5220 California Ave S.W., Suite B / P.O. Box 16486 Seattle, WA 98116-0486(206) 937-5358 FAX (206) 933-6529 / www.woma.org

Summer 2011

Washington D.O.

OMM CMEat PNWU

WOMA is presenting its annualOMM fundraising seminar to benefitthe Washington Osteopathic Foundationat the Pacific NW University of HealthSciences College of OsteopathicMedicine on September 17th. MelicienTettambel, DO, Chair, OsteopathicPrinciples and Practice at PNWU, isprogram chair and has assembled avery interesting day of lectures and labtime on the topic of OMM in SportsMedicine.

Topics include running mechanicsand footwear, nutrition, physiatry, andprolotherapy. Dr. Tettambel will provideosteopathic sports medicine archiveswith lab time. We are grateful to thefaculty, Lisa Griffith, DO, LindaWelch, DO, Kathaleen Briggs Early,PhD, John Long, DO and Dr.Tettambel for volunteering their time tohelp raise funds for the WashingtonOsteopathic Foundation.

Registrants will lunch with thePNWU class of 2015 and are invited toattend the White Coat Ceremony at theCapitol Theatre after the seminar.

Registration brochures have beenmailed and emailed or are available onWOMA’s website, www.woma.org.Blocks of rooms at the PNWU rate arereserved at the Oxford Suites (509-457-1000) and Ledgestone Hotel (509-459-3151)

At its annual Awards and DinnerAuction on June 25th, Mark Hunt, DOwas announced as WOMA’s 2011Physician of the Year.

He has had some pretty big shoes tofill with WOMA, as his father, EugeneHunt, DO, was WOMA’s longest-serving Treasurer. Mark started out asa student member in 1978 and graduatedfrom the Kirksville College ofOsteopathic Medicine in 1980. Uponcompletion of his residency in 1983, hereturned to Seattle to practice andbecame an Active member of WOMA.He served as Chief of Staff atShorewood Osteopathic Hospital andChair of the Anesthesia Department ofAuburn Hospital. He served two termson the Board of Osteopathic Medicineand Surgery.

In 1984, he was elected as a DistrictTrustee and went on to serve in severalcapacities, including President. Evenafter his presidency was completed, hestayed involved by serving on severalcommittees and participating inWOMA’s premed forums. He iscurrently serving his fourth year as yourSecretary and regularly attends andactively participates with the PublicAffairs Committee.

He has served his churchcommunity well as lector, greeter and

2011 Physicianof the Year

Mark Hunt, DO

Eucharistic Minister, served many yearsas a member and chair of the his churchschool commission, and currently servesas chair of the parish finance council.Politically, he has actively participatedin WOMA’s Public Affairs Committeeand served many years as a PrecinctCommittee Officer in the 33rd legislativedistrict.

He and his wife Ginny have fourgrown children.

Governor Christine Gregoire hasappointed Robyn Phillips-Madson,DO as the osteopathic physicianrepresentative on the Robert BreeCollaborative.

The 2011 Legislature passed HouseBill 1311, establishing the Collaborativeto provide a mechanism through whichpublic and private health carepurchasers, health carriers, andproviders can work together to identifyeffective means to improve quality healthoutcomes and cost-effectiveness of care.Although not included in the originallegislation, at WOMA’s request aposition for an osteopathic physicianwas added.

The collaborative will identify andreview certain high-variation or high-utilization health care services inWashington state that do produce bettercare outcomes for patients. It willconsider and develop strategies thatpromote improved care outcomes, suchas patient decision aids, providerfeedback reports, centers of excellenceor other provider qualification standards,and research to improve care qualityand outcomes. The Collaborativeconsists of twenty members, withconsideration given to geographicrepresentation, gender, and ethnic andcultural diversity of workgroup membersthemselves and experience in servingdiverse populations.

Bree Appointment

Robyn Phillips-Madson, DO, MPH

Page 2 Summer 2011 Washington D.O.

5220 California Ave SW, Suite BPO Box 16486

Seattle, WA 98116(206) 937-5358

Fax (206) 933-6529www.woma.org

WOMA Executive CommitteePresident

Stan Flemming, DOPresident-Elect.

Lyndsey Rasmussen, DOVice PresidentMarc Cote, DO

SecretaryMark Hunt, DO

TreasurerSteve Leifheit, DO

Immediate Past PresidentDan Wolf, DO

Government Relations RepresentativeDavid Knutson

Executive Director/EditorKathleen S Itter

Foundation BoardPresident

David Lukens, DOVice President

Loren H Rex, DOSecretary

Lindy Griffin, DOTreasurer

Dan Dugaw, DO

The “Washington DO” is the official pub-lication of the Washington OsteopathicMedical Association, published in Febru-ary, May, August and November. Mem-bers are encouraged to submit articles forpotential publication. Signed columnsare, in all cases, the opinion of the author.For advertising information, please con-tact the WOMA executive offices at (206)937-5358. Deadlines for ads and articlesare the 10th of the month preceding thepublication.

New MembersWelcome

The following applications formembership were approved by theWOMA Board of Governors at theirquarterly meeting held June 22, 2011:

ActiveKathleen Farrell, DO AZCOM’02JP Maganito, DO DMU’05Tony Pham, DO KCOM’99Molly Slate, DO DMU’02Cheryl Snyder, DO COMP’91Tammy Starr, DO MSUCOM’05

StudentAndrea James ATSU-AZ’14Ryan Hoff COMP’14Quynh Le PNWU’15

Status Change toLife MemberJohn Allen, DODaniel Brzusek, DOJohn Fackenthall, DOGary Gaffield, DOKarl Johnson, DOPeter Kilburn, DO

2012 WOMA LeadersAt its annual meeting held June 24,

2011 at the Semiahmoo Hotel andConference Center, the WOMAmembership elected the following toassume leadership positions on January1, 2012.

President Lyndsey Rasmussen,DO; President-elect Marc Cote, DO;Vice President Scott Fannin, DO,Secretary Mark Hunt, DO, TreasurerSteven Leifheit, DO and ImmediatePast President Stan Flemming, DO.

Trustees elected for two yearpositions are District 1 MischaColeman, DO; District 2 Dan Wolf,DO and David Farrell, DO; District 3David Lukens, DO and Tom Shelton,DO; District 4 Amber Figueroa, DO;District 5 Lynda Williamson, DO;Public Affairs Chair Lindy Griffin, DOand Institutional Representative RobynPhillips-Madson, DO.

Dr. Rasmussen will be makingcommittee appointments in the comingmonths. If you have an interest in servingon the Public Affairs Committee or theEducation Committee, please contactExecutive Director Kathie Itter atkitter@woma.org or call 206-937-5358for more information.

WOMA is please to welcome thefollowing new active members:

Kathleen Farrell, DO is a 2002graduate of the Arizona College ofOsteopathic Medicine. Herpostgraduate training took place atCentral Washington Family Medicineand St. James Hospital, Olympia Fields,IL. She practices Family and AddictionMedicine in Sequim.

JP Maganito, DO graduated fromDMUCOM in 2005. He completed hispostgraduate training at BotsfordHospital, where he served as chiefresident. He practices obstetrics andgynecology in Yakima.

Tony Pham, DO is a 1999 graduateof KCOM. He completed a familypractice residency at Via Christi,Riverside Medical Center in Wichita,KS. He is in practice in Seattle.

Getting to Know YouMolly Slate, DO graduated from

DMU in 2002. She completed apediatric residency at the University ofNew Mexico and is a pediatric hospitalistin Yakima.

Cheryl Snyder, DO graduated fromCOMP in 1991. She completed anemergency medicine internship atBrentwood Hospital in Cleveland in1992. She is currently AssociateProfessor of Clinical Skills at PNWUand Medical Director/professor of theParamedic Program at Columbia BasinCollege in Pasco.

Tammy Star, DO is a 2005 graduateof MSUCOM. She served herinternship and residency in obstetricsand gynecology at Genesys RegionalMedical Center, Grand Blanc, MI. Shepractices at Peace Health in Bellingham.

MeetingNotices

The WOMA Board of Governorswill have a dinner meeting at 7:00 p.m.,Friday, September 16th in Yakima.The Washington Osteopathic Foun-dation Board will meet prior to theWOMA Board, at 6:30 p.m.

Washington D. O. Summer 2011 Page 3

Effective August 15, 2011, severallicensing fees for osteopathic physiciansand osteopathic physician assistants willbe reduced. The law requires that eachprofession is self-supporting and directsthe Department to collect fees to paythe cost of regulating the profession.The cost to administer the osteopathicprofession has been consistently belowthe existing fee revenues, due toreductions in administrative andregulatory costs and activities that includecredentialing, complaint intake anddisciplinary activities.For osteopathic physicians:Endorsement application is reduced from$800 to $600Active license renewal is reduced from$750 to $600Active late renewal penalty is reducedfrom $300 to $250Active expired license reissuance isreduced from $300 to $250Inactive license renewal is reduced from$500 to $350Inactive late renewal penalty is reducedfrom $250 to $175Endorsement/state exam application isreduced from $900 to $500Limited license application is reducedfrom $350 to $325Limited license renewal is reduced from$325 to $300For osteopathic physicianassistants:Application fee is reduced from $350 to$250Renewal fee is reduced from $325 to$250Late renewal penalty is reduced from$162.50 to $150All other fees remain the same.

WOMA did provide the followingcomments for the fee reduction hearing.“Looking at the projected revenuethrough 2023, it appears that littleincrease in the number of osteopathicphysicians is anticipated. There arecurrently three osteopathic schools withtraining programs in Washington State.Conservatively speaking, you cananticipate that starting in 2015, aminimum of 50 of these students eachyear will be new licensees in Washington.From 2015 to 2023 you can expect anincrease of 450 new osteopathicphysicians. And that does not includeadditional DOs who are being recruitedfrom other states by new trainingprograms being established inWashington. Perhaps you could reducethe active license renewal fee another$50 to $100.

Blake Maresh, Executive Directorfor the Board of Osteopathic Medicineand Surgery replied,” I did check withour budget director and he said that theydo build in an increase in the numbers oflicensees, but only through the first 6years. His reasoning is that it becomesmore difficult and speculative to continuethe assumptions around the rate ofincrease into years 7-10. I did makesure to share with him both the projectedenrollment numbers at PNWUHS andthe rate at which students who do theirundergrad and post grad in a localitytend to stay in that locality to practice. So he’s aware of that for futurecalculations.”

WOMA will continue to monitor thesurplus funds and request furtherreductions if they do not deplete withthe new fees.

License Fees Reduced Retired ActiveLicense Pursued

When the moratorium on new rulesexpires in December, WOMA willresume its pursuit of a Retired Activecredential for osteopathic physicians.The new credential will likely mirror therecently amended Retired Active rulesadopted by the Medical QualityAssurance Commission for allopathicphysicians.

The newly amended rules now applyto other specialties besides primary careand the limit to practicing 90 days in acalendar year is removed. They mayvolunteer services in emergent orintermittent circumstances and may notreceive compensation for health careservices. “Emergent” is defined as acircumstance calling for immediateaction. “Intermittent” means providingservices on a part-time or full-timenonpermanent basis.

The commission determined thatphysicians with a retired active licensemust keep up with the emergingstandards of practice in their specialtiesin order to provide the best possiblecare to their patients, so the RetiredActive licensee must meet the sameCME requirements as those with activelicenses. The license fee is about half ofthe active license fee.

Medical RecordCopy Charges

How much can a medical provider chargefor searching and duplicating medicalrecords?RCW 70.02.010(15) allows medicalproviders to charge fees for searchingand duplicating medical records. Thefees a provider may charge cannotexceed the fees listed below:Effective July 1, 2011 through June 30,2012.(1) Copying charge per page:(a) No more than one dollar and fourcents per page for the first thirty pages;(b) No more than seventy-nine cents perpage for all other pages.(2) Additional charges:(a) The provider can charge a twenty-three dollar clerical fee for searchingand handling records;(b) If the provider personally editsconfidential information from the record,as required by statute, the provider cancharge the usual fee for a basic officevisit.

A prescription is an order formedication which is dispensed to or foran ultimate user. A prescription for acontrolled substance, all classes, mustbe dated and signed on the date whenissued. The prescription must includethe patient’s full name and address, andthe practitioner’s full name, address andDEA registration number. Theprescription must include:Drug NameStrengthDosage formQuantity prescribedDirections for use

Valid Written Prescription RequirementsNumber of refills (if any) authorized

A prescription for a controlledsubstance must be written in ink orindelible pencil or typewritten and mustbe manually signed by the practitioner onthe date when issued. An individual(secretary or nurse) may be designatedby the practitioner to prepareprescriptions for the practitioner’ssignature.

The practitioner is responsible forensuring that the prescription conformsto all requirements of the law andregulations, both federal and state.

Page 4 Summer 2011 Washington D.O.

Prescription drug misuse is a na-tional and local problem. It has causedan alarming growth in overdose deaths,hospitalizations, admissions for sub-stance abuse, and non-medical use. InWashington, deaths involving uninten-tional prescription pain reliever over-doses increased nearly 21-fold from 24in 1995 to 490 in 2009. In the pastdecade, the numbers of hospitalizationsfor prescription pain reliever depen-dence and abuse have doubled, hospi-talizations for methadone poisoning haveincreased five-fold, and poisoning hos-pitalizations from other prescription painrelievers have increased four-fold.

The Washington State Departmentof Health is implementing a PrescriptionMonitoring Program (PMP) to addressthis problem by collecting all records forschedule II, III, IV, and V drugs. Pre-scribers and pharmacists will be able touse this information as a tool in patientcare.

The state health department held apublic hearing June 27, 2011 for theproposed program rules. The rules be-come effective in late August 27, 2011.

The proposed rules and more informa-tion (www.doh.wa.gov/hsqa/PMP/rules.htm) are available online. The ten-tative plan is to start collecting dispens-ing data in October 2011. Over thesummer, a data submission manual willbe developed, along with other re-sources to help dispensers with thisprocess. The system is expected to beready to receive and respond to re-quests from prescribers and other sys-tem users by January 2012.

This program will affect practitio-ners in two different ways. First, anypractitioner who dispenses controlledsubstances from their office must submitthose records to the state health depart-ment. Practitioners do not have to re-port any prescribing or administering ofcontrolled substances — only dispens-ing. The draft rules require weekly datasubmission using electronic methods. Ifa practitioner does not have the neces-sary software to submit the requiredfiles there will be an online submissionform that can be used to report indi-vidual dispensing records.

Washington’s Prescription Monitoring Programby Mike Quirk, DO, PMP Advisory Committee

The second impact of the projectactually is a tool to improve patient careand work to assure patient safety. Prac-titioners may request prescription his-tory reports for their patients from theprogram. They will be able to accessthis information online 24 hours a day,seven days a week anywhere that a userhas Internet access. The informationprovided will allow a practitioner tolook for duplicate prescribing, misuse,drug interactions, and other potentialconcerns. By having this informationavailable before prescribing or dispens-ing, a practitioner can provide improvedcare to their patients.

The program websitewww.wapmp.org provides more in-formation and an option to receive up-dates through a listserv. You can alsocontact PMP Director ChrisBaumgartner at 360-236-4806prescriptionmonitoring@doh.wa.gov.

(Mr. Baumgartner will provide moreinformation on the program at WOMA'sWinter Seminar on December 3rd inSeattle.)

The AOA held its annual businessmeeting in Chicago, Illinois from July 15to July 17, 2011. Membership includesnearly 75,000 physicians and 16,000osteopathic medical students. Fifty di-visional societies and 23 specialty col-leges were represented by 623 del-egates and alternates. WOMA was rep-resented by Drs. Dave Lukens, PaulEmmans, Jr., Lindy Griffin, HaroldAgner, and our PNWU student repre-sentative Whitney Fix-Lanes. Dr.Emmans served on the CredentialsCommittee,

The Annual Report of the AOA waspresented by Executive Director JohnCrosby, JD. Highlights of his presenta-tion are summarized below, with addi-tional details available at www.do-online.org. 1) “Colleagues in the allopathic worldbelieve we are entering a transforma-

AOA House of Delegates Meetingby Harold Agner, DO, WOMA Delegate

tional era in medicine - The dawn ofosteopathic medicine” 2) AOA Clinical Assessment Pro-gram is helping D.O.s measure theirperformance and can earn a paymentbonus 3) Transforming the mission of theJAOA to “better support research basedon the tenets of osteopathic medicine 4) With the ACOFP, advocating thePatient-Centered Medical Home 5) Building the National OsteopathicAdvocacy Center in Washington, D.C.

A working lunch for the delegatesheld on Friday, July 15, 2011 reviewedelements of Osteopathic ContinuousCertification. Beginning in 2013, therewill be the pathway for initial certifica-tion or recertification. A presentation bythe Federation of State Medical Boardsreviewed elements of its Maintenanceof Licensure program.

135 resolutions covering a variety oftopics were presented before and dis-cussed by members of the Ad Hoc,Professional Affairs, Educational Af-fairs, Public Affairs, and Constitutionand Bylaws Committees. The JointBoard/ House Budget Review Com-mittee reaffirmed the need for an AOACost of Living Dues Increase for FiscalYears 2012 and 2013". Resolutionswere then brought before the body ofdelegates for action. After two days ofdeliberation, the house approved 108resolutions (44 with amendments), dis-approved 7, and referred 13 to otherbodies within the AOA for further ac-tion. Seven resolutions were withdrawnby their submitting organizations beforeconsideration. Martin S. Levine, DO, was sworn in onJuly 17th as the 115th President of the

continued on page 5

Washington D. O. Summer 2011 Page 5

PNWU-COM’s fourth faculty andstudent orientation week just ended,and the fourth class of 75 students isnow on campus. The White CoatCeremony for the Class of 2015 will beheld September 17th. Two classes areon clinical rotations at 16 core sites. These include Portland/Longview,Centralia, Aberdeen, Puyallup, Mt.Vernon, Yakima, Othello, Spokane,Tri-Cities, Hermiston, Boise, Blackfoot,Great Falls, Billings, Anchorage andFairbanks. Each site has a PNWU-COM supported regional dean(physician) and regional coordinator toprovide oversight. The clinical rotationsteam both on and off campus does atremendous amount of work to organizerotations, evaluations, and affiliationagreements. Thank you WOMAadjunct clinical faculty (preceptors), forwelcoming our students into yourpractices. We couldn’t do this withoutyou!

Third year students just completedCOMLEX I boards. Students receivesignificant board preparation support,and are excited to pass this milestone intheir careers. Fourth year students arepreparing for COMLEX 2 board examsand have started their residency auditionrotations. We are looking forward tograduation May 12, 2012, and fullaccreditation. Dr. Karen Nichols willbe the inaugural graduation’s keynotespeaker.

The Board approved Phase II of theButler Haney Hall building project whichwill provide a large auditorium seatingover 300 people which also can be

divided into two large classrooms. Additional office space, restrooms anda kitchen area for school and communityevents will accommodate the projectedclass size increase to 125 students. Theearly renditions are beautiful, and theaddition will finish off the building withsymmetry. The presidential searchcommittee of the board, with theassistance of a national search firm, islooking for a new president since Dr.Butler would like to retire from that roleand pursue other projects. This processis expected to be completed by June,2012.

The AOA approved 8 PNWU-COM sponsored residency programsthis week. They include the following:Puyallup Tribal Health Authority (FamilyMedicine); Good Samaritan Hospital,Puyallup (Family Medicine); SkagitValley Hospital (Family Medicine,Internal Medicine); Kennewick GeneralHospital (Family Medicine, InternalMedicine); Kalispell/Superior, MT(Frontier Family Medicine- the first ofits kind in the nation!); Yakima ValleyFarm Workers Clinic- Prosser (FamilyMedicine). This is a tremendousaccomplishment. Kudos to Dr. RobertSutton and his team, who have beenworking on these programs since 2007.

More residencies are underdevelopment in the next few years, sostay tuned! If you know of qualifiedosteopathic program directors whowould like to work on residencydevelopment, please let Dr. Suttonknow.

PNWU UpdateBy Dean Robyn Phillips-Madson, DO, MPH

Premed ForumsScheduled –

Students & NewPhysicians

NeededWOMA staff has scheduled several

osteopathic premed forums to enlightenpremed students about the osteopathicprofession. Over the years, the forumshave encouraged more interest inosteopathic medicine and generatedmore applications to osteopathicschools.

WOMA staff, schoolrepresentatives, area physicians andstudents participate in the programs.Attendees learn about the history ofosteopathic medicine, the curriculumand the application process.Osteopathic physicians practicing ortraining in the area are encouraged toattend, answer questions and share theirperspectives with the premed students.WOMA hosts the events, providingpizza and information about shadowingopportunities.

All forums take place in the evenings,usually starting about 6:30 pm withrefreshments. Students and residentstraining in the area, as well as newphysicians, are particularly encouragedto attend. Those scheduled to date are:

October 18 – St. Martin’s University

October 19 – Pacific LutheranUniversity

October 20 – University of Puget Sound

October 25 – Seattle University

October 26 – University of Washington

October 27 – Seattle Pacific University

We are also working with WesternWashington University to schedule aforum in early October and hope tohave a forum for Spokane schools thisyear.

If you are available and willing toparticipate in any of the scheduledforums, please contact Kathie Itter at206-937-5358 or kitter@woma.org.

American Osteopathic Association byhis predecessor Karen Nichols, DO.President Levine’s inaugural addresswas entitled “Think Osteopathically,Practice It, Prove It and Promote It”,expounding upon the elements of theOsteopathic Pledge of Commitmentwhich reads:I pledge to: PROVIDE compassion-ate quality care to my patients; PART-NER with them to promote health;DISPLAY integrity and professional-

ism throughout my career; AD-VANCE the philosophy, practice andscience of osteopathic medicine;CONTINUE lifelong learning; SUP-PORT my profession with loyalty inaction, word and deed; and LIVEeach day as an example of what anosteopathic physician should be.

continued from page 4

Page 6 Summer 2011 Washington D.O.

CME, Business and Fun

First Row-Past President Dan Wolf, DO provided the nominaitng committee report;Trustee Mischa Coleman, DO reported for District 2; Trustee Lynda Williamson, DOreports for District 5. Second Row-District 3 Trustee and WOMA's Reprsentative to theProscription Monitoring Program Advisory Committee Mike Quirk, DO providedupdates on both; Trustee Paul Emmans, Jr, DO reported on District 4; PNWU InterimPresident Lloyd Butler, DO and wife Gloria enjoy a reception with AOA PresidentKaren Nichols, DO and her husband Jim Nichols.Third Row- President Stan Flemming,DO recognizes David Lukens, DO for 43 years of membership; Dick Richards, DO isrecognized for 44 years of membership; Don Woods is recognized for 48 years ofmembership. Fourth Row-Dwight Williamson, DO is recognized for 48 years of mem-bership; Tom Summe is recognized for 42 years of membership and Loren H "Bear" Rex,DO is recognized for 41 years of membership.

Washington D. O. Summer 2011 Page 7

Make For a Great Convention

Above, Clockwise from left: Bill Dickinson, DO provided a four-hour program on opioid addiction as part of aprogram to help physicians apply for a waiver to prescribe buprenorphine in an office-based setting; PublicAffairs Chair Lindy Griffin, DO proivdes a legislative update to members; President Stan Flemming, DOpresents Karl Johnson, DO with Life memberhip in WOMA; John Allen, DO also receives Life membership inWOMA.Below, Clockwiise from left - President-elect Lyndsey Rasmussen, DO models a Stetson hat during the annualfundraising auciton for the Washington Osteopathic Foundation; AOA President Karen Nichols provides anupdate on AOA activities; Monte Koschene and Janet Tinney display a hand-knitted quilt made for the auctionby Jenny Sheaffer, mother of member Sara Sheaffer, DO; Stephanie Hunt and Janet Tinney display a victorianrose quilt made by Margaret Agner, wife of Harold Agner, DO for the auction. Both quilts were quite popularwith the bidders.

Page 8 Summer 2011 Washington D.O.

Washington D. O. Summer 2011 Page 9

Page 10 Summer 2011 Washington D.O.

Selection of this region’s MedicareClaims Administrator is still under CMSappeal. Noridian will continue during theappeal process. Selection of the claimsadministrator is expected “soon”

Minimum of 10 (e-Rx) required byOct 2012 to meet standard. OTC medsmay qualify as e-Rx

Four new practice exemptions wereadded to list. Details are on the Noridianwebsite (www.noridianmedicare.com/)

Electronic Billing Submission Changes– The current standard (4010) to bereplaced by 5010 Jan 1, 2012. Providersmust test claims submission with yourclearing houses prior to this date toprevent payment delays

ICD-10 code sets replace ICD-9 codesets Oct. 1, 2013. No extension ofcompliance date is anticipated. AMA,AOA, and Noridian websites offer in-struction and suggestions on preparationand compliance.

Recovery Audit Contractors are fullyoperational in Washington State. Pro-viders following the appeals process mustbe mindful of time deadlines for recordsubmission. There have been no physi-cian practice reviews to date except forduplicate billings.

Claims Adjustment Update - Claimswere paid incorrectly Jan-May 2010 dueto Fee Schedule change - reprocessingof claims is currently underway. Theprojection is that it could take as long as18 months to complete all claims.

Noridian website,www.noridianmedicare.com has beenredesigned to be more user friendly.Referring providers are reminded tocomplete PECOS enrollment - https://pecos.cms.gov as referrals are processedonly to PECOS enrolled professionals.PTAN must cross-match NPI inPECOS. Supply name and NPI# mustbe on line 17/17B. Claims without thisinformation will be rejected starting Jan3, 2012.

The number one problem in processingclaims is insufficient documentation tosupport billingSignatures are required on all records -first name, last name, credentials. Theyare also required on hospital and ancil-lary services requests. Signature stampsor “signed but not read” statements arenot acceptable.

Risks associated with EMHR werenoted:

a. Cloning of notesb. Automatic pulling forward of Hx,

ROS elementsc. Physician must review and sign

Hx and ROS forms if completed bypatient or ancillary staff

d. Documentation must support picklist codes

e. Documentation must support com-plexity of MDM and medical necessity

f. Bill codes based on what is docu-mented - do not include additional com-ponents in the record for the sole pur-pose of meeting a specific level of CPTcode or level”

Billed procedures must be supportedwith:

a. Procedure or Op noteb. Path reportsc. Anesthesia recordd. Nursing notesFor proper amending or correcting

records:a. never write over or obliterate entry

errorb. draw single line through error

maintaining legibilityc. sign and date stating reason for

change in marginWhen changing a record, caution

should be taken:a. never change a record after an

audit requestb. may send a currently dated trans-

lation, clarification, explanation, or com-panion note

c. must be able to document theoriginal record

Notes from CAC Meeting Report - 07/12/2011By Harold Agner, DO, Representative to Carrier Advisory Committee to Medicare

New MemberBenefit

AnnouncedThe WOMA Board of Governors is

pleased to announce its endorsement ofmedical malpractice insurance carrierMedical Protective (MedPro). As ofJuly 1, 2011, WOMA members whorenew or purchase new malpracticeinsurance from MedPro will receive a5% discount on their premium. This isin addition to other MedPro discountssuch as risk management and claimhistory.

For more information, please contactone of the agents listed below:Kibble & Prentice-SeattlePhil Dyer 206-508-6030McDonald Insurance-KirklandDavid Hamilton 425-897-6002Western States InsuranceMike McWhorter-Tri-CitiesRandy Hale 509-946-2622

2011-2012 CMECalendar

September 17, 2011OMM and Sports MedicineYakima7 Category 1-A Credits Approved

December 3, 2011Cardiology Update for PrimaryCareSeattle8 Category 1-A Credits Anticipated

March 10, 2012Pain Management UpdateSeattle8 Category 1-A Credits Anticipated

June 21-24, 201299th Annual NorthwestOsteopathic ConventionBlaine, WA25 Category 1-A CreditsAnticipated

September 15, 2012OMM – Lower ExtremitiesYakima7 Category 1-A Credits Anticipated

December 1, 2012Health Matters: Mars andVenusSeattle8 Category 1-A CME creditsAnticipated

WOMA's CME Committee met lastmonth to review the needs assessmentsurvey results and CME program evalu-ations collected over the last year. Basedon that information as well as informa-tion provided in Medical Journals andwebsites, the Department of Health andthe CDC, the Committee selected thetopics for the 2012 CME programs. Theconvention wil include sessions on pedi-

atric topics, pain management, behav-ioral medicine topics, OMM, STI, Gas-troenteritis, Crohn’s and Ulcerative Coli-tis, Vitamin D, and some non-clinicalbreakout sessions. See the caleandar atright for all program topics and dates.

WOMA members interested in helpingto plan and present CME programs shouldcontact Kathie Itter at 206-937-5358 orkitter@woma.org.

2012 CME Topics Selected

Washington D. O. Summer 2011 Page 11

Last time we were talking aboutseeing the first Circus Poster of thesummer, the herald of a traveling showthat would transform your world ofvarious shades of green to one ofbeautiful colors and unimaginable sightsof rare and exotic animals from the fourcorners of the world. I suppose thatkids today don’t have the time forfantasies with their carefully scripted,parent pleasing existence. If that is true,it is too bad that we have managed torob them of the chance to use theirminds. It would be similar to whenradio, which was called the “theatre ofthe mind” was replaced by televisionwhich was mind-numbing brainpabulum.

About three or more months beforea circus opens, what is called “theadvance” begins their work to make theshow happen. A person called theAgent leaves winter quarters and beginsto book the show route for the season.The shows I was with wintered in HugoOklahoma and spent its season, for themost part, in the Midwest. One year theshow made it as far west as WashingtonState but usually we didn’t cross theRockies. This person meets withdifferent groups who are civic boostersand who want to make some money fortheir cause. My own personal favoritewas the Volunteer Fire Departmentsand my least favorite was the Jaycees.Our agent had been at this job forprobably 30+ years and really knew hisway around. He would file a report ofeach town with the necessary informationand that would go to staff on a need toknow basis.

Next came the Advertising peoplewhich in this case, were Sharelle, my exthat many of you know, and yours truly.In the business these people are calledBill Posters. This name was derivedfrom Handbills that were the earliestform of advertising and were finallyreferred to simply as Bills, thus Billboardsare just today’s giant handbills. Actuallythere is a set size to posters as bills arecalled in the circus business. Originally,they were printed from limestone plates

measuring a standard 28 x 42 utilizingbright colored oiled ink. Today they arelithographs. A bill poster in my day hadan assortment of posters at his disposal.These ranged from regular coloredposters which went together to make adisplay to what were called panels thatmeasured “21 x 54 “ and were calledone-sheet panels to Half-sheet panels,printed with either vertical or horizontaldesigns, measuring 14”x 42.” Theselatter things were called tack sheets andwere tacked to telephone poles.Although it has been nearly 50 years,Sharelle is still somewhat miffed aboutme stapling her fingers to a telephonepole in Michigan. Obviously a womanwith an intact memory. There were alsowindow cards or placards which wereabout a quarter sheet in size. Thesewere somewhat safer than telephonecards.

As a bill poster, it was my job to lookat the Agent’s day sheet and determineif I had any tips to make my job easier,such as an empty building with a civicspirited owner that would let me in toplace a big hit of papers in the windows.This made my life a lot easier. Otherwise,it meant tracking down an owner of anempty building. Likely as not, the ownerwasn’t usually especially happy with theidea of circus paper being stuck in theirempty building, civic pride or not. Eachday there was an allotment of paper thatwas to be hung in the town and thesurrounding smaller towns in the area.The paper was shipped from the printerabout every week or so and had to bepicked up at either the bus station or therail station. Sometimes it was very hardto get all the paper hung, resulting inwhat is known in the world of BillPosters as “Charlieing the paper”. Asyou might imagine, a practice considereda No-No by management. I only gotcaught once and that was by the 24 hourman and he was good about it. Seemshe had once been a Bill Poster and wassympathetic.

The big trick to Bill Posting is learningto put up displays over your head in anempty building and getting the multiple

sheets level. We had a 4 sheet groupingof a Lion and a 3 sheet grouping of anElephant and her calf that could be a realpain to put together when the windowswere 12 to 16 feet high. That probablyadded to my deep feeling aboutElephants. So it was Sharelle’s and myrole to start the process of getting thewhole town excited at the prospect ofthe circus coming to town Using theavailable collection of sheets, we wouldput together displays based on theamount of space we had to fill. It wasalways good to use the poster with abrave man in a Jungle Jim outfit and aknee weakening woman working withhim to subdue an entire cage of the Kingof beasts with only a chair and a pistol.There were, of course, other posters ofa beautiful woman walking on a tightwire looking feminine with a parasolover her shoulder and her feet in balletslippers. The clincher was the poster ofa handsome young man performing on atrapeze or the poster of a gorgeous ladyflying through the air to the outstretchedand waiting arms of a man on anothertrapeze. Never mind that the sheets wehad did not in any way reflect the actswe actually had on the show. But that is,of course, the great thing about themind. The pictures only conjured up thepossibilities of what those acts wouldactually be on show day. The discussionswere long and heated as to what wouldbe the acts on that day.

It was almost more than a young boycould take.

Bear

Page 12 Summer 2011 Washington D.O.

Washington Osteopathic Medical Association5220 California Ave SW Suite BP.O. Box 16486Seattle Wa 98116

It’s summertime again and that meanssummer picnics, July 4th fireworks,summer sports physicals and of coursethe annual AOA business meeting inChicago. While Seattle might have hadless than 2 hours of summer weatherabove 80 degrees, Chicago was gearingup for a heat wave during the House ofDelegates (HOD) meeting. Over 600delegates and alternates were presentas we debated over 130 resolutions.Some of the most intense discussionoccurred at the committee meetings. Iwas able to attend the Committee onEducation.

Although many of the resolutionspresented stirred debate, the mostcontentious subjects were CME and anosteopathic glossary. The resolutionsregarding changes to classifications forCME were sent back to committee, sowe may or may not see them again. Aresolution calling for the AOA torecognize the ECOP osteopathicglossary (the one used by osteopathicmedical schools) as the glossary forosteopathic medicine was met withresistance because currently the AOAdoes not have a voice on the ECOPboard. It is a board of the AmericanAssociation of Colleges of OsteopathicMedicine (AACOM). That resolutionsent back to committee to furtherinvestigate the lack of AOA voice onthe ECOP board. One educationresolution that did make it to a floor votewas Resolution H-204 that voiced AOAsupport for a recent decision by theNational Residency MatchingProgram(NRMP) to disallow allopathicresidency programs to sign pre-Matchcontracts with osteopathic students.Many feel this gave an unfair advantageto osteopathic students, so you canunderstand why students whereopposed to the change. However, theresolution was passed by the HOD andsigns point to NRMP ending the pre-Match as of June 2012.

Here are just a few of theresolutions that passed.

H-434 AOA support of TobaccoFree Colleges of Osteopathic Medicinecampuses

H-502 The creation of a NewPhysician in Practice AOA Board ofTrustees position

H-621 AOA opposition to therequirement for physician prescriptionfor OTC medications for flexiblespending accounts.

One resolution that did not makeit to the floor vote was the student-submitted H-505, rejected because itfailed to follow proper procedures.SOMA proposed amending the codeof ethics to include “sexual orientationor gender identity or expression” in thenondiscriminatory statement. However,that resolution was not published in theJAOA as required by the HOD, so itwas ruled out of order and not presentedfor a vote. The students have vowed toensure that next year procedure isfollowed and expect to see it again nextyear.

Friday and Saturday morningmeant listening to some great reports.There was so much information we rana little behind schedule. Each of thereports is available online to any AOAmembers who want to know more aboutany particular subject. However theenergetic report of the day was Karen J.Nichols D.O. last report as the Presidentof the AOA. She sang a special rewriteof Jonny Cash’s “I’ve BeenEverywhere” highlighting all the locationsshe visited the past year including allcurrent Osteopathic Medical schoolsand attending WOMA’s summerconvention this past June. Dr. Nicholswas the first AOA president who visitedall of the Osteopathic Medical schoolsin one year.

On Saturday evening Dr. Nicholspassed her title and duties on to MartinLevine, DO, a family practice doctorfrom New Jersey. From his speech onhow we need to “Think Osteopathically”it seems the AOA will have anothergreat leader this year who will promote

osteopathic medicine on a national leveland within the AOA.

The House of Delegates alsoelected new trustees, including adding,for the first time, a New Physician inPractice position on the board. We alsoelected the President-Elect, Ray EStowers DO, a family physician fromOklahoma. If you want to learn moreabout the AOA leadership, theirinformation is available on the AOAwebsite osteopathic.org

Another great highlight includedBarbara Ross-Lee DO presenting theA.T. Still Memorial Lecture and calledfor all D.O.’s to incorporate more OMTinto their daily practice. Her speechwas very inspirational and a call to allosteopathic physicians to remember thatA.T. Stills was not a follower, it was hisleadership and vision that has broughtthis profession to the great place it istoday.

The greatest highlight for me wasbeing able to stand up in front of theentire HOD and present my own viewon a resolution to cap the number ofdelegates to the AOA HOD. As astudent and delegate for WOMA I stoodup and voiced my concerns that theresolution did not account for medicalstudent delegates like myself. In otherprofessional circles I might have beendiscouraged from speaking or told thatmy lack of experience caused me tomisread the resolution and that thegrown-ups had it under control. Instead,I was treated like a peer and thanked forpointing out the inconsistency of thewording of the resolution. Throughoutthe rest of the HOD DOs congratulatedme for standing up and representing thestudents (and our state) so eloquently.The fact that I was able to representboth our wonderful state and my fellowstudents and have my voice heard onequal footing with the 438 otherdelegates made me so proud of ourprofession and reminded me why I choseto join the ranks of such a great family.

AOA House of Delegates – A Student’s Perspectiveby Whitney Fix-Lanes, OMSII