-Buck MD David Filipi MD
Harris Frankel MD Sherrill Murphy MD James Newland MD
William Orr MD Laurel Prestridge MD
William Shiffermiller MD Gamini Soori MD
Jeffry Strohmyer MD
eDitOriALADvertiSiNG StAffPublisher | Omaha Magazine LTD
Editor | Marvin Bittner MDArt Director | John Gawley
Senior Graphic Designer | Katie AndersonJunior Graphic Designer | Paul Lukes
Director of Photography | Bill Sitzmann
advertising sales Todd Lemke bull Sandy Besch bull Greg BrunsGwen Lemke bull Gil Cohen bull Alicia Smith bull
Vicki Voet bull Paige Edwards bull Jessica Linhartfor advertising information
402-884-2000
Physicians Bulletin is published bi-monthly by Omaha Magazine
LTD PO Box 461208 Omaha NE 68046-1208 copy 2012 No whole
or part of contents herein may be reproduced without prior permission
of Omaha Magazine or the Metro Omaha Medical Society excepting
individually copyrighted articles and photographs Unsolicited
manuscripts are accepted however no responsibility will be assumed
for such solicitations Omaha Magazine and the Metro Omaha
Medical Society in no way endorse any opinions or statements in this
publication except those accurately reflecting official MOMS actions
B2B
Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WIN
NER bull 2012 bull WIN
NER
Des Moines | Kansas City | LeawooD
o M a h a
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
4 Physicians Bulletin MarchApril 2013
wwwsaint judehospiceorgWhere Love and Healing F low
ldquoLove one another as I have loved yourdquo John 1334
A Catholic Hospice serving all people according to the directives of the Church on end-of-life care
For More Information 4026094818 or 18889801226
member benefitsFOR THE PASSIONATE GOLFER
Pure air clear blue skies and endless grass covered sand dunes stretching unobstructed for miles in every direction Rugged serene untarnished The Nebraska Sand Hills is the finest golf country in the world This book tells you about the magnificent golf courses that have created a golf trail in the Nebraska Sand Hills
To Order Call (402) 884-5995 wwwGolfintheNebraskaSandHillscom
$2995
MarchApril 2013 Physicians Bulletin 5
Did you Know
MOmSNmA memberShip beNefitS phySiciANS in a variety of ways ndash
everything from legislative representation access to health and dental plans designed for physicians and access to a variety of personal and medical practice products and services to save you time and money
Here is one of our membership benefits
reduce your total cOpic
premium by up to 10 percentMembers with COPIC medical liabil-
ity insurance receive an automatic 5 percent premium reduction
Combine it with another 5 percent reduc-tion for participating in risk manage-ment education and save even more
Contact Kristin Stepien director of sales at COPIC at (800) 421-1834or kstepienCOPICcom for more
information on the premium credit or a premium indication
For a complete list of membership benefits
visit wwwomahamedicalcom
Not currently a MOMSNMA member but would like to start
taking advantage of our many membership benefits
Apply for membership online at wwwomahamedicalcom or
complete the membership applica-tion on page 36 and return it
Contact Laura Polak at the Metro Omaha Medical Society if you have any
questions ndash phone (402) 393-1415 or email lauraomahamedicalcom
MOMS Foundation
7906 Davenport St
Omaha NE 68114
402-393-1415
The Metro Omaha Medical Society
Foundation identifies and provides
support to community priorities where
physician involvement can
make a difference in improving the
health of the Metro Omaha Community
6 Physicians Bulletin MarchApril 2013
thiS issue Marchapril 2013
f e a t u r e s d e p a r t m e n t s 19 COVER When Nature Leaves
Its Calling Card
20 ldquoProud of the Medical Profession that Dayrdquo Bergan Mercy and the 1975 Tornado
22 Ready If Necessary
24 lsquoWill You be Readyrsquo HIPPA and Your Liability
27 Minimizing Down Time Accessing Patient Records After a Disaster
10 Editorrsquos Desk Community Leaders + Physicians = Greater Understanding
12 NMA Message Your Dues Your Association
14 Legal Update HIPPA Omnibus Rule Modifies What Constitutes A
Reportable Breach of Protected Health Information
15 Young Physician Report The Glamour of Medicine
16 Clinical Update Top Ten Tips for Prescribing Pain Medication
29 MOMS Coming Events
30 MOMS Events
32 Member News
34 Campus Update
37 New Member Update
MarchApril 2013 Physicians Bulletin 7
Wealth Management Personally Delivered
spend time with them
wwwbonnettwmcom
14710 West Dodge Road 203Omaha NE 68154
(402) 556-8858
Leave your wealthmanagement to usItrsquos what we do
Learn about our approach Call today
Securities offered through Securities America Inc member FINRASIPC Jerome P Bonnett Jr CFPreg ChFCreg Registered Representative Advisory services offered through BWM Advisors LLC Jerome P Bonnett Jr Investment Advisor Representative BWM Advisors LLC (dba Bonnett Wealth Management) and Securities America companies are unaffiliated
8 Physicians Bulletin MarchApril 2013
NOvemberDecember 2012 vOLUme 33 NUmber 6
A Publication of the
Metro Omaha Medical Society7906 Davenport St bull Omaha NE 68114
(402)393-1415 bull wwwomahamedicalcom
OfficerSPresident | Marvin J Bittner MD
President-Elect | Debra L Esser MDSecretary-Treasurer | David D Ingvoldstad MD
Past President | Pierre J Lavedan MDExecutive Director | Diane Parsons
eXecUtive bOArDMarvin Bittner MD Debra Esser MD
David Ingvoldstad MD Pierre Lavedan MD
Mohammad Al-Turk MD Jane Bailey MD
Lori Brunner-Buck MD David Filipi MD
Harris Frankel MD Sherrill Murphy MD James Newland MD
William Orr MD Laurel Prestridge MD
William Shiffermiller MD Gamini Soori MD
Jeffry Strohmyer MD
eDitOriALADvertiSiNG StAffPublisher | Omaha Magazine LTD
Editor | Marvin Bittner MDArt Director | John Gawley
Senior Graphic Designer | Katie AndersonJunior Graphic Designer | Paul Lukes
Director of Photography | Bill Sitzmann
advertising sales Todd Lemke bull Sandy Besch bull Greg BrunsGwen Lemke bull Gil Cohen bull Alicia Smith bull
Vicki Voet bull Paige Edwards bull Jessica Linhartfor advertising information
402-884-2000
Physicians Bulletin is published bi-monthly by Omaha Magazine
LTD PO Box 461208 Omaha NE 68046-1208 copy 2012 No whole
or part of contents herein may be reproduced without prior permission
of Omaha Magazine or the Metro Omaha Medical Society excepting
individually copyrighted articles and photographs Unsolicited
manuscripts are accepted however no responsibility will be assumed
for such solicitations Omaha Magazine and the Metro Omaha
Medical Society in no way endorse any opinions or statements in this
publication except those accurately reflecting official MOMS actions
B2B
Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WIN
NER bull 2012 bull WIN
NER
Des Moines | Kansas City | LeawooD
o M a h a
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
member benefitsFOR THE PASSIONATE GOLFER
Pure air clear blue skies and endless grass covered sand dunes stretching unobstructed for miles in every direction Rugged serene untarnished The Nebraska Sand Hills is the finest golf country in the world This book tells you about the magnificent golf courses that have created a golf trail in the Nebraska Sand Hills
To Order Call (402) 884-5995 wwwGolfintheNebraskaSandHillscom
$2995
MarchApril 2013 Physicians Bulletin 5
Did you Know
MOmSNmA memberShip beNefitS phySiciANS in a variety of ways ndash
everything from legislative representation access to health and dental plans designed for physicians and access to a variety of personal and medical practice products and services to save you time and money
Here is one of our membership benefits
reduce your total cOpic
premium by up to 10 percentMembers with COPIC medical liabil-
ity insurance receive an automatic 5 percent premium reduction
Combine it with another 5 percent reduc-tion for participating in risk manage-ment education and save even more
Contact Kristin Stepien director of sales at COPIC at (800) 421-1834or kstepienCOPICcom for more
information on the premium credit or a premium indication
For a complete list of membership benefits
visit wwwomahamedicalcom
Not currently a MOMSNMA member but would like to start
taking advantage of our many membership benefits
Apply for membership online at wwwomahamedicalcom or
complete the membership applica-tion on page 36 and return it
Contact Laura Polak at the Metro Omaha Medical Society if you have any
questions ndash phone (402) 393-1415 or email lauraomahamedicalcom
MOMS Foundation
7906 Davenport St
Omaha NE 68114
402-393-1415
The Metro Omaha Medical Society
Foundation identifies and provides
support to community priorities where
physician involvement can
make a difference in improving the
health of the Metro Omaha Community
6 Physicians Bulletin MarchApril 2013
thiS issue Marchapril 2013
f e a t u r e s d e p a r t m e n t s 19 COVER When Nature Leaves
Its Calling Card
20 ldquoProud of the Medical Profession that Dayrdquo Bergan Mercy and the 1975 Tornado
22 Ready If Necessary
24 lsquoWill You be Readyrsquo HIPPA and Your Liability
27 Minimizing Down Time Accessing Patient Records After a Disaster
10 Editorrsquos Desk Community Leaders + Physicians = Greater Understanding
12 NMA Message Your Dues Your Association
14 Legal Update HIPPA Omnibus Rule Modifies What Constitutes A
Reportable Breach of Protected Health Information
15 Young Physician Report The Glamour of Medicine
16 Clinical Update Top Ten Tips for Prescribing Pain Medication
29 MOMS Coming Events
30 MOMS Events
32 Member News
34 Campus Update
37 New Member Update
MarchApril 2013 Physicians Bulletin 7
Wealth Management Personally Delivered
spend time with them
wwwbonnettwmcom
14710 West Dodge Road 203Omaha NE 68154
(402) 556-8858
Leave your wealthmanagement to usItrsquos what we do
Learn about our approach Call today
Securities offered through Securities America Inc member FINRASIPC Jerome P Bonnett Jr CFPreg ChFCreg Registered Representative Advisory services offered through BWM Advisors LLC Jerome P Bonnett Jr Investment Advisor Representative BWM Advisors LLC (dba Bonnett Wealth Management) and Securities America companies are unaffiliated
8 Physicians Bulletin MarchApril 2013
NOvemberDecember 2012 vOLUme 33 NUmber 6
A Publication of the
Metro Omaha Medical Society7906 Davenport St bull Omaha NE 68114
(402)393-1415 bull wwwomahamedicalcom
OfficerSPresident | Marvin J Bittner MD
President-Elect | Debra L Esser MDSecretary-Treasurer | David D Ingvoldstad MD
Past President | Pierre J Lavedan MDExecutive Director | Diane Parsons
eXecUtive bOArDMarvin Bittner MD Debra Esser MD
David Ingvoldstad MD Pierre Lavedan MD
Mohammad Al-Turk MD Jane Bailey MD
Lori Brunner-Buck MD David Filipi MD
Harris Frankel MD Sherrill Murphy MD James Newland MD
William Orr MD Laurel Prestridge MD
William Shiffermiller MD Gamini Soori MD
Jeffry Strohmyer MD
eDitOriALADvertiSiNG StAffPublisher | Omaha Magazine LTD
Editor | Marvin Bittner MDArt Director | John Gawley
Senior Graphic Designer | Katie AndersonJunior Graphic Designer | Paul Lukes
Director of Photography | Bill Sitzmann
advertising sales Todd Lemke bull Sandy Besch bull Greg BrunsGwen Lemke bull Gil Cohen bull Alicia Smith bull
Vicki Voet bull Paige Edwards bull Jessica Linhartfor advertising information
402-884-2000
Physicians Bulletin is published bi-monthly by Omaha Magazine
LTD PO Box 461208 Omaha NE 68046-1208 copy 2012 No whole
or part of contents herein may be reproduced without prior permission
of Omaha Magazine or the Metro Omaha Medical Society excepting
individually copyrighted articles and photographs Unsolicited
manuscripts are accepted however no responsibility will be assumed
for such solicitations Omaha Magazine and the Metro Omaha
Medical Society in no way endorse any opinions or statements in this
publication except those accurately reflecting official MOMS actions
B2B
Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WIN
NER bull 2012 bull WIN
NER
Des Moines | Kansas City | LeawooD
o M a h a
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
6 Physicians Bulletin MarchApril 2013
thiS issue Marchapril 2013
f e a t u r e s d e p a r t m e n t s 19 COVER When Nature Leaves
Its Calling Card
20 ldquoProud of the Medical Profession that Dayrdquo Bergan Mercy and the 1975 Tornado
22 Ready If Necessary
24 lsquoWill You be Readyrsquo HIPPA and Your Liability
27 Minimizing Down Time Accessing Patient Records After a Disaster
10 Editorrsquos Desk Community Leaders + Physicians = Greater Understanding
12 NMA Message Your Dues Your Association
14 Legal Update HIPPA Omnibus Rule Modifies What Constitutes A
Reportable Breach of Protected Health Information
15 Young Physician Report The Glamour of Medicine
16 Clinical Update Top Ten Tips for Prescribing Pain Medication
29 MOMS Coming Events
30 MOMS Events
32 Member News
34 Campus Update
37 New Member Update
MarchApril 2013 Physicians Bulletin 7
Wealth Management Personally Delivered
spend time with them
wwwbonnettwmcom
14710 West Dodge Road 203Omaha NE 68154
(402) 556-8858
Leave your wealthmanagement to usItrsquos what we do
Learn about our approach Call today
Securities offered through Securities America Inc member FINRASIPC Jerome P Bonnett Jr CFPreg ChFCreg Registered Representative Advisory services offered through BWM Advisors LLC Jerome P Bonnett Jr Investment Advisor Representative BWM Advisors LLC (dba Bonnett Wealth Management) and Securities America companies are unaffiliated
8 Physicians Bulletin MarchApril 2013
NOvemberDecember 2012 vOLUme 33 NUmber 6
A Publication of the
Metro Omaha Medical Society7906 Davenport St bull Omaha NE 68114
(402)393-1415 bull wwwomahamedicalcom
OfficerSPresident | Marvin J Bittner MD
President-Elect | Debra L Esser MDSecretary-Treasurer | David D Ingvoldstad MD
Past President | Pierre J Lavedan MDExecutive Director | Diane Parsons
eXecUtive bOArDMarvin Bittner MD Debra Esser MD
David Ingvoldstad MD Pierre Lavedan MD
Mohammad Al-Turk MD Jane Bailey MD
Lori Brunner-Buck MD David Filipi MD
Harris Frankel MD Sherrill Murphy MD James Newland MD
William Orr MD Laurel Prestridge MD
William Shiffermiller MD Gamini Soori MD
Jeffry Strohmyer MD
eDitOriALADvertiSiNG StAffPublisher | Omaha Magazine LTD
Editor | Marvin Bittner MDArt Director | John Gawley
Senior Graphic Designer | Katie AndersonJunior Graphic Designer | Paul Lukes
Director of Photography | Bill Sitzmann
advertising sales Todd Lemke bull Sandy Besch bull Greg BrunsGwen Lemke bull Gil Cohen bull Alicia Smith bull
Vicki Voet bull Paige Edwards bull Jessica Linhartfor advertising information
402-884-2000
Physicians Bulletin is published bi-monthly by Omaha Magazine
LTD PO Box 461208 Omaha NE 68046-1208 copy 2012 No whole
or part of contents herein may be reproduced without prior permission
of Omaha Magazine or the Metro Omaha Medical Society excepting
individually copyrighted articles and photographs Unsolicited
manuscripts are accepted however no responsibility will be assumed
for such solicitations Omaha Magazine and the Metro Omaha
Medical Society in no way endorse any opinions or statements in this
publication except those accurately reflecting official MOMS actions
B2B
Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WIN
NER bull 2012 bull WIN
NER
Des Moines | Kansas City | LeawooD
o M a h a
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 7
Wealth Management Personally Delivered
spend time with them
wwwbonnettwmcom
14710 West Dodge Road 203Omaha NE 68154
(402) 556-8858
Leave your wealthmanagement to usItrsquos what we do
Learn about our approach Call today
Securities offered through Securities America Inc member FINRASIPC Jerome P Bonnett Jr CFPreg ChFCreg Registered Representative Advisory services offered through BWM Advisors LLC Jerome P Bonnett Jr Investment Advisor Representative BWM Advisors LLC (dba Bonnett Wealth Management) and Securities America companies are unaffiliated
8 Physicians Bulletin MarchApril 2013
NOvemberDecember 2012 vOLUme 33 NUmber 6
A Publication of the
Metro Omaha Medical Society7906 Davenport St bull Omaha NE 68114
(402)393-1415 bull wwwomahamedicalcom
OfficerSPresident | Marvin J Bittner MD
President-Elect | Debra L Esser MDSecretary-Treasurer | David D Ingvoldstad MD
Past President | Pierre J Lavedan MDExecutive Director | Diane Parsons
eXecUtive bOArDMarvin Bittner MD Debra Esser MD
David Ingvoldstad MD Pierre Lavedan MD
Mohammad Al-Turk MD Jane Bailey MD
Lori Brunner-Buck MD David Filipi MD
Harris Frankel MD Sherrill Murphy MD James Newland MD
William Orr MD Laurel Prestridge MD
William Shiffermiller MD Gamini Soori MD
Jeffry Strohmyer MD
eDitOriALADvertiSiNG StAffPublisher | Omaha Magazine LTD
Editor | Marvin Bittner MDArt Director | John Gawley
Senior Graphic Designer | Katie AndersonJunior Graphic Designer | Paul Lukes
Director of Photography | Bill Sitzmann
advertising sales Todd Lemke bull Sandy Besch bull Greg BrunsGwen Lemke bull Gil Cohen bull Alicia Smith bull
Vicki Voet bull Paige Edwards bull Jessica Linhartfor advertising information
402-884-2000
Physicians Bulletin is published bi-monthly by Omaha Magazine
LTD PO Box 461208 Omaha NE 68046-1208 copy 2012 No whole
or part of contents herein may be reproduced without prior permission
of Omaha Magazine or the Metro Omaha Medical Society excepting
individually copyrighted articles and photographs Unsolicited
manuscripts are accepted however no responsibility will be assumed
for such solicitations Omaha Magazine and the Metro Omaha
Medical Society in no way endorse any opinions or statements in this
publication except those accurately reflecting official MOMS actions
B2B
Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WIN
NER bull 2012 bull WIN
NER
Des Moines | Kansas City | LeawooD
o M a h a
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
8 Physicians Bulletin MarchApril 2013
NOvemberDecember 2012 vOLUme 33 NUmber 6
A Publication of the
Metro Omaha Medical Society7906 Davenport St bull Omaha NE 68114
(402)393-1415 bull wwwomahamedicalcom
OfficerSPresident | Marvin J Bittner MD
President-Elect | Debra L Esser MDSecretary-Treasurer | David D Ingvoldstad MD
Past President | Pierre J Lavedan MDExecutive Director | Diane Parsons
eXecUtive bOArDMarvin Bittner MD Debra Esser MD
David Ingvoldstad MD Pierre Lavedan MD
Mohammad Al-Turk MD Jane Bailey MD
Lori Brunner-Buck MD David Filipi MD
Harris Frankel MD Sherrill Murphy MD James Newland MD
William Orr MD Laurel Prestridge MD
William Shiffermiller MD Gamini Soori MD
Jeffry Strohmyer MD
eDitOriALADvertiSiNG StAffPublisher | Omaha Magazine LTD
Editor | Marvin Bittner MDArt Director | John Gawley
Senior Graphic Designer | Katie AndersonJunior Graphic Designer | Paul Lukes
Director of Photography | Bill Sitzmann
advertising sales Todd Lemke bull Sandy Besch bull Greg BrunsGwen Lemke bull Gil Cohen bull Alicia Smith bull
Vicki Voet bull Paige Edwards bull Jessica Linhartfor advertising information
402-884-2000
Physicians Bulletin is published bi-monthly by Omaha Magazine
LTD PO Box 461208 Omaha NE 68046-1208 copy 2012 No whole
or part of contents herein may be reproduced without prior permission
of Omaha Magazine or the Metro Omaha Medical Society excepting
individually copyrighted articles and photographs Unsolicited
manuscripts are accepted however no responsibility will be assumed
for such solicitations Omaha Magazine and the Metro Omaha
Medical Society in no way endorse any opinions or statements in this
publication except those accurately reflecting official MOMS actions
B2B
Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WIN
NER bull 2012 bull WIN
NER
Des Moines | Kansas City | LeawooD
o M a h a
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 9
Have your cake And eat it too
Dining Family Fun Health amp Beauty Household Retail Services Transportation
Always Local Always Beautiful
A Publication of
MayJune 2012
Always Local Always Beautiful
WAtkins ULtimAte
Backyard Challenge
CUrt Hofer ConstrUCtion
ldquoBand of Brothersrdquo
A Publication
Architect Steven Ginnrsquos Innovative Residence
SeptemberOctober 2011
A Home For All Ages
Always Local Always Beautiful
Kitchen Remodel
Room spotlight
Field Club Historical District
neighboRhood pRofile
ASID Project Awards
2011 nebRaska-iowa
A Publication of
JulyAugust 2012
Always Local Always Beautiful
Ponca HillsneighBorhood profiLe
hot products
Luminous Lamps
A Publication of
MarchApril 2012
Architect ron hAckettrsquos
Home inthe Woods
Always Local Always Beautiful
Certified Green Homes Jeff rensch ampBrau Builders
tApestryruG WeAverMary Zicafoose
Each issue also features human interest pieces including architectdesignerbuilder profiles hot products maintenance columns room spotlights landscaping columns neighborhood
profiles home transformations home hap-penings mortgage columns new business stories green design features and much
much more
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
10 Physicians Bulletin MarchApril 2013
eDitOrrsquoS desk
Community Leaders + Physicians = Greater Understanding
Marvin Bittner MD
President
Metro Omaha Medical Society
M y LASt cOLUmN tOOk issue with a statement made by the governor of
Nebraska a Republican In this column I am taking issue with a statement made by the ex-governor of Kansas a Democrat
Some weeks ago she issued a statement con-sisting of fact interpretation and threat Fact The increasing use of electronic health records has been associated with an increase in the level of billing by physicians Interpretation This increase in billing is inappropriate and represents nefari-ous conduct Threat Physicians engaging in this practice will be punished Because her statement was made in her role as secretary of Health and Human Services and issued in conjunction with the attorney general the threat had credibility
I cannot argue with the facts However her interpretation is not the most plausible one to me One of the things that has struck me about electronic health records is the ease with which extensive documentation can be recorded More documentation facilitates higher billing codes
I am not the only one who has found this interpretation to be plausible Why is it that the ex-governor of Kansas did not exclude this interpretation before issuing her statement Surely this reflects a lack of familiarity on her part with day-to-day medical practice
This is not the only setting in which a lack of familiarity with medical practice has become evident when the subject of electronic health records has been discussed At a MOMS meeting last year our former president Harris Frankel made an intriguing statement about the use of information technology in medicine In most fields he noted the introduction of information
technology has lowered cost or increased efficiency This has not been the case in medicine Why I got some insight into this puzzle the other day I was reading an article by an individual who is of all things a writer
John McPhee a renowned writer for the New Yorker recounted his introduction to computers when he was in his 50s and a faculty member at Princeton University A Princeton information technology specialist came to him and started a conversation by saying ldquoTell me what you dordquo Is this the way electronic health records have been introduced to medicine Hardly Instead administrators have coerced physicians into Procrustean beds of information technology
A bizarre episode in the coercive introduction of information technology occurred some years ago A clinic was in the final stages of transition from paper to electronic records I received a message The use of paper ndash now prohibited ndash had been detected in my clinic I inquired In what situation had paper been used Administrator after administrator could not tell me I was accused of an infraction and could not be told what it was Straight out of Kafka
When a federal cabinet official or an admin-istrator introducing electronic health records is unfamiliar with the practice of medicine ndash yet trying to affect it we can expect trouble MOMS is doing something about this We have a com-munity internship program Community leaders spend time with physicians They see what is happening All this can only result in greater understanding fewer misinterpretations and fewer threats
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 11
Robert G Penn MD FACP FSHEA FIDSABoard Certified Infectious Diseases
Your Best Choicefor Antibiotic Infusion Therapy
Learn more at wwwidmidwestcom
More than 50000 successful infusions
Office Infusion Center for IV Antibioticsbull Healthcare provider on sitebull Open 7 days a week
Infectious Disease Specialistsbull Inpatientoutpatient comprehensive care
Vaccine Clinicsbull for immunocompromisedbull for travelers
Douglas Penington APRNAllison McLeay APRNStacey Shinaut APRNElizabeth Jacobsen PA-CCourtney Sullivan ACNP
Infectious Diseases Associates PC8111 Professional Building bull 8111 Dodge Street Suite 363 bull Omaha NE 68114
Phone 4029346504 bull Fax 4029346518 bull wwwidmidwestcom
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
12 Physicians Bulletin MarchApril 2013
NmA message
Your Dues Your Association
iN eArLy 2013 we sent our annual member-ship survey to all NMA members to query
why you joined the NMA how you describe your activity in the NMA your perception of the NMA if your needs are being met if there is value in your NMA membership what issues are important to you if you receive and read the NMA email update STAT as well as requesting general demographic information This year we inquired about employed or private practice status as the trend toward employed practice continues Every year we find a common theme Physicians join the NMA to support the medical profession We also review the results to find ways we can improve as an organization so that we provide the best value possible to our members We wouldnrsquot ask these questions if we didnrsquot sincerely want to know the answers
In addition to purchasing discounts with COPIC and access to our NMA-sponsored health plan we believe in many cases that one phone call to our office can validate the cost of your membership NMA dues have not increased since 1996 and we remain confident that we continue to provide value to the physicians who have placed their confidence in us and continued their memberships over the years
From an information standpoint we believe our bi-weekly electronic STAT our quarterly NMA News and Nebraska Medicine provide both valuable and timely information to our mem-bership Last year we joined Facebook (please Like our page) which serves as another way
to open a dialogue with physicians and patients alike While I understand the hectic schedules our members maintain I am always disappointed when I review the survey results associated with our informational offerings We try our best to give you timely and effective communication and welcome any suggestions anyone has to improve our ability to communicate to you
As I mentioned earlier this year active partici-pation in the advocacy arena needs to include a mobilized well-informed membership I remain confident that the physicians of Nebraska will continue to be advocates for their patients just as we will continue to be advocates for both you and your patients
The NMA consists of a very diverse group of physicians practicing in various practice arrangements and in very different geographic locations When we advocate for our members with a commercial carrier Medicaid or Medicare we are advocating for all physicians in the state regardless of specialty location or employment status Likewise when we advocate on a spe-cific issue on behalf of a member or specialty we hope our efforts if possible can benefit the entire membership
In closing a membership organization is what you want it to be Our hope is that you see it as an opportunity to shape the future of medicine and to improve the lives of your patients We appreciate your past support of the NMA and we look forward to having your support into the future
Dale Mahlman
Executive Vice President
Nebraska Medical Association
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 13
2606 S 156th Circle | Omaha NE 68130(402) 399-9233 | wwwsparklingkleancom
Commercial
Construction
Green Environments
Disaster Recovery
Industrial
Medical
Education
A+ Rating
B2
B Omaha Magazinersquos
Om
aharsquos Business to Business M
agaz
ine
WINNER bull 2012 bull W
INNER
4 ConsecutiveYears
Boys Town Medical CampusPacific Street Clinic
14040 Hospital Road(139th amp Pacific Street)
(402) 778-6800
Boys Town Medical CampusDowntown Clinic
555 North 30th Street(402) 498-6540
Ear Nose and Throat Clinic320 McKenzie Avenue Suite 202
Council Bluffs Iowa 51503(712) 256-5272
Boys Town Ear Nose amp Throat Institute
Helping Your PatientsFeel Better Again
BOYS TOWNEar Nose amp Throat
InstituteSM
BoysTownENTorg
Our Board Certified physicians specialize
in treating problems ranging from
chronic ear nose and throat illnesses to
complex head and neck disorders calling
for specialized surgical care
MOMSMEMBER
EVENTat the
Sunday June 9thStormchasers vs
Oklahoma City RedHawks
1230 PM bull Lunch Buff et205 PM bull First Pitch
No cost for MOMS members and their immediate family
Call 402-393-1415 to reserve your tickets
Sponsored by
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
14 Physicians Bulletin MarchApril 2013
LeGAL update
HIPPA Omnibus Rule Modifies What Constitutes A Reportable Breach of Protected Health Information
Tom Kelley
Partner
McGrath North Mullin amp Kratz
O N JAN 25 the Health Insurance Portabil-ity and Accountability Act (ldquoHIPAArdquo)
regulations (the ldquoOmnibus Rulerdquo) implementing the statutory amendments under the Health Infor-mation Technology for Economic and Clinical Health Act (ldquoHITECH Actrdquo) were published in the Federal Register1 The Omnibus Rule modi-fies the HIPAA privacy security enforcement and breach notification rules under the HITECH Act The Omnibus Rule becomes effective on March 26 and compliance is required by Sept 23 While the rule modifications span more than 130 pages in the Federal Register and cover a variety of areas one key change involves the breach notification requirements first enacted under the HITECH Act
Since the passage of the HITECH Act in 2009 covered entities have had to provide notification of discovered breaches to affected individuals the federal government and even the media in some cases For HIPAAHITECH Act purposes a breach was defined as an unauthorized acqui-sition access use or disclosure of ldquoprotected health informationrdquo (ldquoPHIrdquo) that compromised the security or privacy of the PHI Under the interim rule released by US Department of Health
1 ModificationstotheHIPAAPrivacySecurityEnforcementandBreachNotificationRulesundertheHealthInformationTechnologyforEconomicandClinicalHealthActandtheGeneticInformationNondiscriminationActOtherModificationstotheHIPAARulesDepartmentofHealthandHumanServicesOfficeoftheSecretary(45CFRParts160and164)78FedReg5566(Jan252013)
and Human Services (ldquoHHSrdquo) later in 20092 covered entities and their business associates were required to determine if a reportable breach had occurred by performing a risk assessment of whether there was a ldquosignificant risk of harmrdquo to the individual as a result of the unauthorized acquisition access use or disclosure of PHI In its comments included with the Omnibus Rule HHS noted its concern that the risk assessment focused on ldquoharm to the individualrdquo in the interim rule was too subjective and often led to incon-sistent interpretations and results across covered entities and business associatesrdquo3
In order to address this concern the Omni-bus Rule replaces the current ldquosignificant risk of harmrdquo standard with a ldquolow probability of compromiserdquo standard for determining whether an unauthorized acquisition access use or dis-closure of PHI constitutes a reportable breach In addition under the new standard there is presumption that any unauthorized acquisition access use or disclosure of PHI is a reportable breach In other words a covered entity andor business associate may now be required to pro-vide notification of an unauthorized acquisition access use or disclosure of PHI absent a finding that there is a low probability that the PHI has been compromised
The Omnibus Rule requires covered entities and business associates to assess the probability that PHI has been compromised based on a risk assessment that considers at least the follow-ing factors
2 74FedReg427403 78FedReg5642
(1) The nature and extent of the PHI involved including the types of identifiers and the likelihood of re-identification
(2) The unauthorized person who used the PHI or to whom the disclosure was made
(3) Whether the PHI was actually acquired or viewed and
(4) The extent to which the risk to the PHI has been mitigated
HHS believes that use of these factors which are derived from the factors listed in the interim rule as well as many of the factors suggested by commenters to the Omnibus Rule will result in a more objective evaluation of the risk to PHI and a more uniform application of the breach noti-fication rule4 It is also likely that the Omnibus Rule changes will result in substantially more breach notifications
The new breach reporting standard under the Omnibus Rule will need to be incorporated into the policies and procedures of covered entities and business associates and if as expected the new standard results in additional reporting such organizations will also need to anticipate the additional costs associated with this reporting
Editorrsquos Note This article has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice Please consult your regular counsel in connection with any fact-specific situation under federal law and the applicable state or local laws that may impose additional obligations on you andor your organization
4 78FedReg5642
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 15
yOUNG physician report
The Glamour of Medicine
a S A LittLe GirL who grew up on a farm in western Nebraska the life of a physician
had always seemed so glamorous to me I could picture it every day wearing a crisp white coat with a stethoscope around my neck saving lives every other minute working with patients who were eager for my help and always receiving copious amounts of thanks for a job well done By the time I started medical school I definitely had a more realistic version of the life of a physi-cian but I was still a little starstruck So on my first day of medical school I was filled will an overwhelming sense of excitement and accom-plishment Sure I was extremely nervous and scared of the unknown but I was more excited to start the poetic life of service and fulfillment that belongs to those in medicine
I quickly realized during the first week that this journey would not be easy nor what I had expected As I wandered around the halls look-ing for where I was supposed to be I realized I was once again the low man on the totem pole Not only that but once I found my classes I quickly realized medical school was education on crack cocaine The pace of lectures was so fast that if I was not trembling from three cups of coffee beforehand I would be struggling to keep up ldquoFree timerdquo I also found out was a luxury only afforded one afternoon every three weeks after a five-hour Saturday exam And to top it all off I stunk Yes for the first 10 weeks of school during anatomy class we all smelled like formaldehyde and embalming fluids Finally it was also my introduction to the fact that in medicine there is no time for yourself to be sick
As I came down with mononucleosis at the end of my first semester my own physician told me to ldquoJust keep goingrdquo
But my first year was also the year that I participated in the MOMS Medical MESS Club performance where physicians all across Omaha get together to perform comedic numbers while poking fun at themselves and the unique situations physicians find themselves in It was the first time that I was on a ldquopeerrdquo level with multiple physicians The camaraderie was infectious and most everyone was sharing stories about their own medical school experiences and assuring me there will be many more life-changing events in my future It was then that I realized that all these experiences were actually character-building rites of passage for me and all those that will come after me
So as I finish my third year of school I look back at these three anxiety-provoking life-changing years with fondness It is because of these difficult and eye-opening years that I see the true glamour of medicine I see a community of like-minded individuals who have sought knowledge and lifelong learning in order to serve the people they treat I see physicians who continue to fight for the best care of their patients even if that means not being financially compensated and using their own personal time This is a glamour that might only be appreciated by those of us in this wonderful field A glamour that doesnrsquot revolve around fancy cars or big paychecks and may not even include words of gratitude from the patients we care for For me the glamour of medicine is the journey
Ashley Bauer
Third-year Medical Student
University of Nebraska Medical Center
One thing I am certain about is my malpractice protectionrdquo
ldquoAs physicians we have so many unknowns coming our way
Professional Liability Insurance amp Risk Management Services
ProAssurance Group is rated A (Excellent) by AM Best ProAssurancecom bull 8002798331
Medicine is feeling the eff ects of regulatory and legislative changes increasing risk and profi tability demandsmdashall contributing to an atmosphere of uncertainty and lack of control
What we do control as physicians our choice of a liability partner
I selected ProAssurance because they stand behind my good medicine In spite of the maelstrom of change I am protected respected and heard
I believe in fair treatmentmdashand I get it
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
16 Physicians Bulletin MarchApril 2013
cLiNicAL updateTop Ten Tips for Prescribing Pain Medication
p reScriptiON DrUG USe AND its associated abuse and diversion have repeatedly made
national headlines this past year While Nebraska has one of the lowest per-capita utilization rates for opioids in the nation recent events such as one involving a hostage at an Alliance Pharmacy and a large-scale illicit marketing scheme in Fremont prove that we are not immune to the epidemic
At a series of presentations this past fall an investigator from the Nebraska State Patrol provided evidence of abuse and diversion a PhD pharmacist from Creighton University provided insight into addiction and its associated problems and a physician provided advice on risk management strategies for the appropriate use of these medications There is a collaborative effort underway between health-care profession-als state agencies and other groups to address this problem and develop solutions
The following are not guidelines They are merely suggestions or tips for clinicians to consider when they are prescribing these medications
1) Make sure the clinical diagnosis is correct Is the opioid yoursquore giving indicated for the diagnosis that you are treating When pain is out of proportion to the disease you need to consider if there is another process or even a malignancy causing the severe pain A thorough history and physical is helpful in sorting through what is going on Make sure the opioids are necessary and if they are not working ask ldquowhat else is going onrdquo
2) Consider alternative treatments If the pain is from neuropathy or shingles consider some of the many other neurologic medicines that work for these illnesses If treating fibromy-algia remember that there are no controlled studies that suggest opioids help with this condition Again consider alternative (often neurologic) drugs Finally if the patient was a 7 out of a 10 before starting opioids and is still at the same level after a month then consider a different treatment regimen
3) Be aware of the risk of accidental death from overdose The Centers for Disease Control and Prevention estimated accidental overdose deaths for prescription pain kill-ers at more than 16500 annually a nearly four-fold increase from incidences reported in 1999 Pain management experts point to four common issues in reviewing accidental
overdose deathsa) A lack of appreciation of the highly vari-
able metabolism of methadone particu-larly when first starting the medication
b) Trusting conversion tables and switch-ing 100 percent ldquoequivalencyrdquo when changing to a new agent The conversion tables have been called into question especially in the initial period Close follow-up and potential reduction of the initial doses when converting among different opioids is likely indicated
c) A lack of appreciation of the complex-ity of the metabolism of concomitant long- and short- acting opioids leading to unpredictable toxic levels
d) Concomitant prescription of benzodi-azepines in combination with high-dose short and long acting opioids
4) Perform an addiction screen There are many screens available The CAGE screen is simple and well known Some of the others such as the Screener and Opioid Assessment for Patients in Pain (SOAPP) are made especially for chronic narcotic use and are subtler It is important to know if the patient has a high-risk for addiction andor if there is an underlying psychological disorder or prior abuse that makes opioids have a higher addiction potential These types of screens can provide information that is important to know prior to prescribing chronic potentially addictive drugs
5) Do a urine toxicology screen In conjunction with the above a urine toxicology screen should be considered before embarking on treatment It can help answer several questionsbull Is the patient using other street drugsbull Is the patient claiming that he or she is not taking opioids yet testing positive on the toxicology
bull Is the patient supposedly on drugs yet the toxicology screen is negative Consider diversion in this situation
Check with your lab to see what drugs show up on their screen for the patient Not every urine toxicology screen checks for the same drugs and has the same sensitivities You can make random urine toxicology screens a condition of your continued prescribing via the opioid contractagreement but must still inform the patient that you are doing the test (it cannot be done surreptitiously)
6) Have the patient sign a pain consent form The informed consent form is a tool to help you review the risks and benefits for using opioids as well as the potential side-effects (constipation sexual dysfunction and
drowsiness are among the many potential side-effects) Remember to warn patients about using opioids while driving or using heavy machinery And make sure you talk about the interaction with other drugs especially alcohol and marijuana
7) Also consider a pain agreement This is distinct from the informed consent form It is similar to that discussion you had with your teenager when you gave him or her car keys for the first time The agreement establishes the boundaries rules and regulations that yoursquove set up around the prescribing of opi-oids An example rule would be ldquono refills on the weekend or at nightrdquo These established rules also help you deal with stories you may hear such as ldquothe cat ate the Oxycodonerdquo ldquomy script got stolenrdquo or ldquoI lost my pills down the toiletrdquo
8) Understand the street price Law enforcement has given us the range of the street price for Oxycodone as $1 to $2 per 1mg This means that a one-month script of 120 Oxycodone (5mg) could be sold for as much as $1200 Once you see the prices that Oxycodone Percocet and Oxycontin can be sold for you will understand why diversion is such an issue
9) The buzz words Addiction is the compulsive use of a drug that results in personal harm Often in these cases there is psychological dependence and a history of preexisting abuse Tolerance refers to decreased effectiveness over time The important issue is to avoid labeling patients as ldquoaddictedrdquo when they are really becoming tolerant and needing to increase their medication Finally there is physical dependence which is the abstinence syndrome that occurs when discontinuing opioids Withdrawal symptoms following discontinuation of opioids does NOT indicate that the patient is an addict most patients can suffer some withdrawal symptoms following a course of continuous opioids even when indicated and appropriately administered
10) Listen Some of our most difficult patient conversations occur around these drugs It can be a complex issue The patient wants pain relief and we have an obligation to relieve suffering On the other hand there are times when it is clear that opioids are not what are best for the patient ldquoPrimum Non Nocererdquo is the first precept of medical ethics Instead of starting the boundaries discussion with a resounding NO listen to what the patient is concerned about understand his or her fears and see if there is compromise that will meet the patientrsquos needs and still be considered safe medicine
By COPICrsquos Patient Safety and Risk Management Department
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 17
(720) 858-6000 bull (800) 421-1834
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
18 Physicians Bulletin MarchApril 2013
(402) 393-3110 Alegent Creighton Health Cancer Center - Bergan
(402) 354-8124Methodist Estabrook Cancer Center
(402) 593-3141Midwest Cancer Center Papillion
(402) 334-4773Midwest Cancer Center Legacy
(402) 941-7030Fremont and West Point
Nationally Recognized in Clinical Trials and Oncology Research by the American Society of Clinical Oncology (ASCO)
Margaret Block MD
M Salman Haroon MD
Ralph J Hauke MD
Timothy K Huyck MD
Robert M Langdon Jr MD
Kirsten M Leu MD
John M Longo MD
Patrick J McKenna MD
Geetha Palaniappan MD
David A Silverberg MD
Gamini S Soori MD
Yungpo Bernard Su MD
Stefano R Tarantolo MD
Peter M Townley MD
Too many patients not enough time
Consider hiring a Physician Assistant
PArsquos practice medicine as a licensed professional with physician supervision
They exercise autonomy in medical decision-making and can
bull take complete medical historiesbull perform physical examinationsbull order and interpret diagnostic studiesbull make diagnosesbull order treatmentsbull write prescriptionsbull assist with surgerybull perform procedures such as stress electrocardiograms sigmoldoscopic exams lumbar punctures suturing lacerations and bone aspirationsbull apply casts and splints to fracturesbull provide emergency treatments for life-threatening situations
NAPA at1335 H Street Ste 100Lincoln NE 68508-3784402-476-1528infonebraskapaorg
medicaloffice building for lease
FOR MORE
INFORMAT ION
CONTACTPart of the CBRE affiliate network
David Barton Steve Sheppard+1 402 334 8877
located next to lakeside hospital
up to 14508 sf
newer construction
ample parking
17055FRANCES STREET
OMAHA NE
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 19
SpeciAL eDitiON Natural Disasters and health care
T he OmAhA DAiLy NewS headlines tell this story ldquoPitiful Scenes on Franklin Strdquo ldquoTwo Babies Blown Out and Killedrdquo ldquoRoy Counsman Missingrdquo
Easter Sunday March 23 1913 ndash a tornado smashed its way though Omaha Its toll 140 deaths 300 injured and estimated damages of more than $5 million
Sixty-two years later another tornado battered Omaha causing three deaths and up to $500 mil-lion in damages This time Civil Defense sirens provided early warnings Survivors told the Omaha World-Herald that they had heard the sirens and had enough time to take cover
ldquoPeople had ample warningrdquo Public Safety Director Richard Roth told the World-Herald ldquoBut even at that itrsquos miraculous we didnrsquot lose morerdquo
Tornadoes and other natural disasters can knock communities at their core Health-care institu-tions must ready themselves for the possibility of disaster This special edition of the Physicians Bulletin examines issues related to health care and natural disasters starting with an emergency room physicianrsquos recollection of how Bergan Mercy staff banded together when the tornado in 1975 blindsided the hospital Learn about how community leaders are banding together to be ready should disaster strike again Finally some advice for health-care institutions for backing up their important data and ensuring access to patient records should disaster strike
When Nature Leaves Its
Calling Card
The Child Saving Institute
sustained considerable
damage in the 1913 tornado
that tore through Omaha
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
20 Physicians Bulletin MarchApril 2013
feature
TO thiS DAy JOe McCaslin MD canrsquot explain how the $1 bill ended up on the front seat of the family station wagon
Dr McCaslin noticed the dollar bill after he made his way through the rubble in Bergan Mercy Hospitalrsquos parking lot ndash rubble left from a tornado that had rocked Omaha earlier in the day He was headed home after a long day of directing patient traffic as Omaha dealt with one of the worst tornadoes to ever blow through town He knew his wife and their 11 children were waiting at home and wondered what he would find when he arrived
First he found his station wagon in the physician parking lot and noticed all the windows were gone Then he noticed the $1 bill
Dr McCaslin 81 recalls the details of that day nearly 38 years later He mostly talks about how the hospital staff led by administrator James John-son rallied to treat patients immediately following the storm and to ensure the safety of its resident patients No one died that day because of injuries suffered when the tornado broadsided the hospital Dr McCaslin recalled
Ironically the hospital had just conducted a disaster drill several months previously True that drill hadnrsquot attracted a crowd of participants but when it came time to react to the real thing hospital staff knew what to do he said Even that drill couldnrsquot prepare hospital staff for what happened that day ldquoDisaster drills donrsquot presume your own hospital is going to get hitrdquo
Several days after the May 6 1975 storm World-Herald writer Al Frisbie
ldquoProud of the Medical Profession that Dayrdquo
Bergan Mercy and the 1975 Tornado
recounted the ordeal ndash as told by a host of hospital staffers including Dr McCaslin and Johnson the hospital administrator Frisbie quoted patients who praised the staff for remaining calm during an obviously stressful stretch of time Frisbie wroteAlltoldthehospitalcaredfor35emergencypatientsTuesdaynight
plusmorethan400alreadyunderitscareOneonlookerviewingthedamageshookhisheadwheninformednot
oneresidentpatienthadbeenkilledorseriouslyinjuredldquoItrsquosamiraclerdquohesaidPerhapsButifsoitwasonebornofpreparationandexecution
andresponsibilitySaidAdministratorJohnsonldquoIcanrsquotpraiseourhospitalpeopleenoughrdquoNeither can Dr McCaslin ldquoEveryone in the hospital seemed to know
what to do The doctors nurses lab technicians X-ray personnel and certainly the administration knew what to do
ldquoThe biggest part of the story is the medical community Doctors nurses X-ray techs nursesrsquo aides just showed up and asked what they could do Some didnrsquot even work at the hospitalrdquo
Before this story continues letrsquos take a moment to explain how Dr McCaslin ended up working in Bergan Mercyrsquos Emergency Room on that Tuesday in May 1975
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
Photo courtesy of Alegent Creighton Health
MarchApril 2013 Physicians Bulletin 21
feature
After finishing medical school and a one-year internship at St Cath-erinersquos (the precursor to Bergan Mercy Hospital) Dr McCaslin joined Dr Harry Sullivanrsquos downtown Omaha family practice in 1957 ldquoThere wasnrsquot emergency medicine when I was a young doctor My intention was to do all I could do I had no intention of specializing I wanted to treat young people old people do surgery and deliver babies Working with Dr Sul-livan I got to do it all He was one of the last of the house-call doctorsrdquo Several years later Dr McCaslin started his own practice in a building near 61st and Ames streets that he shared with a dentist Nine years later Immanuel Hospital was forming a physician group for emergency medi-cine and Dr McCaslin joined them No more house calls ldquoGoing to ER was like a vacation When you worked you worked hard But when your shift was over your work was over until the next time ndash a big change from family practicerdquo He remained at Immanuel until January 1975 when he moved to Bergan Mercy
On that Tuesday McCaslin recalled not being overly concerned about the possibility of a storm Weather forecasting wasnrsquot as sophisticated as it is today he said He recalled chatting with one of the nuns at the hos-pital who asked about his day ldquoItrsquos kind of a slow day Not much going onrdquo he told her
In those days when a tornado watch was issued the hospital announced it over a loudspeaker Hospital staff then followed protocol to prepare for the possibility of a severe storm ldquoIf they announced a tornado warning that meant one was goingrdquo
When the announcement of the tornado watch came Dr McCaslin recalled not giving it much thought ldquoThe truth is you get a lot of tornado watchesrdquo So he kept working Other staffers however were instigating hospital protocol including shutting the window blinds which would prevent glass from blowing through the hospital They also began moving patients
ldquoThen theyrsquore announcing a storm warning It was coming but I never did see itrdquo
Just prior to the storm Dr McCaslin was working on a patient who had come by rescue squad The working prognosis was cardiogenic shock which has a poor prognosis he said The man had no blood pressure or pulse
Dr McCaslin said he heard the warning over the loud speaker to take cover ldquoI couldnrsquot see how I could do that I just kept working on this guyrdquo
When the tornado struck Dr McCaslin and a nurse hit the floor The gurney and their patient were in the line of flying debris They were able to move the gurney ndash and out of harmrsquos way
The World-Herald writer reported that the door where the three were was blown off its hinges ldquoThatrsquos a bit dramatizedrdquo Dr McCaslin recalled
ldquoI remember there was this tremendous noise You could hear this glass breaking at the same time The door didnrsquot get blown off its hinges I think the reporter just couldnrsquot figure out what happened to door ndash so he had it blown off its hingesrdquo
In Bergan Mercyrsquos disaster plan patients ndash walk-ins and those brought by rescue squad ndash were diverted from the emergency room to the main lobby which was set up as a triage station with a physician in charge ldquoIn a disaster you thought the emergency room would be jammed so you started patients elsewhererdquo
From there patients were sent to other locations in the hospital depend-ing on the seriousness of their injuries Some for example were sent to a treatment station set up in surgery others to a station set up in physical therapy ndash which was for those with less severe injuries
For Dr McCaslinrsquos part he stayed in the Emergency Room and triaged patients who still showed up there Several treatment rooms still could be used ndash and a physician and nurse were assigned to each He also directed the physicians and other health-care staff who offered their services
Clean-up crews arrived shortly after the storm hit and began clearing away debris which opened space in the Emergency Room to treat more patients The hospital was operating on generator power which meant some areas didnrsquot have lights
Eventually the public learned that Bergan had been hit Dr McCaslin said and started heading to other hospitals Emergency transports were diverted to other hospitals
The dayrsquos list of heroes should lead with Johnson the hospital adminis-trator and LaVerne Burner who was in charge of nursing services ldquoThey never got their due I was really proud of the medical profession that dayrdquo
ldquoIt was a great team effort that day ndash from the administration on downrdquo Dr McCaslin who retired for the second time in 2010 recalled it was
still light outside when his shift ended The family station wagon had been hit on the side but was still drivable All the windows were gone
On his way home Dr McCaslin recalled the damage near 72nd and Pacific streets was especially daunting On his return he would learn that his wife Theresa had managed to get the 11 children and Dr McCaslinrsquos father who was in his 90s down to the basement Everyone was OK including Theresa who was pregnant with the couplersquos 12th child The family home was not damaged
As for the $1 bill ldquoIt was very wet The old saying that a dollar doesnrsquot go very far didnrsquot hold true that dayrdquo
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
22 Physicians Bulletin MarchApril 2013
feature
a tOrNADO StrikeS OmAhA cAUSiNG damage and potentially casualties Emergency responders representing law enforcement health care and others move quickly to ensure
public safety assess the damage and start the recovery processRest assured because of years of planning Omaha would be ready to respond should a natural
disaster strike said Tom Williams MD a pathologist who has been part of an effort to prepare the community should a disaster strike
The Omaha Metropolitan Medical Response System or OMMRS a consortium that includes representatives from more than 70 local organizations is part of the federal Metropolitan Medical Response System which was founded by the Department of Health and Human Services after ter-rorist attacks in the mid-1990s
ldquoOMMRS is by and large a volunteer effortrdquo Dr Williams said ldquoThe money comes from federal funding and goes directly to benefit the community through training and equipmentrdquo
The MMRS includes 24 of the nationrsquos largest cities and covers 80 percent of the countryrsquos popula-tion The MMRS program was founded in 1996 to improve emergency response in the Washington DC area and then expanded to include Atlanta in preparation for the 1996 Summer Olympics
The Omaha program stands out said Dr Williams a pathologist with the Methodist Pathology Center ldquoOMMRS is a bit unique because it was one of the few developed emergency plans that emerged via a consortium of committees In many cities the planning is done by public safety ndash and health care has more limited input
ldquoWe plan for the expansion of care during difficult times Plans for alternate care sites ndash the needs of hospitals and other health-care systems We plan for the worst-case scenariordquo
Ready If Necessary
The Williams FileHometown
Lincoln
Bachelorrsquos Degree University of Nebraska
Lincoln in chemistry
Medical Degree University of Nebraska
Medical Center
Residency Methodist Hospital in anatomical
and clinical pathology
Specialty Pathology
Location Methodist Pathology Center
Why Joined ldquoTo support medicine locally
and to meet other physicians
in the Omaha areardquo
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
DrTomWilliamsatthe911Com-municationsCenter
MarchApril 2013 Physicians Bulletin 23
feature
He explained that OMMRS consists of 22 committees that focus on such areas as law enforcement equipment and training behavioral health and transportation Local health-care systems have set aside their competitive nature he said to become involved in a common cause preparing to respond to a natural disaster a medical pandemic or a terrorist attack
The organizations involved include the obvious ndash hospitals law enforcement and public safety ndash and a few of the not-so-obvious busing companies veterinarians behavioral health specialists and nursing home administrators OMMRS participates in local emergency disaster drills
Since the Omaha effort began in 2000 its assistance has been needed one time ndash when Hurricane Katrina ravaged the southeast displacing many of its residents Some ended
up in Omaha ndash and the community responded Dr Williams said
Should a natural disaster strike the Omaha area OMMRS members would be called to action ndash via telephone or by amateur radio if necessary to the Douglas County Civic Center Among their responsibilities would be to track casualties and available resources
ldquoWe would conduct ongoing bed counts ndash as one (hospital) fills up we can move resources to another What do we need ndash and whererdquo
Dr Williams encourages physicians to get involved in emergency planning ndash be it with OMMRS or their own organization ldquoAll (health-care institutions) have emergency management committees ndash people who are planning for these eventsrdquo
He also encouraged physicians especially retired ones to get involved with the Medical Reserve Corps Visit httpwwwuwmidlandsorgmedicalreservecorps
Finally he encouraged his peers to have their own emergency plan in place for their families ndash check out wwwreadygov ldquoHave your own family plan in place so you can assist the publicrdquo
For more information about OMMRS visit wwwommrsorg
We protect your peace of mind Itrsquos what we do for medical professionals and specialists We know your organization is unique We are too MMIC provides medical liability insurance coverage and delivers personalized peace of mind Itrsquos a movement and wersquod love to have you join us
Contact your independent agent or broker or go to PeaceofMindMovementcom to see what MMIC can do for you
Be protected stay cool
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
Richard D Vroman
Attorney
Koley Jessen PC LLO
24 Physicians Bulletin MarchApril 2013
feature
T he ef5 mULtipLe-vOrteX tOrNADO that struck Joplin Mo on a late afternoon in May 2011 caught the local hospital in transition as it converted to electronic patient records
ldquoUnfortunately they still had paper records on siterdquo said Rick Vroman a corporate attorney who specializes in health law with the Omaha firm of Koley Jessen
ldquoThose records were strewn for hundreds of miles and found in farm fields and elsewhere following the tornadoesrdquo said Vroman a member of the American Health Lawyers Association
But the tornado which resulted in 158 deaths and left more than 1100 people injured raises questions for health-care systems and their potential liability should disaster strike
ldquoWhat are the issues when a farmer finds a medical record in his fieldrdquo Vroman asked ldquoThere are questions of confidentiality and liabilityrdquo Such liability he said goes beyond the arguable breach of security ldquoWhat liability exists if providers cannot access medical information on their patientsrdquo
HIPAA requires the implementation of reasonable policies and procedures designed to protect the confidentiality security and integrity ndash so information remains accurate ndash of medical records
In Joplin the hospital did not violate HIPAA Vroman said However lessons still can be learned ldquoThis was not an intentional act The question is whether the hospital took reasonable measures to protect information under HIPAA and maybe more importantly to ensure that information was available for use in the aftermath of the disasterrdquo
In Joplinrsquos situation the hospital took appropriate actions The hospital acted reasonably Vroman explained as it had converted to electronic medical records several months prior and presumably had taken reasonable measures to protect the remaining paper records Unfortunately for the hospital and its patients the tornado destroyed the hospital and the paper records were lost
Following the tornado the hospital promptly notified the Department of Health and Human Services as required by HIPAArsquos breach notification rule This rule requires that if a breach occurs patients must be notified the incident logged and HHS notified ldquoThey did thatrdquo By working with HHS and the public the hospital was able to limit the potential damages that could have been caused by the medical information falling into the wrong hands ndash such as identity theft
lsquoWill You be Readyrsquo
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 25
feature
In addition to properly responding to the breach the hospital also had a contingency plan in place and was able to access the electronic medical records following the tornado The hospital was able to treat the townrsquos injured with accurate information available
Vroman encourages health-care organizations to ensure that they have reasonable policies and procedures in place including contingency plans Ask these questions ldquoWhat would we do if our current records were destroyed or lost Do you have a backup system in place Can you access the backup records in a reasonable timerdquo A good contingency plan is not only required by HIPAA but imperative for the provider to be able to access accurate and complete medical records for future treatment
Vroman pointed out that ldquonot all penalties under HIPAA are imposed because of a breach ndash many are imposed due to the lack of policies and proceduresrdquo In most cases the first ques-tion thatrsquos going to be asked in an investigation will be ldquoCan we see a copy of your policies and proceduresrdquo
ldquoWill you be readyrdquo he said
HEARTLANDVEIN amp VASCULARINSTITUTE
heartlandveincom
swollenachylegsleg ulcers
varicose spideramp
To speak with a dedicated specialist from our Health Care Banking Divisioncall Ed Finan at 402-399-5028
FINANCIAL EXPERTISE FOR THE HEALTH CARE INDUSTRY
wwwanbankcom bull 32 locations in Nebraska and Iowa Call 402-457-1077 or 800-279-0007
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
26 Physicians Bulletin MarchApril 2013
Customed Tailored
TO FITYour Practice
Clinical Expertise
Professional and Friendly Service
Convenient Scheduling and Location
501 N 87th Street Omaha NE 68114(P) 402-397-7100(F) 402-505-6949
wwwomahaimagingcom
bull Asset Protection Planningbull Business Succession Planning bull Estate Planning bull Business Structure amp Transactionsbull Retirement Plan Design amp Tax Planningbull Health Care Law
CONTACT US 40250413005332 S 138TH ST SUITE 100
OMAHA NE 68137-2974
Blogs Videos Legal Articles amp Information can all be found at
wwwpvwlawcom
LEGALTECHNOLOGYWITH PERSONAL SERVICEWe are dedicated to legal innovation and have taken steps to make the practice of law a more streamlined accurate and interactive experience
METRO OMAHA MEDICAL SOCIETY PRESENTS
MEDICAL MESS CLUB
Friday April 26 2013Joslyn Art Museum Witherspoon Hall
What is Medical MESS Club Itrsquos a unique evening of entertainment featuring MOMS member physicians
performing musical parodies of popular songs that they have rewritten
with a medical theme
Our MESS performers will once again be led by Chuck Penington Orchestra Conductor for Mannheim Steamroller
630 PM - Reception Hors Drsquooeuvres and Cash Bar
800 PM Performance
ATTENDANCE IS OPEN TO EVERYONE (Medical community friends family and anyone with a sense of humor)
Reservations - $30 per person
RSVP at wwwomahamedicalcomor call 402-393-1415 for reservations
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 27
featurefeature
i t ALL cOmeS DOwN to what is acceptable down time for a health-care organizationA natural disaster strikes ndash causing severe
damage to local health-care organizations including hospitals and private clinics These organizations will quickly need access to their stored data said Nick Bock chief executive officer of Five Nines Technology Group with offices in Omaha and Lincoln and a client list that includes health-care organizations and banks But ldquoquicklyrdquo is a relative term he said
Minimizing Down Time
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
LeftNickBockofFiveNinesTechnologyGroup
BelowDrWilliamLivingstonandhiscolleaguesatMidwestGastrointestinalAssociatesareamongthemedicalclientsthatrelyonFiveNinesforITsupport
28 Physicians Bulletin MarchApril 2013
feature
And how ldquoquicklyrdquo is defined also dictates the costs a health-care orga-nization must spend for immediate access to its data Bock said
These organizations ndash no matter the size and the immediacy of access needed ndash should have a system in place for backing up data and storing it off-site Bock said
Health-care organizations other than hospitals typically need access to data including patient records within 24 hours ndash should something cata-strophic happen at their location The Metro Omaha Medical Society and the Nebraska Credentials Verification Organization are Five Ninesrsquo clients as are Omaha Orthopedic Mid City OB-GYN Midwest Gastrointestinal Associates and Outpatient Surgical Specialties Center
ldquoWhile we might not need access to our data as quickly as a hospital should disaster strike we owe it to our members to be able to assure them that our membership information is kept confidential and secure and is accessiblerdquo said Diane Parsons MOMS executive director
Hospitals Bock explained donrsquot have the luxury of being able to wait 24 hours for access to their stored data They require robust data recovery systems and access within minutes he explained as do banks
Bock uses terms such as ldquowarmrdquo and ldquohotrdquo to describe the degree of immediacy for access to stored data Bock likens the need for a backup data recovery system to insurance ldquoYou donrsquot need insurance until the day your house burns down or you wreck your car Itrsquos an investment but itrsquos money well-spentrdquo
ldquoIt is important for physicians ndash in the same sense that they will take
enough interest in the operations of their practice to make sure it is finan-cially healthy ndash to know and verify their informational technology is backed up and will be available in case of a tornado or a fire burns the building Make sure data are protected by a robust off-site data backup systemrdquo
He added ldquoItrsquos a given that they should have a backup system in place Itrsquos not a given that all of them dordquo
Bock explained the need for companies such as his Many companies are not large enough to justify the expense of having a full-time employee responsible for technology For example a company with 75 employees doesnrsquot need a fulltime IT person ldquoSome still choose to overspend for the luxury of having someone there ndash but not busy all the timerdquo Others outsource
Thatrsquos where companies such as Five Nines come into play Bock said ldquoThese companies take care of what a business needs ndash laptops and desktops servers and the backing-up environment and networking ndash and everything in betweenrdquo They provide 24-hour technical support
Bock said his company also provides specific technical service for its clients He said cardiology practice recently asked Five Nines to optimize its connectivity between the vehicles it uses to service hospitals throughout Nebraska Instead of waiting until its trucks returned home to transmit images technicians can now transmit those images from the vehicles onsite
Bock explained his companyrsquos name Five Nines refers to 99999 per-cent up time ldquoItrsquos a technology term used to measure uptime of servers or networks It refers to high performance and high availability which is what Five Nines is all aboutrdquo
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 29
mOmS events
Coming Events
ApriL 26meDicAL meSS cLUb
perfOrmANceJOSLyN Art mUSeUm witherSpOON hALL
630 PM ndash Reception amp Cash Bar800 PM Performance
mAy 15retireD phySi-
ciANS meetiNGmOmS - 7906 DAveNpOrt St
1000 AMFeaturing Ben Sasse President
Midlands UniversityPresenting ldquoEconomics of Medi-
cine Present and Futurerdquo
mAy 16mOmS OShA SemiNAr
itt techNicAL iNStitUte ndash 1120 N 103 pLz Ste 200
100 PM ndash 430 PM
JUNe 9mOmS member eveNt
At StOrm chASerSwerNer pArk ndash pApiLLiON
100 PM ndash 230 PM Lunch Buffet200 PM First Pitch
call 402-393-1415 for more information or to make reservations for any of these events
877-592-2435 bull 402-592-6914 (fax)wwwmidwestrespiratorycom
Dedicated to providing wellness solutions to the communities we serve in the form of state of the art treatment options education and products
bull Lift Chairsbull Portable Oxygenbull Wheelchairsbull Power Chairs amp Scooters
bull CPAP amp BiPAPbull Trilogy Ventilatorsbull Rampsbull Stairlifts
Serving OmahaLaVista Lincoln Grand Island Blair
Regain the Joy of Reading Vision Helpers has modern solutions to help you
New HD Reading MachinesLighted Magnifiers
Large Print
FREE Showroom or In Home Demo Call 402-491-3191
11110 Fort St |Omaha NE | 68164wwwvisionhelperscom
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
30 Physicians Bulletin MarchApril 2013
mOmS eventsANNUAL meetiNG fiLLeD with Activity
The Metro Omaha Medical Society held its Annual Meeting Jan 24 at the Omaha Marriott The evening recognized outgo-ing members of the Board of Directors and Foundation Board the 2012 MOMS Foundation grant recipient organizations and MOMS 2013 Strategic Partners as well as a check presentation to Food Bank of the Heartland with proceeds from the MOMS Foundation Match Program
Following the recognitions a panel discussion featured repre-sentatives from the arearsquos federal health centers
1 Dr Marvin Bittner MOMS president delivers an unusual and entertaining address to attendees Itrsquos not every event when opening remarks include phrases such as ldquoa suitcase full of speculumsrdquo
2 Dr James Newland outgoing MOMS Foundation chairman was recognized for his dedication and years of service
3 Susan Ogborn president of Food Bank of the Heartland accepts a check for $15906 which was the proceeds from the MOMS Foundation match program
4 Dr Richard Brown chief executive officer of Charles Drew Health Center (left) and Cecelia Creighton execu-tive director of All Care Health Center served as two of the four members on the discussion panel
5 Also serving on the discussion panel were Joel Dougherty chief operating officer of OneWorld Community Health Center (left) and Dr David Filipi board member of HOPE Medical Outreach Coalition
1 2
3
4
5
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 31
mOmS events mOmS eventsmeDicAL LeGAL DiNNer
The Metro Omaha Medical Society and the Omaha Bar Asso-ciation hosted its annual joint event at Champions Run on March 19 Keynote speaker Dr Lee Simmons Chairman of the Omaha Zoo Foundation started off the evening with a joke comparing the event for physicians and attorneys to the difficult balancing act of some of the Henry Doorly Zoorsquos ldquomixed exhibitsrdquo (pairing predators and prey) He went on to entertain the full house with stories from his years of adventures
1 Dr Jack Lewis Dr Lee Simmons and Dr Paul Sherrerd conversed during the networking reception
2 Michaela Harper and Dr James Harper were in attendance
3 Tom Brush a third year medical student Dr Jane Dahlke Kyoko Fuller and Dr Jonathan Fuller visit before dinner
4 Dr Deb Esser MOMS President-Elect started the pro-gram by welcoming members of both organizations and thanking the MOMS event sponsors
5 Dr Lee Simmons injected humor as he shared storiesmdashthat stretched over decades and around the globemdashof his work as director of the Henry Doorly Zoo
1
2
3
4 5
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
member news
32 Physicians Bulletin MarchApril 2013
Gene Herbek MD
Dr Herbek is incoming CAP President
G eNe herbek mD whO has practiced anatomic and clinical pathology at Methodist Hospital since 2004 will take office in October as president
of the College of American Pathologists (CAP) ldquoAs CAP president I hope to make pathologists better known to patients medi-
cal colleagues hospital administrators and policy makers by educating them on our role in patient carerdquo says Dr Herbek
Dr Herbek has been involved in CAP throughout his professional career He has served as chairman of the Finance Committee and Audit Subcommittee He has served as a member of the Collegersquos Compensation Committee Executive Com-mittee Governance Committee and Investment Subcommittee He also served as chair of the CAP Political Action Committee the CAP Council on Membership and Public Affairs and as vice-chair of the CAP Council on Scientific Affairs
At the CAP annual meeting in 2005 Dr Herbek received the CAP Outstanding Communicator Award established in honor of William H Kuehn PhD for his efforts to raise public awareness about the role that pathologists play in both determining the cause of illness and in the preventive health care available to patients He was also awarded the CAP Presidentrsquos Honors Award in 2001 and 2004 In addition Dr Herbek was recognized at the Collegersquos annual meeting in 2004 for his outstand-ing efforts dedication vision and support of the CAP Foundationrsquos Humanitarian Grant Program He is a past recipient of the CAP Foundationrsquos Lansky Award
As CAP President Dr Herbek who will serve a two-year term plans to ldquofocus on improving the CAP Laboratory Improvement Program with CAP members and staffrdquo His other goals include supporting CAP members in their various practice settings by promoting practice enhancement skills beyond the traditional pathologist skills while maintaining the support of traditional pathologist roles
ldquoI plan to work to form solid relationships with other pathology and medical organizations to advocate for patients and pathologists in a changing health care environment at local and national levelsrdquo he said
Audrey Paulman MD
Dr Paulman involved in study aimed at reducing Medicare costs
a UDrey pAULmAN mD A UNMC family medicine physi-cian was involved recently in a statewide effort aimed at
lowering costs in Medicare patients by reducing hospitalizations and re-hospitalizations
Dr Paulman serves as principal clinical coordinator for CIMRO of Nebraska the Medicare Quality Improvement Organization (QIO) for the state of Nebraska CIMRO works with health-care organizations to assure that services delivered are appropriate safe and high quality and that consumers are educated about their rights and what can be done to ensure they receive the right care at the right time every time
In her position with CIMRO Dr Paulman was involved in a study that appeared in the Jan 23 issue of the Journal of the American Medical Association The study determined that hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interven-tions with communities
The study showed how state-based QIOs funded by the Medicare program systematically coordinated community-based efforts to improve the quality of care transitions and avoid costly readmissions
CIMRO of Nebraska is one of the 14 state-based QIOs that received funding from the Centers for Medicare amp Medicaid Services (CMS) to participate in the project
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 33
member news
Kevin Garvin MD
Dr Garvin makes it all
three
K eviN GArviN mD prOfeSSOr and chair of the Department of Orthopaedic Surgery
and Rehabilitation was elected into membership of the International Hip Society Dr Garvin is the first and only orthopaedic surgeon from Nebraska to be a member of the International Hip Society The Hip Society and The Knee Society three of the most pre-eminent groups in the field of orthopaedic surgery
8901 Indian Hills Drive Suite 200
Omaha NE 681144023977057
or 4025043880
17001 Lakeside Hills Plaza Suite 200Omaha NE 681304028858700
Midwest Gastrointestinal Associatesrsquo dedicated endoscopy centers perform thousands of procedures annually This allows our team of GI professionals to provide the highest quality of care at the lowest cost in the region To learn more about screening colonoscopy and other GI issues visit our website at midwestgicom
Tyron A Alli MD
Alexander B Bernal MD
Douglas E Brouillette MD
John J Cannella III MD
Jason J Cisler MD
Joshua T Evans Sr MD
John J Ferry MD
Kimberly S Harmon MD
Michael B Jones MD
William C Livingston DO
Thomas R McGinn MD
Matthew M McMahon MD
John C Mitchell II MD
Trevor J Pearson MD
Edwin C Schafer MD
Michael E Schafer MDMarc A Scheer DOBradley J Schroeder MD
Brian W Ward MD
Steven D Wilkening MD
midwestgicom
Wersquore Making Healthcare a Little Easier to Digest
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
CAMPUS update
34 Physicians Bulletin MarchApril 2013
Resident and fellow training
programs implement new
system
T he NeXt AccreDitAtiON SyStem touted to possibly be the biggest change in medical
education in more than 100 years will change how resident physicians and fellows are trained
It goes into effect across the country in July 2013 with seven specialties ndash internal medicine pediatrics emergency medicine neurosurgery radiology urology and orthopaedic surgery ndash being the first to implement the system
By July 2014 all 23 medical specialties and their fellowships will implement the NAS
ldquoThis is a well overdue paradigm shiftrdquo said Kelly Caverzagie MD assistant professor internal medicine for the University of Nebraska Medical Center Dr Caverzagie is a member of UNMCrsquos Graduate Medical Education Committee which
is working closely with the UNMC Center for Continuing Education to implement the system
With NAS residents will be evaluated on their achievement of educational outcomes called Milestones categorized by six different general competencies
bull Patient carebull Medical knowledgebull Interpersonal and communication skillsbull Professionalismbull Practice-based learning and improvement andbull System-based practice
Dr Caverzagie said the new system will take away the subjectivity of evaluating residents ldquoIt will define the outcomes that we expect our residents to accomplishrdquo he said ldquoIt gives them the direction they need to move forward It is a very meaningful change that really makes senserdquo
He said the new system is being introduced because there is evidence that residency pro-grams are training physicians who are not ready to function in our increasingly complex health care system
Residents will need to achieve these milestones that will be spelled out to them over the course of their training Dr Caverzagie said
ldquoIt no longer will be good enough to be the
top resident in your classrdquo Dr Caverzagie said ldquobecause that could mean that you are merely the best of an incompetent grouprdquo
Cancer guidelines to help
adolescents and young girls
a UNmc peDiAtric ONcOLOGiSt peter Coccia MD served as chairman of a
national panel that developed patient guidelines to help guide adolescents and young adults with cancer through diagnosis treatment and after therapy
These guidelines answer patients and their familyrsquos most common questions related to how to prepare for treatment what to ask the doctor and explain the most common medical terms
ldquoThe adolescent and young adult (AYA) group includes individuals between the ages of 15 to 39 and represents a challenging age group for oncologists to treat successfullyrdquo Dr Coccia said
The guidelines were developed through the National Comprehensive Cancer Networkreg (NCCN) The UNMC Eppley Cancer Center at The Nebraska Medical Center is a charter member of the NCCN
Creighton Receives
Department of Defense
Grants
T he DepArtmeNt Of DefeNSe (DoD) announced the approval of more than $650000 in grants
to help Creighton University researchers continue their work toward developing an improved treat-ment approach for prostate cancer
Yaping Tu PhD associate professor of phar-macology was awarded more than half a million dollars to design a new drug that will block the growth of prostate cancers and keep them from spreading to other parts of the body He will collaborate with Peter Abel PhD professor of pharmacology and Poonam Sharma MBBS
associate professor of pathology to expand on previous research also funded by the DoD in which he identified two genes at work in the development of prostate cancers
ldquoBecause the Department of Defense only funds about four percent of applicants they want to make sure we are studying something that has a real-world applicationrdquo Dr Tu said ldquoWe hope to potentially have a drug to test on advanced prostate cancers in the next three to five yearsrdquo
Creighton to host Pulmonary
Critical Care and Sleep
Medicine Conference
c reiGhtON UNiverSity wiLL SpONSOr the ninth annual Pulmonary Critical
Care and Sleep Medicine Conference on April 19-20 at the Omaha Marriott Regency The conference is designed to enhance attendeesrsquo clinical competence in the diagnosis and treat-ment of select pulmonary critical care and sleep medicine diseases
The two-day conference is split into sessions
based on topic and covers an array of subjects in these fields During three sessions on sleep medicine attendees will discuss obstructive sleep apnea the science of circadian rhythms the neurocognitive consequences of sleep depriva-tion and new advances in the treatment of sleep apnea beyond the CPAP An optional workshop will help clinicians with CPAP mask selection fitting and troubleshooting
Two sessions will focus on pulmonary medi-cine including a pharmacy update new asthma therapies whatrsquos new in COPD pulmonary rehabilitation and recent controversies in patients with pneumonia The two sessions on critical care will address the roles and responsibilities of providers when dealing with suicidal patients how to evaluate and treat delirium in the ICU the pathophysiology of sepsis and recent advances in the care of patients with neurologic injury
The cost of the conference is $175 for physi-cians nurse practitioners physician assistants and pharmacists and $75 for fellows residents and full-time students Continuing education credits are available
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 35
wwwtheVNAcaresorg
VNA is one of the arearsquos largest providers of IV therapy in the home Our highly skilled team of Pharmacists IV Technicians Registered Dietitians and Certified Infusion RNs offer comprehensive patient care to improve patient outcomes
bull Specialize in providing safe efficacious evidence-based nutrition support for parenteral and enteral nutrition patients
bull ASPEN and Board of Pharmacy Specialties Certified Nutrition Pharmacist
bull Provide a full range of drugs that can be safely administered in the home
bull Telehealth in-home health monitor for daily monitoring of patients
bull Joint Commission accredited since 2005
Contact Laura Grothe PharmD BCNSP at 402-342-5566 to learn more
VNA INfusIoN PhArmAcy
EXPECT MORE FORYOUR PATIENTS
STRATEGIC PARTNERS
Metro mahaMedical Society
The Metro Omaha Medical Society Strategic Partners offer products and services that are of value to our member physicians
Many of our member events and membership benefits are made possible by these partner organizations
We encourage you to talk with our Strategic Partners when making decisions
for yourself or your practice
PLATINUM PARTNERS
BRONZE PARTNERS
GOLD PARTNER
SILVER PARTNERS
wwwCallCopiccom wwwFosterGrpcom
wwwGoNinescom
wwwYourFutureCountscom
wwwKoleyJessencom wwwSeimJohnsoncom
wwwLutzCPAcom wwwNebMedcom
For more information on our Strategic Parnters visit wwwomahamedicalcom
wwwNebraskaSpineHospitalcom wwwTsyscomtms
Molly Maidrsquos private label cleaningproducts are environmentally safe biodegradable and non-toxic
Itrsquos healthier for my family the products are all natural cleaners and disin-fectants I donrsquot worry about fumes residue or build up
Irsquom doing my part to help the environmentEven the smallest contributions can make a big difference over time
Molly Maidrsquos ldquoSmall Efforts Big Resultsrdquo brochure provide additional informa-tion about creating a more green friendlyhome
People always notice how clean and fresh my home is now Irsquom proud totell them itrsquos also a Molly Maid Green Home
1
2
3
4
5
Molly Maid clean is now green
5
Trust Molly Maid to clean your home so thoroughly people are guaranteed to notice
Each franchise independently owned and operated
Reasons why it makes sense
For a Cleaning Plan designed aroundyour home and your lifestyle
Call your Local
MOLLY MAID OF CENTRAL OMAHACOUNCIL BLUFFS
402932MAID (6243)A clean you can
trust
cathytichymollymaidcom
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
36 Physicians Bulletin MarchApril 2013
Applicationfor Membership
This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the NebraskaMedical Association (NMA) I hereby consent and authorize MOMS to use my application information that has beenprovided to the MOMS credentialing program referred to as the Nebraska Credentials Verification Organization (NCVO)in order to complete the MOMS membership process
Personal Information
Last Name _____________________________ First Name _______________________ Middle Initial ______Birthdate_________________________________________________ Gender Male or Female
ClinicGroup __________________________________________________________________________________Office Address ________________________________________________________________ Zip __________Office Phone ____________________ Office Fax ___________________ Email _________________________Office Manager _______________________________________ Office Mgr Email ________________________
Home Address ____________________________________________________ Zip ________________________Home Phone __________________________________________ Name of Spouse ________________________Preferred Mailing Address Annual Dues Invoice Office Home Other __________________________________ Event Notices amp Bulletin Magazine Office Home Other __________________________________
Educational and Professional Information
Medical School Graduated From __________________________________________________________________Medical School Graduation Date ____________________ Official Medical Degree (MD DO MBBS etc) _______Residency Location _____________________________________________ Inclusive Dates _________________Fellowship Location _____________________________________________ Inclusive Dates _________________Primary Specialty ______________________________________________________________________________
Membership Eligibility Questions
YES NO (If you answer ldquoYesrdquo to any of these questions please attach a letter giving full details for each)
Have you ever been convicted of a fraud or felonyHave you ever been the subject of any disciplinary action by any medical society hospital medical staffor a State Board of Medical ExaminersHas any action in any jurisdiction ever been taken regarding your license to practice medicine(Including revocation suspension limitation probation or any other imposed sanctions or conditions)Have judgments been made or settlements required in professional liability cases against you
I certify that the information provided in this application is accurate and complete to the best of my knowledge
_____________________________________ ___________ Signature Date
Mail Application toMetro Omaha Medical Society
7906 Davenport StreetOmaha NE 68114
Fax Application to402-393-3216
Apply Onlinewwwomahamedicalcom
B
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
MarchApril 2013 Physicians Bulletin 37
New member update
Interested in becoming a MOMS Member
Call 402-393-1415
apply online at
wwwOmahaMedicalcom
or complete the application
on page 36
NEW MEMBERSRobert Lindau III MD Head and Neck Surgery
Samuel Medaris MD Otolaryngology
Pablo Palomo MD Pediatric Gastroenterology
Chad Reade MD Internal Medicine
Jean Thomsen MD Anatomical amp Clinical Pathology
Joby Varghese MBBS
Anesthesiology
Dustin Volkmer MD Orthopedic Sports Medicine Surgery
Joshua Woelk MD Obstetrics and Gynecology
Judy Wolpert MDMedical School
Creighton University
School of Medicine
Specialty Dermatology
Location Dermatology Specialists of Omaha
Dr Wolpert (formerly Judy Wong) is newly married She recently moved back to Nebraska from Vermont where she completed dermatology training
She and her husband Joseph Wolpert MD received numer-ous kitchen gadgets as wedding presents and have had a wonder-ful time using family members as guinea pigs to test out the culinary creations from such appliances as the Panini-maker slow-cooker steamer and juicer Now all they need is more counter space
Aishwarya Patil MBBSMedical School
Government Medical
College Miraj India
Specialty Physical Medicine and Rehabilitation
Location Immanuel Rehabilitation
Center Omaha
Dr Patil is a world traveler She is captivated by the National Parks and enjoys hiking in the parks across the United States with her husband Amol Having done her internship and residency in Milwaukee and New York she is happy to call Omaha her home
Jeremiah Ladd MD Medical School
University of Nebraska Medical Center
Specialty Physical Medicine and Rehabilitation
Location Nebraska Spine Center LLC
Dr Ladd has traveled to Africa Central America and South America for medical missions work and hopes to continue international medical missions in the future
He also says he ldquobleeds Husker redrdquo and believes there is no better thing than college football Saturdays in Lincoln
Marc Scheer MD Medical School
Nova Southeastern University
Specialty Gastroenterology
Location Midwest Gastrointestinal
Associates PC
Dr Scheer was born and raised in Toledo Ohio He completed his internship and residency in internal medicine at Northwestern University (Evanston Hospital) before moving to Omaha where he recently com-pleted his fellowship at UNMC
In his free time he enjoys short- and long-distance running including marathons He also plays a defensive position on a recreational ice hockey team and pitches for the Midwest GI slow-pitch softball team
He and his wife enjoy spending time with their three children taking them to the zoo or going to the Orpheum Theater for plays and musicals EditorrsquosNoteDrScheerrsquos
profilewasincludedintheJanuaryFebruaryissueoftheBulletinbuthadanincorrectphoto
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
38 Physicians Bulletin MarchApril 2013
Selecting a builder is as much an expression of taste as it is a statement of confidence No one understands this better than Curt Hofer amp Associates As one of the arearsquos most respected custom homebuilders we provide a one-of-a-kind experience in creating your once-in-a-lifetime home
Your wants your needs your style your preferences ndash everything we do at Curt Hofer amp Associates is advanced with the thought of you in mind That means spending time with you from the very beginning and at every step along the way
From individual rooms to how these rooms come together to create a home to the landscape and exteriors that immediately bid you welcome the team at Curt Hofer amp Associates knows how to bring the best ideas to life ndash yours The result Your homeyour builder Exceptional
CURTHOFER
amp A S S O C I A T E SYour homeyour builder Exceptional
2332 Bob Boozer DriveOmaha NE 68130
Phone 4027580440n
wwwcur thofercom
Your homeyour builder Exceptional
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
A REVOLUTIONARY HEART PROCEDURE THAT GIVES PATIENTS WITHOUT OPTIONS WHAT THEY NEED AN OPTION
Alegent Creighton Health Heart amp Vascular Institute stands alone as the highest quality program in the Omaha-Council Bluffs metro area And we are the only heart program in Omaha to offer TAVR a new technology for treating aortic stenosis For hear t patients with severe aor tic stenosis where traditional open-hear t surgery is generally not an option we have TAVR (Transcatheter Aor tic Valve Replacement) Itrsquos a new revolutionary minimally invasive technique with major benef its ndash no chest wall incision no hear t-lung machine a shor ter procedure with earlier ambulation and a shor ter hospital stay Itrsquos all par t of Alegent Creighton Healthrsquos larger vision to be at the leading edge of cardiology by providing consistent care with extraordinary outcomesndashand then going even fur ther Because we like you want to get patients back to their lives and the things that matter most And thatrsquos what makes healthcare healthier To learn more about TAVR call Dr Satpathy at Alegent Creighton Health Hear t amp Vascular Institute at 402-398-5880 Or visit AlegentCreightoncomHear t
058428 Alegent TAVR Ad Physician Bulletin | 8375 x 10875 | 125 bleed 10-25-12
1-800-ALEGENTAlegentCreightoncom
Bergan Mercy Creighton University Medical Center Immanuel Lakeside MercyCouncil Bluffs MidlandsPapillion
Ruby Satpathy MD
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM
PRSRT STDUS POSTAGE
PAIDPERMIT NO 838
OMAHA NE
Metropolitan Omaha Medical Society 7906 Davenport Street Omaha NE 68114
ADDRESS SERVICE REQUESTED
ChildrensOmahaorg
One number accessesneonatal and pediatric transportany problem anytime
1855850KIDS (5437)Physiciansrsquo PriOrity Line
your 24-hour link to pediatric specialists for physician-to-physician consults referrals admissions and transport service
PhysiciansBulletinFNL Mar 2013indd 1 22713 112 PM