4700 42nd SW, Suite 530 / P.O. Box 16486 Seattle, WA 98116-0486(206) 937-5358 FAX (206) 933-6529 / www.woma.org

Summer 2013

Washington D.O.

At its annual awards banquet onJune 29, 2013 the honor of WOMAPhysician of the Year was bestowedupon H Ken Cathcart, DO.

When making this decision, theBoard takes into consideration anumber of qualities. Sometimes aphysician is nominated by a patient,colleague or staff because of his orher caring nature and service aboveself. Sometimes a recipient is aleader of the profession that hasserved in one or several capacitiesover the years. Sometimes therecipient is an educator or a mentor,or in this year’s case, both.

Dr. Cathcart is a 1984 graduate ofthe Philadelphia College ofOsteopathic Medicine. He completedhis internship and residency inInternal Medicine at Doctors Hospitalin Columbus Ohio where he servedas Chief Resident. His residencytraining was followed by anEndocrine/Metabolism fellowshipfrom 1988-1990. He is certified bythe American Osteopathic Board ofInternal Medicine and is a Fellow ofthe American College ofEndocrinology.

2013 Physician of the YearTo our benefit, he migrated to

Washington in 1990 with his lovelywife and colleague, Sharon Cathcart,DO. They both joined WOMA in 1991.

Dr. Cathcart has earned severalhonors over the years, includingMost Outstanding Pre-MedicalStudent, Resident of the Year andOutstanding Diabetes Educator forthe State of Washington.

Before and after the presentation,audio testimonials were providedby former students Gelar Biscaro,DO, Austin Shelton, DO, AshleyMeganck, DO and Jonathan Pasma,DO. Dr. Pasma was actually in theprocess of moving across countryfrom his internship to his residency.He went to a public library tosend the following testimony to beplayed before Dr. Cathcart wasannounced as the recipient of theaward: “This physician is a preceptorthat truly inspired me in the midst ofmy clinical rotations bydemonstrating a passion forteaching. This preceptor always tooktime to point out interesting physicalexam findings or ask pertinent,thought provoking questions. Ourdaily conversations regarding myovernight reading always turned intolengthy discussions filled with“pearls and tidbits”. It was thebreadth & depth of our longdiscussions that ultimately causedme to realize that this physician’sfund of medical knowledge mightexceed the allotted capacity for asingle individual. This physician is arole model, and the contributions tomy medical education will be foreverappreciated. “

Congratulations Dr. Cathcart!

“FUN”draisingAbound inYakima!

The Washington OsteopathicFoundation is the beneficiary of allproceeds raised at WOMA’s 2013Fall Seminar, “An Approach to ChronicPain Utilizing OMT”. The program,approved for 8 Category 1-A CMEcredits, will take place on Saturday,September 21 at PNWU in Yakima.Program Chair Harold Agner, DO hasassembled an excellent program forhoning OMT skills for managingchronic pain patients.

Don Woods, DO will start off theday with Myofascial Release,followed by Bill Powell, DO’s NovelApproach to Cranial Screening andTreatment. Dr. Larry Lefors willcontinue with Strain/Counterstrainand Richard Koss, DO will coverLymphatic Treatment. Muscle Energywill be presented by Dr. LyndaWilliamson and Dr. Agner willcomplete the course with AppropriateDocumentation and Coding: GettingPaid for What You Do.

The Foundation is grateful to thefaculty for donating their time toenhance the proceeds for a depletingfund. If you are unable to participatein the seminar, but can help with atax-deductible contribution, yourdonation may be made payable toWOF and sent to PO Box 16486,Seattle, WA 98116-0486.

Golfers are encouraged to come aday early and participate in the 6thAnnual PNWU Golf Classic at theYakima Elks Golf and Country Clubon Friday, September 20th.Registration information is availableon the PNWU website atwww.pnwu.org or call JoAnneHanses at 509-249-7734.

Executive Director Kathie Itter pre-sents H Ken Cathcart, DO the WOMA2013 Physician of the Year award, anengraved crystal desk set.

Page 2 Summer 2013 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

Marc Cote, DOPresident-Elect.

Scott Fannin, DOVice President

Harold Agner, DOSecretary

Mark Hunt, DOTreasurer

Steve Leifheit, DOImmediate Past PresidentLyndsey Rasmussen, DO

Government Relations RepresentativeDave 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 columns are,in all cases, the opinion of the author. Foradvertising information, please contactthe WOMA executive offices at (206) 937-5358. Deadlines for ads and articles arethe 10th of the month preceding the pub-lication.

WOMA WelcomesNew Members

At its quarterly meeting on June 27,2013 the WOMA Board of Governorsapproved the following applicationsfor membership:ActiveRose-Marie Colombini, DO COMP’97Jason Dreyer, DO KCOM’07Mitchel Storey, DO PCOM’80Christen Cage Vu, DO CCOM’00PostgraduateGelar Biscaro, DO PNWU’13Isaac Brauner, DO PNWU’13Jessica Chan, DO PNWU’13Ryan David, DO PNWU’13David Escobar, DO PNWU’13Julie Hamilton DO COMP’13Vanessa Herring, DO LECOM’13Jennifer Kohnlien, DO PNWU’13Nathanial Lilya, DO AZCOM’13Justin Medlock, DO PNWU’13Michael Moore, DO PNWU’13Brian Nelson, DO PNWU’13Tricia Nielsen, DO AZCOM’09Aaron Rhyner, DO PNWU’12Caroline Roeder, DO PNWU’13Austin Shelton, DO PNWU’13Christine Wong, DO PNWU’13StudentRachael Banda PNWU’17Annagreta Bowen, DMU’14Courtney Certain, PNWU’17Zachery Featherstone, PNWU’17Wilfredo Henriquez, PNWU’17Anna Kenney, PNWU’17Carolyn Ranten, PNWU’17Alexandra Ostromecki, PNWU’17Justin Watkins, PNWU’17

2014 WOMALeadership

ElectedAt its annual membership meeting

on June 28, 2013, the WOMAmembership elected its 2014leadership. The Executive Committeewill assume their duties on January 1,2014 for a one-year term. IncomingPresident Scott Fannin, DO, will bemaking committee appointments andwould like to hear from members whowould especially like to serve on thePublic Affairs (legislative) Committeeand the CME Committee.

In addition to Dr. Fannin, themembers of the 2014 ExecutiveCommittee are President-elect HaroldAgner, DO, Vice President MicheleColeman, DO, Secretary Mark Hunt,DO, Treasurer Steven Leifheit, DO, andImmediate Past-President Marc Cote,DO.

Trustees elected to two-year termscommencing January 1, 2014 are District1 Tom Harris, DO, District 2 Dan Wolf,DO, District 3 Rosemarie Colombini,DO, District 4 Amber Figueroa, DO andDistrict 5 Lynda Williamson, DO. TheInstitutional Representative is RobynPhillips-Madson, DO, and StudentRepresentative is Patricia Egwautu,OMSII. AOA Delegates are Drs. HaroldAgner, Paul Emmans Jr, Paul EmmansIII, Lindy Griffin, David Lukens andRobyn-Phillips-Madson. Drs. ScottFannin and Amber Figueroa wereelected as alternate delegates.

WOMA is pleased to welcome thefollowing new Active members:Rose-Marie Colombini, DOgraduated from COMP in 1997 andcompleted her family medicinetraining at San Bernardino CountyMedical Center//ArrowheadRegional Medical Center. Shepractices family medicine in GigHarbor.Jason Dreyer, DO is a 2007 graduateof KCOM. He completed his rotatinginternship at MSU ProvidenceHospital and Medical Center inSouthfield MI in 2008 and aneurosurgery residency in 2013. Hepractices neurosurgery in WallaWalla.

Mitchel Storey, DO graduated fromPCOM in 1980. He completed hisinternship at Community GeneralOsteopathic Hospital in Harrisburg,PA and a sports medicine fellowshipat The Sports Medicine Clinic inSeattle. He practices primary caresports medicine in Seattle.Christen Cage Vu, DO is a 2000graduate of CCOM. She served herinternship at Genesys RegionalMedical Center in Grand Blanc, MIand a family practice residency atUniversity of Massachusetts. Herfamily medicine practice is inTacoma.

Getting to Know You

Meeting NoticesFriday, September 20, 2013

CME Committee 7pm

Saturday, September 21, 2013WOF Board

5:30 p.m.WOMA

Board Dinner6:00 P.M.

All meetings take place at thePNWU Administration Bldg

Second Floor111 University Parkway

Yakima

Washington D. O. Summer 2013 Page 3

PA Rules Amended Rx Law ChangeEffective July 28, 2013, all

Schedule III through V controlledsubstances must be dispensedpursuant to a written, oral, orelectronically transmittedprescription. This law supersedesWAC 246-887-030, which allowedfor the dispensing of certain ScheduleV substances without a prescription.

Except when dispensed directlyby a practitioner authorized toprescribe or administer a controlledsubstance, other than a pharmacy,to an ultimate user, a substanceincluded in Schedule III, IV, or V,which is a prescription drug asdetermined under RCW 69.04.560,may not be dispensed without awritten, oral, or electronicallycommunicated prescription of apractitioner. Any oral prescriptionmust be promptly reduced to writing.

As mof July 28, 2013, the practiceof providing certain C-V substanceswithout a prescription will no longerbe permitted (i.e. codeine containingcough syrups logged in exemptnarcotic register)

After considerable time spent byrepresentatives of the AOA and theOsteopathic Physicians andSurgeons of Oregon on behalf ofseveral state osteopathic societies,including WOMA, Regence auditshave stopped. All physicians thatwere requested to submit charts foran audit should have received a letterfrom Regence informing them of thisdecision. However, Regencereported a glitch in their automatedletter system that has continuedsending requests for paymentrecoupment. Regence MedicalDirector Casaba Mera, MD made itclear that Regence is not seekingany payment recoupments andconfirmed all audits and currentrequests for refunds are terminated. Dr. Mera did not have an exact date

regarding how far they would goback with repayments, but said itwould be at least through December2012

At its meeting withrepresentatives of the osteopathicprofession, Dr. Mera proposed afollow-up letter to all DOs regardingtheir insurance audits. Review ofthe letter indicated it contained manyinaccuracies and the AOA puttogether a detailed response with alist of what should be included in theletter. Dr. Mera stated that ourconcerns will be addressed. Regencemade additional edits and justreturned it to the AOA legal staffwho is working on a response.WOMA will continue to track thisissue.

After continual urging fromWOMA, the Department of Healthhas issued proposed rulemaking toreduce osteopathic licensing fees.Current licensing fees generate morerevenue than needed to cover the fullcost of administering the Board ofOsteopathic Medicine and Surgery.The department is proposing toamend WAC 246-853-990 to reducethe initial application and licenserenewal fees by $175, bringing eachdown from $600 to $425. This doesnot include the $25 substance abusemonitoring surcharge or the $16.00UW online access (HEAL-WA) fee.

A hearing is scheduled forSeptember 12, 2013 at 1:00 p.m. itthe DOH office in Tumwater. Theintended adoption date is October 1,2013. Implementation is anticipatedlater this Fall.

License FeeReductionProposed

During the 2013 legislative session,the Washington State Legislatureenacted Substitute House Bill 1737,which modifies the law governingphysician assistants. You can find thenew law at http://apps.leg.wa.gov/documents/billdocs/2013-14/Pdf/Bills/Session%20Laws/House/1737-S.SL.pdf

Under the new law, effective July28, 2013:♦ Practice arrangement planswill now be called delegationagreements;♦ The Board of OsteopathicMedicine and Surgery may grantapproval for a physician assistant towork in a remote site if there is ademonstrated need for the utilization,there is adequate provision for timelycommunication between the primaryor alternate physician and the licenseeexists; the supervising or sponsoringphysician spends at least ten percentof the practice time in the remote siteunless the physician demonstrates thatadequate supervision is beingmaintained by an alternate methodsuch as telecommunication;♦ The names of the sponsoringor supervising osteopathic physicianand the physician assistant must beprominently displayed at the entranceto the clinic or in the reception area;

♦ No physician assistant holdingan interim permit may be utilized in aremote setting;♦ An osteopathic physician mayenter into delegation agreements withfive physician assistants, but maypetition the Osteopathic Board for awaiver of this limit. However, noosteopathic physician may have underhis or her supervision more than threephysician assistants who are workingin remote sites or more physicianassistants than the osteopathicphysician can adequately supervise.♦ The Medical Quality AssuranceCommission and the Board ofOsteopathic Medicine and Surgery,working in collaboration with astatewide organization representingthe interests of physician assistants,shall adopt new rules modernizing thecurrent rules regulating physicianassistants and report to the Legislatureby December 31, 2014.

The Medical Quality AssuranceCommission and the Board ofOsteopathic Medicine and Surgery willbegin the process to adopt new rulesshortly.

Should you have questions aboutthis procedural change or the new law,please contact Brett Cain, ProgramManager for the Board of OsteopathicMedicine and Surgery atbrett.cain@doh.wa.gov or 360-236-4766.

Regence Audits Update

Page 4 Summer 2013 Washington D.O.

As mentioned previously in anemail to members, WOMA hasbecome aware of physicians’complaints regarding the needlessdelay of patient access to timesensitive medications and is workingwith the AOA Division of StateGovernment Affairs and WashingtonState Medical Association to alleviatethis burden.

We have been made aware ofcomplaints that certain largepharmacies (such as Costco, CVS,and Walgreens) will not fillprescriptions for controlledsubstances (all controlledsubstances, not just opioids) if theprescriber does not include certaininformation that is not usuallyrequired on a prescription, and whichappears to exceed the statutory/regulatory requirements in our state. For example, one pharmacy isrequiring that the physician add: (i)the diagnosis code for the patient(ICD-9), not just the indication (suchas “for low back pain); (ii) whetherthe condition is chronic; and (iii) whenthe patient is going to be seen again. We are aware of an anecdotal reportof a pharmacy which would not fill aprescription for a hospice patientbecause they could not contact herphysician to obtain such information. Patients are caught in the middle iftheir insurance requires them to usea particular pharmacy.

According to the local DEA office,the DEA is not mandating the newrequirements – they just requirecompliance with their statutes and

rules (which do not include the typeof specific requirements thepharmacies are demanding). Thelocal DEA is forwarding this issue totheir national office in Virginia. Hopefully we will get notification ofthe official DEA position at somepoint in the future.

According to WOMA sources, theinformation requested by thepharmacies does not violate HIPAArequirements.

The executive director of theWashington State Board of Pharmacyhas stated that they will investigatespecific complaints filed with them. They cannot respond to generalcomplaints about what’s happening. So if you experience particularlyegregious problems, you can file acomplaint along with the details withthe Board of Pharmacy. Informationand forms are on their website ath t t p : / / w w w . d o h . w a . g o v /LicensesPermitsandCertificates/FileComplaintAboutProviderorFacility.aspx

WOMA is working with the WSMAand AOA to collect information fromWashington physicians. If you haveexperienced this problem, pleasesend the details* or copy of yourcomplaint to kitter@woma.org orNick Schilligo, Director of AOA StateGovernment Affairs, atnschilligo@osteopathic.org.

(*Name of pharmacy/pharmacist,extra information required forcontrolled substance prescriptions,reason given for requiring additionalinformation, did you comply?, if not,what was the result?)

Issue Update: PharmacyDispensing Concerns

RegenceImplements PriorAuthorization forPhysical Medicine

Members have contacted theWOMA office concerning a letterreceived from Regence about theirnew physical medicine programwhich will require pre-authorizationfor several services includingmassage, chiropractic, acupuncture,physical, occupational and speechtherapy. Osteopathic ManipulativeTreatment (OMT) is not listed as oneof those services. However, customerservice representatives areinforming osteopathic physiciansthat OMT will require pre-authorization.

Executive Director Kathie Ittercontacted Regence Deputy ChiefMedical Officer Csaba Mera, MD forclarification. Dr. Mera responded,on August 2nd, ” We are stillfinalizing these issues. I have adiscussion with the implementationteam on Monday. Within the nextcouple of weeks, or sooner, we shouldhave finalized the CPT list. Iappreciate your patience. Csaba”

On August 1, Regence’sConnection Online states that thedate for implementation of the priorauthorization program has beenpushed back from October 1 toNovember 1, 2013. WOME will notifymembers when more information isavailable.

The Centers for Medicare andMedicaid Services (CMS) PhysicianQuality Reporting System (PQRS)offers incentives and, starting in2013, future penalties to encouragephysicians and other professionalsto report quality measure data toCMS.

Register for the AOA’s ClinicalAssessment Program (CAP) for PQRSto easily submit your data, earn yourbonus, and avoid the penalty.

What you should know:

♦ In 2013, there will be anincentive payment of 0.5% forphysicians and group practices whoparticipate successfully in the PQRS.♦ 2013 is the second-to-lastyear an incentive will be available.♦ Physicians and other eligibleprofessionals who don’t participatein the PQRS in 2013 will be subject toa 1.5% penalty, which will be appliedto physician payments in 2015.♦ In 2016 and beyond, thepenalty will increase to 2%.

Non-participation in 2013 PQRSProgram will Result in 2015 Penalty

Benefit AddedUpon approval of membership, all

WOMA members have access to themany benefits of the AffiliatedAssociations of America (AAOA). Ithas added Costco’s NationalMembership Programs to the memberbenefit suite.

Find everything you need tocelebrate summer at Costco!

Getting ready for vacation? Checkout Costco’s assortment of luggage andapparel items. Staying home andenjoying your outdoor spaces? Costcohas everything you need for your lawnand garden, and outdoor entertaining.

For more information on yourAAOA Member benefits, log in towww.aaoamerica.org using your AAOAPIN or call 866.968.0545.

Washington D. O. Summer 2013 Page 5

The faculty, staff andadministrators are busy preparingfor the students in the Class of 2017who will arrive August 6th fororientation week. This is the sixthclass to matriculate in the COM’shistory, and the first at the increasedclass size of 135 students. Theirorientation includes not only the nutsand bolts of surviving and thriving inmedical school, but also engagementin the Yakima community throughservice projects.

The Class of 2017’s White CoatCeremony will be held August 10th.This ceremony honors the incomingstudents and underscores the COM’scommitment to nurture thehumanistic characteristicsthroughout their training andultimately their careers. This classwill also be the first to enjoy Butler-Haney Hall as it was originallyintended. The 400 seat auditorium,which can be divided into twoauditoria if needed, additionaloffices, restrooms, catering kitchenand vending area with additionaleating space, are complete.Renovation of the simulation lab,faculty offices, and library is almostcomplete as well, and will provideadditional teaching and study space.

The members of the Class of 2015have moved to their respectiveregional rotation sites. PNWU-COMis fortunate to have the dedicatedregional deans and coordinators tooversee the students and adjunctclinical faculty. Please sign up to beone of the adjunct faculty if youhaven’t done so already, and if youalready have, thank you for yourcommitment to the future ofosteopathic medicine.

The Class of 2014 is beginningthe process of residency applicationwhich can be both exciting anddisconcerting. While 100% ofPNWU-COM graduates matched intoresidency programs this year, theprocess is highly competitive giventhe growth of graduates outstrippingthe supply of residency slots. Thismonth, the AOA Board of Trusteesand the AACOM Board of Deans bothrejected a memorandum ofunderstanding from the American

Council on Graduate MedicalEducation (ACGME), and they arehopeful that future talks can lead toan acceptable agreement. Thiswould be beneficial for osteopathicmedical students on a number oflevels, especially that of having asingle match day. Please check onthe AOA’s website for moreinformation, and take the time towatch Dr. Boyd Buser’s update to theAOA House of Delegates regardingthis important issue.

As many of you know, this is myfinal PNWU-COM update, as Iresigned as dean July 22nd. I amcontinuing on as an assistantprofessor of family medicine atPNWU-COM on educational leave,and am excited about pursuingpersonal and professional interestsI’ve put on hold over the past sixyears. Dr. Anita Showalter has beennamed the acting dean, with anannouncement of an interim deanpending in the next month. This willbe followed by a national search fora permanent dean. A search is alsounderway for an Associate Dean ofStudent Affairs. Dr. Bob Sutton hasstepped back into the recentlyvacated position of Associate Deanof Medical Education, and continuesto provide leadership in residencydevelopment.

There aren’t adequate words toexpress my gratitude to WOMA,Kathie Itter, and each of you, for yoursupport, willingness to serve,friendship and mentorship over mypast 33 years of WOMA membership,as well as the past six years at PNWU-COM. PNWU-COM would not existwithout you, nor could I have servedas dean without yourencouragement. I recently read aquote by Nelson Henderson whichdescribes how we can continue tocontribute in a meaningful waywherever we may go: “The truemeaning of life is to plant trees,under whose shade you do not expectto sit.” I wish that for each of you asyou journey down the path of yourunique adventure.

Warmest regards,Robyn Phillips-Madson, DO, MPH

PNWU-COM Updateby Robyn Phillips-Madson, DO

New L&I OpioidTreatmentGuideline

The Department of Labor &Industry’s new Guideline for PrescribingOpioids to Treat Pain in Injured Workers,became effective on July 1. It providesinformation specific to treating injuredworkers covered by Washington Stateworkers’ compensation system.

When you are treating acute injuryor following surgery, opioids will becovered for up to 6 weeks withoutauthorization. Beyond the acutephase, you must seek authorizationfrom L&I or the insurer; continuedcoverage will depend on yourdocumented use of best practices.

The best practices includeevaluation of function, pain, and riskat three critical phases:1. At the end of the acute phase (about6 weeks following injury or surgery),to determine whether continuedopioid therapy (COT) is warranted inthe subacute phase.2. At the end of the subacute phase (3months following injury), todetermine whether to prescribe COT.3. Periodically during COT, to assessimpact on function and risk of thetherapy.

The L&I guideline provides valuableinformation to help you improvetreatment, including sections onprescribing precautions; managingsurgical pain in workers on COT; anddiscontinuing COT. It supplementsboth the Agency Medical Directors’guideline (2010) and the Departmentof Health’s pain management rules(2011–2012).

The new guideline was developedin 2011–2012 by the IndustrialInsurance Medical AdvisoryCommittee (IIMAC) and itssubcommittee on chronic non-cancerpain, groups made up of practicingphysicians who specialize in treatinginjured workers and in painmanagement. The new guideline isbased on the best available clinicaland scientific evidence from asystematic review of the literature anda consensus of expert opinion.

L&I is now working closely with theadvisory group on ways to helpproviders understand how to fulfillthe guideline’s new requirements.Continuing medical education is beingdeveloped which will be available freeonline, and L&I staff will be availableto answer questions.

Page 6 Summer 2013 Washington D.O.

Cockwise from top left: Robyn Phillips-Madson summarizes the ACGME merger proposal for members at theannual meeting; Dr. Cote recognizes Dwight Williamson, DO for 50 years of membership; Drs. AdamHoverman and Tom Harris enjoy the Icebreaker reception; Dr. Dan and Kathleen Dugaw at the reception;Student doctor Whitney Fix-Lanes (right) provides a PNWU student update at the annual meeting; Attendeesand exhibitors take time to network; President-elect Scott Fannin, DO (right) provides the professional affairsreport as Drs. Lyndsey Rasmussen, Harold Agner, Marc Cote and Executive Director Kathie Itter look on.

2013

100th Annual Northwest

Washington D. O. Summer 2013 Page 7

From top left: Drs. Allen Quinn and Bill Cox assist Alice (Aurora McCone)in the annual Osteopac member drive; the Mad Hatter (public affairs chairLindy Griffin, DO) explains the need for Osteopac; President Marc Cote and40-year member Paul Emmans, Jr, DO; Bill Gritzbaugh of Medical Protec-tive is given appreciation for their suppot; Loren H Rex, DO (Bear) isrecognized for 43 years of membership.

Osteopathic Convention

Why joinWOMA?

AdvocacyRespect

CMEFellowship

FriendsFamilies

Fun

Page 8 Summer 2013 Washington D.O.

I had the privilege of attending theHouse of Delegates for the AmericanOsteopathic Association again hisyear. As a sophomore attendee, Iwas better oriented than on my visitthe previous July. It takes one sometime to understand who is who, andwhat is what, and what properetiquette and procedure is.

This year was of particular interestto me as a medical educator since AOA/ACGME United Accreditation mergerwas on the table for discussion andwould undoubtedly inspire livelyconsideration. Our members hadbeen briefed on this topic, andproduced a vote at the WOMAconvention at Suncadia and providedour delegation direction as we headedto the HOD. We discussed this andother topics on Thursday evening priorto the opening of the House. OnFriday, the House was presented anupdate regarding the ongoingnegotiations between the AOA andthe ACGME. The AOA went into thesenegotiations with five non-negotiables as listed on the AOwebsite:•The discussion is limited to GME anddoes not extend backward toundergraduate medical education orforward to licensing or certification.•The osteopathic medicine licensingexamination (COMLEX-USA) remainsin place and viable.•Osteopathic board certificationremains in place and viable.•teopathic physicians must be givenan equal opportunity to participate inall training programs under any unifiedaccreditation system.•Any unified accreditation systemmust not adversely affect primary careprograms in community-basedsettings.

At least two of these were notadequately acknowledged by theACGME in their Memorandum ofUnderstanding (MOU) and the boardof the AOA as well as AACOMASrecommended against going forwardwith the MOU as presented.

For now, this puts a halt onnegotiations. The AOA and the ACGMEare set to meet in late July to discusshow to proceed next.

To provide context to thisdiscussion, the AT Still memoriallecture was delivered by Dr. DonKrpan. He outlined our history, and

his experiences as a DO in the 60’s, and70’s, the amalgamation etc. Hearticulated the urgency of oursituation. We have a self-inflictedproblem as a result of “unbridled”growth of our schools and class sizes.This, without due consideration ofwhere our graduates are going to train.Today, more than half of our graduatesare going to ACGME programs as it is. We have a deficit of 2000 residencyslots and this will intensify as 12-15new schools are in various stages ofdevelopment come to fruition. Ourosteopathic identity is dear to us, andthe AOA has worked hard to protect itin these negotiations. However, withthis significant exodus of graduatesfrom the osteopathic family as theytrain in ACGME programs, how firm arewe going to hold to these principles?

The problem here is huge, and it isfairly easy to articulate. However thesolution is less clear. We can’t producequality residency programs overnight. The quality of our training isparamount. The bar we set forourselves must be high. As a thirdgeneration DO who trained in anACGME program and then “came backinto the fold” I have some perspectiveon this. I understand the vote of theAOA and of the House, but if we don'tdo something about our currenttrajectory, then we are actively kissingour osteopathic uniqueness “goodbye”.

As Dr. Krpan indicated, we arenegotiating from a dependentposition, and the ACGME really doesn’tneed us to proceed ahead with theirplan. The bigger issue is that theInstitute of Medicine is due out with areport on their analysis of budget andoversight of all of GME. The ACGMEand their 9,000 programs are at risk ofa future wedded to significantgovernmental oversight. Our 1,000programs are really a lesser concern tothem. This whole issue is a matter oflife and death for both camps, but fordifferent reasons.

Thank you again for allowing me torepresent WOMA at the HOD. I amgrateful for the opportunity and foundit an invaluable experience.

Respectfully submitted,Paul Emmans III, DOOsteopathic Program DirectorCentral Washington Family

Medicine Residency

AOA House Opposes ACGME MOA

By Paul (PJ) Emmans, III, DO

Doctors Audited forCertifying DME

By Lindy Griffin, DO, Public Affairs ChairBy now we have all heard of

unscrupulous durable medicalequipment (DME) companies and howthey have gotten in trouble with local,state, and federal authorities. Most ofus have seen the TV ads – just call usand we will contact your doctor andget them to authorize this equipment.I am sure all of us have gotten phonecalls and faxes requesting DME forpatients – both those that do and don’tneed them.

You try and explain to the patientand they say, “But the company toldme all you have to do is sign a form.” Itis never that easy.

It has been reported that DMEsuppliers represent up to 40% ofcriminal fraud cases for Medicare andMedicaid. Other insurers are nowinvestigating DME suppliers andphysicians for fraud. Yes, I saidphysicians.

Remember that contract you signedwith the insurance company, or in somecases your employer? Well, it said youhave to have “medical necessity” foreverything you do. And yes, thatincludes prescribing DME.

Audits are starting. Companies anddoctors are being sanctioned. Aconsultant for a federal contractor said,“Make sure you have everything inyour file you would need to justify (in)an audit.”, then you won’t have toworry.

Another recommendation is tohave a written policy on DME requests.This will help protect your patientsand you. A sample policy is shownbelow:Durable Medical Equipment Policy

1. All DME requests must beinitiated by the patient.2. No faxed documents will beaccepted without a patient firstinitiating the request.3. Staff will receive memos onthis.4. DME companies will beinformed of this policy.5. If DME companies continueto make repeated calls this willbe viewed as harassment and willbe reported to the insurancecommissioner.6. Shred all faxed requests notinitiated by patients.

Hopefully, this information will helpyou and help free up your staff toconcentrate on patient care.

Washington D. O. Summer 2013 Page 9

The AOA held its annual businessmeeting in Chicago, Illinois from July19 to July 21, 2013. Physician andosteopathic medical studentmembership now exceed 140,000. Fiftydivisional societies and 25 specialtycolleges were represented by 569delegates and alternates with 54students and student alternates.WOMA was represented by Drs. DaveLukens; Paul Emmans, Jr.; Lindy Griffin;Paul (PJ) Emmans, III; Robyn Phillips-Madson; Harold Agner, and our PNWUstudent representative Jarrad Morgan,OSM ll. Committee assignments wereas follows: Robyn Phillips-Madson, AdHoc Committee; Harold Agner, PublicAffairs Committee.

A town meeting was held theevening of July 19th to presentbackground information regarding theproposed joint accreditation pathwaywith the AMA for graduate medicaleducation. On July 20th, it wasannounced that the memorandum ofunderstanding as presented by theACGME was not acceptable to the AOABoard of Trusties as it did notadequately protect and preserve thedistinctiveness of the osteopathicgraduate medical education. The AOAwill continue its negotiations with theACGP regarding this important topic.In the interim, the AOA is developingnew residency locations and isstreamlining its residency approvalprocess.

Referencing the current difficultiesregarding preserving osteopathicgraduate medical education,executive director, John Crosby, JD,presented The Annual Report of theAOA with a speech entitled “FromKirksville to Gettysburg: Rededicatingthe AOA to the People” . The annualreport is available on the web at http://www.osteopathic.org/inside-aoa/about/leadership/Pages/annual-report.aspx.

One hundred thirty two resolutionscovering a variety of topics were

presented before and discussed bymembers of the Ad Hoc, ProfessionalAffairs, Educational Affairs, PublicAffairs, and Constitution and BylawsCommittees. Resolutions were thenbrought before the body of delegatesfor action. After two days ofdeliberation, the house approved 123resolutions (32 with amendments, 1by substation), disapproved 4, andreferred 4 to other bodies within theAOA for further action. One resolutionwas withdrawn by its submittingorganizations before consideration.Resolutions are available at the AOAwebsite http://www.osteopathic.org

Norman Vinn, DO, was sworn in onJuly 20th as the 117th President of theAmerican Osteopathic Association byhis predecessor Ray Stowers, DO.President Vinn’s inaugural addresswas entitled “Creating Opportunityfrom Problems”, expounding theimportance of preparing for thechanges which are occurring in healthcare delivery and reimbursement.Robert Juhasz, D.O. was elected to thePresident-elect position on Sunday,July 21st. Adrienne White-Faines, MPAwas introduced to the House ofDelegates as the new executivesecretary, replacing the retiring JohnCrosby, J.D.

The Osteopathic Pledge ofCommitmentI pledge to:

PROVIDE compassionate quality careto my patients;

PARTNER with them to promotehealth;

DISPLAY integrity andprofessionalism throughout my

career;ADVANCE the philosophy, practice

and science of osteopathicmedicine;

CONTINUE lifelong learning;SUPPORT my profession with loyalty

in action, word and deed; andLIVE each day as an example of whatan osteopathic physician should be.

AOA House of Delegates MeetingBy Harold Agner, DO

WOMA is grateful to the followingfirms for their support of the 100th

Annual Northwest OsteopathicConvention held June 27-30 atSuncadia Lodge in Cle Elum:GlaxoSmithKline, Teva Respiratory,Kibble & Prentice, PhysiciansInsurance, AstraZeneca, Veterans

Health Administration, MedicalProtective, Singulex, ReckittBenckiser, ATSU-SOMA, AuxiliumPharmaceuticals, NorthwestOsteopathic Medical Foundation,Adler Giersch, P.S., Sanofi, AbbVie, USAir Force, Waddell & Reed FinancialA d v i s o r s , C O M P - N o r t h w e s t ,

NovoNordisk, Astellas Pharma US, Inc.,Health Diagnostic Laboratory, Inc.,Purdue Pharma , PNWU, Peace HealthLabs and the Washington OsteopathicFoundation.

Please extend courtesies if theopportunity presents itself.

Convention Support Appreciated

CDL ExaminersUpdate

For those interested in becomingcertified examiners, Yakima WorkerCare will begin offering a Home StudyCourse for Commercial DriverExaminers on September 2, 2013.

To become certified as a MedicalExaminer, you must complete thenecessary training and pass thecertification test required by FMCSA.In order to take the certification test,you must first register through theNational Registry web site andreceive a unique identificationnumber. You will provide your uniqueidentification number to the testingorganization that you select from thelist of approved testing organizationson the National Registry web site.

h t t p s : / /nationalregistry.fmcsa.dot.gov/NRPublicUI/home.seam

There are two trainingorganizations listed for Washington– Group Health Cooperative andYakima Worker Care. For informationabout the online course, emailCMEtrainer@gmail.com. A link tothe registration form is on WOMA’shome page at www.woma.org.

Visit the National Registry website at http://nrcme.fmcsa.dot.gov and go to the training and testingsection for more information.Web Links:http://www.fmcsa.dot.gov/rules-regulations/topics/medical/medical.htmhttp://www.fmcsa.dot.gov/rules-regulations/administration/fmcsr/fmcsrruletext.aspx?reg=391.43

101st Annual NWOsteopathic Convention

June 19-22, 2014Skamania LodgeStevenson, WA

Page 10 Summer 2013 Washington D.O.

According to Kathie, I owe her aBear Dropping Column , so here goes.It is always a challenge to decidebetween what I should write andwhat I would like to write since, asyou can imagine, my preferencewould be to write with a somewhatsharper tongue on my observationsof society, however, that is not in mypay grade.

So here I am, sitting on the deckon the third floor following doctor’sorders to take my Lasix and do an I &O of the resulting predictable urinaryevent. Now I don’t know if you haveever taken Lasix but at least for me Ican’t do anything else but micturatefor the life of the drug effect. Ibelieve there is always humor ineverything if you just look for it. I justused the spell checker and it hassuggested that I should changemicturate to masturbate. Maybe thatis a good idea for the spell checker,but for me I am going to pass on thatsuggestion. But I digress.

I decided that since I have a greatview of the golf course next door andI can’t do much of anything else, Iwould just sit with my urinal and my1 liter Becel Margarine tub and thinkabout Life, Love and the ChicagoCubs. I suppose I could have pickedthe Mariners since they are the sametype of perpetual losers as are theCubs, but the Cubs have a longerrecord of losing in unique ways. Alas,we all seem to need a losing cause tobelieve in.

My view is of three ranks of theCanadian Costal Mountain range andthe mountains nearest to the condoare snow covered in the winter andthe back rank has snow all year. Thegolf course banks into the closestrange which is Crown land, theequivalent of National Park, and sinceCrown Land doesn’t get cut, the viewyou’ve got is the view you get. Anda great view it is. The condooverlooks the water hazard and theapproach to the eighteenth hole so

lots of green and water to see. Oneof the more interesting things is thesound lens that allows me to hearalmost everything the golfers say. Icould do a column on Golfer speak,but since I don’t know who will readthese columns, we had probably bestnot go there, although they seem touse the same expletives.

The area where I am is called theNorth Fraser Valley and is, ofcourse, becoming more denselypopulated with housing and big boxstores. This area is unique in that itis suburban becoming urban yet itmight as well be rural. The area wasdeveloped by Dutch immigrants afterWW1 (The war to end all wars) andnaturally is a series of dikes andfarm land linked together. The areais about 45 minutes East ofVancouver and just North of Lynden.The economy is heavily agriculturalwith multiple kinds of berries andvegetables and, of course, one ofGod’s questionable inventions: Cows.I would also guess that the bordercrossing industry is a large source ofincome. It is certainly a large sourceof irritation when you are trying tocross. I have found it is rare for theCanadian border guards when youare coming in but the Americans areoccasionally funny when you arecoming home.

At some point some developersdecided that golf courses would be agreat idea so there are five 18 holeand four 9 hole courses that arealmost linked. This has led to a sortof wild life park including the largestGreat Grey Heron Rookery in NorthAmerica and one would assume alarge reservoir of golfers. There isalso a huge flock of Canada Geese(Duh!) a giant murder of Crows, atransient flock of Sea gulls, a bigflock of Starlings, and much to theconsternation of the Condo owners,a flock of Pigeons, and many birdsthat I do not have a clue as to their

names. I would be remiss if I didn’tgive attention to the 1 Bald Eaglewho ,while constantly challengingthe fowl population, seems to makehis living catching fish in the waterhazard. After dark, the course isowned by the Coyotes and occasionalBear.

I find the geese interesting in thatevery morning they go through theritual of deciding the Goose of theday. I’m not sure if they areegalitarian or simply not brightenough to remember who the leaderwas yesterday. They seem to breakupin gaggles of about 10-15 and spendthe next 10 or so minutes chasingeach other until a leader is electedthen no more fights for the day. TheGeese totally ignore the golfersunless a ball lands in their midst.When this happens they simply moveover but rarely fly. The Crows, on theother hand act like Crows. They fightwith themselves and everything elsein the area including the golfers,who they challenge for the right tobe on the course. The Seagulls seemto be, more or less, thugs. Whenthey show up, usually after a rain,everyone else leaves and stays awayuntil the Gulls leave. The Starlings,or ,as some people call them “blackbirds”, seem to mainly practiceaerobatics by flying weird patternsin the sky without hitting each other.

The other various species seemto be interesting but beyond mylearned observations. The swallowsare always a delight as they swoopand bank working to catch the latesthatch of insects and build their mudhouses. There are also a number ofsong birds but I don’t know whatthey are. And of course, there arethe various species of duck that swimup and down the water hazard as ifthey were part of the protective fleetfor the place. Those are myobservations of our feathered friendsand I’m sticking with them.

Bear

Washington D. O. Summer 2013 Page 11

AN APPROACH TO CHRONIC PAIN UTILIZING OMTTAKING THE PAIN OUT OF CARING FOR CHALLENGING PAIN PATIENTS

SATURDAY, SEPTEMBER 21, 2013

PACIFIC NORTHWEST UNIVERSITY OF HEALTH SCIENCESCOLLEGE OF OSTEOPATHIC MEDICINE

200 University ParkwayYakima, WA 98901

(509) 452-5100

8.5 Hours Category 1-AAOA - Approved CME

Presented by the Washington Osteopathic Medical AssociationA Certified Sponsor of Category 1-A, AOA-Approved CMEProceeds Benefit the Washington Osteopathic Foundation

Learning ObjectivesThe diagnosis and treatment involving chronic pain and somatic dysfunction,incorporating the holism of osteopathic medicine.

Harlod Agner, DOProgram Chair

7:30 a.m. Registration & Breakfast

8:00 a.m. Myofascial Releasew/Lab TimeDon Woods, DO

9:30 a.m. A Novel Approach to CranialScreening & Treatment w/Lab TimeBill Powell, DO

11:00 a.m. Strain/Counterstrainw/Lab TimeLarry Lefors, DO

12:30 p.m. Lunch

1:30 p.m. Lymphatic Treatmentw/Lab TimeRichard Koss, DO

2:30 p.m.Muscle Energyw/Lab TimeLynda Williamson, DO

4:00 p.m.AppropriateDocumentation andCoding: Getting Paid forWhat You DoHarold Agner, DO

5:00 p.m.Seminar Adjourns

DirectionsPNWU is located at 200 University Parkway,Yakima, WA, 98901For directions, go to:http://www.pnwu.edu/students/prospective-students/visit-pnwu/

Questions? Call the WOMA office at 206-937-5358 or email kitter@woma.org

WOMA Fall Seminar

Page 12 Summer 2013 Washington D.O.

“AN APPROACH TO CHRONIC PAIN UTILIZING OMT” SEPTEMBER 21, 2013 - PACIFIC NW UNIVERSITY OF HEALTH SCIENCES, YAKIMA, WA

Name ______________________________________________ Phone __________________________

AOA# ____________________ Email ___________________________________________________

Address ________________________________________________________________________________

City _______________________________________ State __________ Zip ________________________

Registration Fees Member * Member * Non-Member

Before 8/19 8/19 or later add surcharge

Physician $275.00 $325.00 $175.00 $ ____________ Allied Health Professional $275.00 $325.00 $175.00 $ ____________ Postgraduate $200.00 $250.00 $175.00 $ ____________ Retired Physician $200.00 $250.00 $175.00 $ ____________ **Printed Syllabus $ 25.00 $ ____________*Member fee also applies to out of state physicians who are members of theState AOA Divisional Society of the state in which they practice.Seminar Fee includes access to web-based syllabus, continental breakfast and lunchRegistrants are encouraged to bring their laptops and will be able to type notes to save on them.iPads may be used to follow along, but notes cannot be typed or saved on them.**Printed syllabus must be pre-ordered with registration

WOF/WOMA Board Meetings Saturday, September 21, 2013 PNWU Administration Building 5:30 p.m. WOF Board Meeting 6:00 p.m. WOMA BOG Dinner $ 45.00 $ ____________

Total $ ____________

Complete this form and send with your check made payable to WOMA or Visa/MasterCardinformation to: PO Box 16486, Seattle, WA 98116.

Pay with:_____Visa_____MC Name on Card_________________________________________________

Card Number____________________________________________Expiration Date___________________

Signature_________________________________________3-Digit Security Code_____________________

All cancellations will be converted to contributions to the Washington Osteopathic Foundation. No refunds will be made. Questions - Call the WOMA Office at 206-937-5358. SEMINAR REGISTRATION DISCOUNT DEADLINE AUGUST 18, 2013 Because this is Fair Weekend in Yakima, early hotel reservations are advised.

OFFICIAL NOTICEWashington Osteopathic

Foundation Board Meeting5:30 p.m.

Saturday, September 21, 2013WOMA Board of Governors

Dinner MeetingSaturday, September 21, 2013. 6:00 P.M.

PNWU Administration Building111 University Parkway, 2nd Floor

Use the registration form inside to reserve your space at eithermeeting.

WOMA CME Committee MeetingFriday, September 20, 2013, 7:00 pm

PNWU Administration BuildingRSVP kitter@woma.org

ACCOMMODATIONSOxford Suites

1701 E. Yakima Avenue, Yakima, WA 98901 509.457.9000reservations 800.404.7848$85 for a single or double

Ask for PNWU rateLedgestone Hotel

107 N. Fair Avenue, Yakima, WA 98901 509.453.3151www.ledgestonehotel.com

$119 for a Single QueenAsk for the PNWU rate

Due to the Yakima County Fair, early reservations areAdvised!

huttle Service: Yakima Oxford Suites provides complimentaryshuttle service to and from the Yakima Airport. There is acourtesy phone near baggage claim or call Hotel at (509) 457-9000.

Washington D. O. Summer 2013 Page 13

Please Join Us!

What: Mixer/BBQ

When: Saturday, August 24 from 12 Noon to 4:00 p.m.

Where: Rocky Reach Dam picnic area, the first one on the left as you enter

Who: residents, students, docs newer into practice, those interested inbeing mentors, local DOs, and of course your families!

Why: network, fun outing with the kids before school starts

Your host, Amber Figueroa, DO, will provide burgers, dogs, buns, and fixins, you bring aside dish, beverages, games, etc. Come and go, the visitor center is free, hopefully there willbe some salmon on the fish ladder. This will be will be lots of fun!

Please RSVP and for questions to Amber Figueroa, anfigueroa22@gmail.com

For more information about Rocky Reach Dam, go tohttp://www.chelanpud.org/visitor-center.html.

WOMAPO Box 16486Seattle, WA 98116-0486