The Doctor is Deployed

Transcription

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

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