Ohio Medicine PAGE 12 MEET OUR NEW PRESIDENT MARY J. WALL, MD, JD ISSUE 2 Ohio State Medical Association. Inside This Issue

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1 Ohio Medicine 2014 ISSUE 2 Ohio State Medical Association MEET OUR NEW PRESIDENT MARY J. WALL, MD, JD PAGE 12 Inside This Issue Quarterly Digest Updates 04 OSMA Annual Meeting Recap 14 Malpractice Suits Hit 7-year Low 17 Member Profile: Alice Dachowski, MD 20

2 TABLE OF CONTENTS 2014 Issue 2 Published June 2014 Ohio Medicine Disclaimer This publication provides general coverage of its subject area. It is provided to OSMA members with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice or services. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The publisher shall not be responsible for any damages resulting from any error, inaccuracy or omission contained in this publication. Paid advertisement may or may not imply OSMA endorsement. Ohio Medicine Copyright Notice 2014 by the Ohio State Medical Association. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without express written permission from the publisher. Publisher: D. Brent Mulgrew Editor: Reginald Fields Ohio Medicine 04 Education and Services Digest 06 Legislative Digest 08 Legal and Regulatory Digest 10 Partners Digest 12 Cover Story: Profile of Dr. Mary Wall 14 OSMA Annual Meeting Recap 17 Malpractice Suits Hit 7-year Low 20 Member Profile: Alice Dachowski, MD 22 Member Newsmakers 23 Physician Leadership Institute of Ohio 24 OSMA Member Develops Program to Assist Physicians Who Prescribe Controlled Substances 26 Physicians Save Time with New Electronic Student-Athlete Physical Form 27 Executive Director s Closing Point MESSAGE FROM THE PRESIDENT The Ohio State Medical Association, its members and its leadership have been actively working on multiple projects since the OSMA s Annual Meeting in early April. Most prominent is the activity on phase 1 of the Smart Rx program, the OSMA s opioid initiative. A diverse opioid workgroup of OSMA members is being developed to include physicians in many practice settings and specialties. In this way, the organization will be best positioned to develop the Smart Rx program in a manner that is relevant, practical and useful to the largest possible number of physicians. The OSMA is currently in the process of developing educational toolkits for physicians for use both in the office and healthcare facility settings. The OSMA is actively exploring partnerships to assist in furthering the Smart Rx program, among physicians, in the healthcare community, and among the public. It is anticipated that this will be a long term project, with the initial phase focused on physician education. Another major issue that has come to the forefront in recent weeks is Maintenance of Certification. An MOC/MOL workgroup of both Council and OSMA membership is being formed to explore the factors, issues and challenges of the current MOC/ MOL environment. These issues include, but are not limited to, economic issues, time commitment, and the relationship of MOC/MOL activities to quality outcomes. The MOC issue is quite complex as there are dozens of primary care and specialty board organizations, each with its own specific requirements. Meanwhile, work continues with Ohio Gov. John Kasich s Office of Healthcare Transformation and the Medicaid expansion program. The OSMA membership will be updated on any developments in this area as information becomes available. Other anticipated activities will involve work in insurance, including dealings with private carriers, understanding of insurance exchanges, patient eligibility, performance benchmarks, and optimizing resources available to physicians. Additionally, the areas of medical education and graduate medical education are currently in distress, from both economic and non-economic resource standpoints. As time and resources become available, I would like to develop a medical education workgroup. Also, the structure of the OSMA workgroups is changing. In prior years, participants in these groups were primarily members of the OSMA Council. Currently, I am aspiring to have a more diverse makeup of project workgroups, with at least half of the makeup of the workgroups composed of OSMA members who do not serve on Council. In this way, more members have an opportunity for direct input into the activities of the organization between the annual meetings. The working group participants will gain experience, which can serve to benefit them in their employment settings and practices. In addition, the working groups can bring fresh and novel ideas to the table, and can serve to develop future leaders for the OSMA. On a personal note, I am gratified by the willingness of many of our OSMA members to donate their talents and energies to benefit the medical community. My hope is that we get into the business of ideas, ideas to better ourselves, the medical community, our patients, and our own working environments. Mary J. Wall, MD, JD President Ohio State Medical Association

3 GET READY GET FOR READY FOR ICD-10 ICD-10 STAY ON THE ROAD TO 10 STAY STEPS ON TO THE HELP ROAD YOU TO TRANSITION 10 STEPS TO HELP YOU TRANSITION The ICD-10 transition will affect every part of your practice, from software upgrades, to patient registration and referrals, to clinical documentation and billing. The The ICD-10 transition will will affect every part part of of your your practice, from from software upgrades, to to patient registration CMS can help and and you referrals, prepare. to Visit to clinical the documentation CMS website at and and billing. and find out how to: CMS CMS can Make can help help a Plan Look you you prepare. at Visit the Visit codes the the CMS you CMS website use, develop at at a budget, and prepare and and find your find out staff out how how to: to: Train Your Staff Find options and resources to help your staff get ready for the transition Make a Plan Look a at at the the codes you you use, use, develop a budget, a and and prepare your your staff staff Update Your Processe Review your policies, procedures, forms, and templates Train Your Your Staff Find options and and resources to to help help your your staff staff get get ready for for the the transition Talk to Your Vendors and Payers Talk to your software vendors, clearinghouses, and billing services Update Your Your Processe Review your your policies, procedures, forms, and and templates Test Your Systems and Processes Test within your practice and with your vendors and payers Talk Talk to to Your Your Vendors and and Payers Talk to to your your software vendors, clearinghouses, and and billing services Now is the time to get ready. Now is is the time to to get ready. Test Test Your Your Systems and and Processes Test within your your practice and and with with your your vendors and and payers Official CMS Industry Resources for the ICD-10 Transition Official Official CMS CMS Industry Industry Resources for the for the ICD-10 ICD-10 Transition

4 OSMA Education The Ohio State Medical Association (OSMA) offers a number of continuing medical education courses each year on a variety of topics in convenient formats, giving you access to professional development in your own office. Topics include ICD-10 Implementation, Medicare/Medicaid Updates, OSHA Compliance and Private Payer Updates. Make sure to check out the OSMA s new On Demand Content Catalog for additional course offerings. For a list of current classes, visit Ohio State Medical Association upcoming events MEDICARE AND MEDICAID UPDATES June 24 Hilliard Ohio State Medical Association June 25 Athens OU Inn July 10 Mansfield Mid Ohio Conference Center July 23 Independence Doubletree by Hilton Cleveland East July 24 Westlake Holiday Inn Westlake July 29 Dayton Holiday Inn Fairborn July 30 Cincinnati Holiday Inn Eastgate Aug. 6 Lima Howard Johnson Inn Aug. 7 Toledo/Perrysburg Hilton Garden Inn Aug. 12 Boardman Holiday Inn Boardman Aug. 13 Canton Courtyard by Marriott Aug. 20 Cambridge Pritchard Laughlin Center Aug. 21 Akron Sheraton Suites Cuyahoga Falls Aug. 26 Hilliard Ohio State Medical Association

5 New Medicare and Medicaid Changes: THE OHIO STATE MEDICAL ASSOCIATION HAS YOU COVERED Admit it, the words healthcare and change just seem to go together. No problem. The Ohio State Medical Association has you covered. Join us for our 2014 Medicare and Medicaid Update Series. This is a once-a-year opportunity to hear valuable information and learn of recent updates to Medicare and Ohio s Medicaid program. Changes regarding topics, such as: MEDICARE n Discuss new and ongoing Medicare initiatives n Provide information regarding medical record review contractors n Provide CGS operational reminders n Introduce resources and self-service technology options MEDICAID n Eligibility n MyCare Ohio n ICD-10 n Medicare Part B and C billing n Policy Updates You will also hear updates on Medicaid Managed Care and MyCare Ohio from the following payers, who will be exhibiting at many of the locations: n Buckeye Community Health Plan n CareSource n Molina Healthcare of Ohio n Paramount Advantage n UnitedHealthcare n Aetna n Humana By presenting this Update we intend to make it easier for providers to understand the changes being proposed and the programs being administered. Registration discounts available for early registration and multiple registrations from the same practice. EDUCATION&SERVICESDIGEST I know you re busy, but we were just served suit papers on a patient. Send me the number of my malpractice insurance carrier. Who would you be without your reputation? Make sure your reputation is protected with medical malpractice insurance coverage from PSIC. Scan or visit psicinsurance.com Call Malpractice insurance is underwritten by Professional Solutions Insurance Company University Avenue Clive, Iowa PSIC NFL 9459

6 LEGISLATIVEDIGEST GOVERNMENT RELATIONS STATEHOUSE UPDATE: LAWMAKERS TAKE A SUMMER BREAK The 130th General Assembly (GA) just left Columbus for the summer, and they won t return until sometime after Labor Day. The final weeks before a recess generally entail a flurry of legislative maneuverings, as lawmakers and advocates all work to pass bills before taking a break. This May was no different, and the last few weeks of spring flew by as the House and Senate worked through wide-ranging legislation that impacts the practice of medicine. Over the past few months, the OSMA government relations team closely monitored nearly twenty legislative proposals; some of the most important bills are outlined below. Passed by both chambers and being sent to the governor: House Bill 341 Use of the Ohio Automatic Rx Reporting System (OARRS) OSMA Supports This bill requires prescribers who write for opioids and benzodiazepines to (1) register to use OARRS and (2) to query OARRS if they are writing prescriptions for 7+ days under most conditions. The OSMA s lobbying efforts also ensured that there are a few important conditions when prescribers do not need to query the database. The OSMA supported HB 341 because it smartly balances a prescriber s administrative responsibilities and clinical judgment with the need to protect patients health and safety. House Bill 314 Parental/Guardian Consent when Writing Opioid Prescriptions to Minors OSMA Neutral This legislation requires prescribers to obtain written parental/guardian consent when writing prescriptions for opioids to minors. The OSMA worked with the bill s sponsor to make sure that HB 314 included a number of excepted circumstances for times that a prescriber will not be required to obtain written consent. Senate Bill 99 Oral Chemotherapy Cost Parity OSMA Supports Currently, the cost of oral chemotherapy treatment can force patients to pursue use of less expensive intravenous chemotherapy drugs. SB 99 addresses this issue by requiring insurance companies and Medicaid plans that cover traditional intravenous treatments to either establish comparable coverage for oral medications or to only charge up to $100 for a 20-day supply of oral chemotherapy medication. The OSMA strongly supported SB 99 because it champions each individual patient s ability to receive the chemotherapy treatment that their physician feels will be most effective. Senate Bill Standards for the Delivery of Non-Self-Injectable Cancer Drugs OSMA Supports This legislation will end the dangerous drug dispensing practice known as brown-bagging, which occurs when an insurer requires a patient to receive medications from a mail-order pharmacy. To end brown-bagging, SB 230 prohibits pharmacists from dispensing non-self-injectable cancer drugs to a patient, a patient s representatives, or a patient s private residence. The OSMA supported SB 230 because it goes a long way towards ensuring the integrity of some very important medications while furthering patients safety. Passed by the House Judiciary Committee and awaiting consideration by the full House: House Bill 276 Medical Liability Tort Reform OSMA Supports HB 276 contains two changes to Ohio s medical malpractice laws: (1) Updates Ohio s I m Sorry law to allow health care professionals to have a broader conversation with a patient following an adverse event - beyond just offering an apology - and then protects that conversation from later being introduced into evidence as an admission or statement against interest. (2) Prohibits the use of federal and third-party insurer payment policies and quality guidelines from being used to establish the standard of care to determine medical liability. The OSMA developed this legislation, in consultation with the Ohio Hospital Association, and it is a priority for enactment by the end of the year. 6 Ohio Medicine The official publication of the Ohio State Medical Association

7 House Bill 131 Restrictions on Minors Use of Ultraviolet (UV) Tanning Beds OSMA Supports This legislation requires parental consent and parental presence for the duration of all tanning sessions for minors under age 16, requires recurring parental consent and requires a parent to be present for the duration of the first tanning session for minors between ages 16 and 18, and requires tanning facility operators and employees to obtain written consent from all individuals over age 18 who use sun lamp tanning services. The OSMA is supportive of HB 131 s incremental changes because they provide better protection for children than the laws currently in place today. Passed by the Senate and now pending in the House: Senate Bill 54 Dense Breast Tissue Notification OSMA Neutral This bill requires mammography facilities to send a letter to each patient who has a mammogram containing the written results of the test. If a patient is found to have dense breast tissue, the letter must contain specific language that tells the patient they have dense breast tissue, that this is not a cause for concern, and that they should discuss this finding with their health care provider. Though the OSMA generally opposes regulation that details exactly why, when, where, or how providers should talk with patients, the organization is not opposed to this particular bill because it was crafted in a minimally prescriptive way and it encourages discussion between providers and patients. LEGISLATIVEDIGEST Passed by the House and now pending in the Senate: By ensuring participation in alternative rating/ premium discount programs, cost containment strategies and safety best practices, we annually save our clients $100 million in workers compensation premium paid. Ask us how today! (800) Endorsed by the Ohio State Medical Association 2014 ISSUE 2 7

8 LEGAL&REGULATORYDIGEST Health Care Stakeholders Support Proposed MOLST Legislation The purpose of MOLST legislation in Ohio is to replace the current DNR form and to encourage and facilitate more communication between the patient and medical staff about end-of-life decisions, while allowing the patients and medical professionals more flexibility to make these considerations as patients medical conditions change. MOLST stands for Medical Orders for Life-Sustaining Treatment. The MOLST is a medical order issued by a physician after communication with and approval by the patient. It is not an advanced directive and does not alter current law in Ohio concerning advanced directives. Other than making technical changes to some laws, the primary Ohio law to be changed with this legislation is to sunset the DNR form and to replace that form with the MOLST form which will: n Be patient-centered and patient-driven. The uniform MOLST form will allow the patient to better understand and drive his or her own end-of-life care, including those decisions regarding the administration of life-sustaining treatment. n Make clear that no one is required to complete a MOLST form. The MOLST form is a way to uniformly document and transfer end-of-life medical orders. Just like any medical order, a patient or decisionmaker should discuss and understand the options carefully with his or her medical professional. No one is required to complete a MOLST form, and this statement will be included on the form itself. Further, nothing in the legislation, or on the MOLST form, will create a bias in favor of more aggressive or less aggressive forms of treatment. n Assure that the MOLST form is transferable across settings of care. A MOLST form will be transferable across all settings, including emergency settings. A copy of a MOLST form is equally valid as an original, and medical professionals will be required to notify other medical professionals if they know a patient or decision-maker has completed a MOLST form. n Provide immunity to all health care workers who honor the medical orders outlined in a MOLST form, if acting under their scope of practice. Like current DNR law, the new MOLST law will protect health care personnel from civil and criminal liability who follow end-of-life medical orders outlined in a patient s MOLST form. MOLST legislation will not change the following existing Ohio advance directive laws: n Ohio law allows an individual to make informed decisions about his/her medical care including refusing any and all treatment which aims to prolong life (ORC 2133) n Ohio law allows an individual to name an agent (attorney in fact) who would make informed medical decisions for the individual at his/her direction (ORC ) n Ohio law limits when an agent can authorize medical personnel to withdraw artificially or technologically supplied nutrition and hydration (ORC 2133) n When an individual has not named an agent for health care decision making, Ohio law contains a priority list of who can make informed medical decisions when he/she is unable to make such decisions (ORC (B) & D1bi). The OSMA wishes to thank Jeff Lycan with Midwest Care Alliance for providing this article reflecting the efforts of a large health care stakeholder group to bring MOLST to Ohio. 8 Ohio Medicine The official publication of the Ohio State Medical Association

9 The Power of Cloud Intelligence Because the athenahealth network is maintained and updated in the cloud, we have unique visibility into the performance of more than 47,000 caregivers visibility that helps us keep claims clean, reduce DAR and get providers paid for the care they deliver. Midwest-East North Central $12,409, Quality-Based Revenue Collected 8,998 Number of Providers 1,620,399 Claims Billed *Data as of Sept % Claims Paid on First Submission (FPR) 94% -29% 2012 Meaningful Use Attestation Rate Days in Accounts Receivable (DAR) ATHENAONE SM : A PROVEN, INTEGRATED SOLUTION A fully integrated suite of cloud-based services. Named Best in KLAS as #1 Overall Software Vendor. TO LEARN MORE VISIT: athenahealth.com/osmacloudintel

10 PARTNERSDIGEST Including Risk Management in Your Vacation Planning Allows You to Relax Because liability never takes a holiday, your vacation plans should include medical coverage arrangements for your practice, particularly when you use locum tenens. The following tips will help reduce risks in your practice and promote the safety of your patients as you plan your vacation: n Review managed care contracts for relevant coverage requirements. Some managed care contracts contain very specific language on this topic and many contain indemnification clauses that could expose you to the liability of the covering physician (as well as breach of contract). n Whenever possible, make secondary coverage arrangements. Confirm coverage arrangements via or fax with the locum tenens who are covering your practice in order to avoid misunderstandings, possible uncertainty of dates or time frame, and exposure to abandonment. n Ensure that the practice coverage arrangements include an understanding about patient billing practices in conjunction with any managed care contracts or plans. n Choose covering physicians who share your medical specialty and have privileges at the same hospitals that you do. n Determine if covering physicians carry professional liability coverage and the limits of such coverage. While asking these questions could be awkward, you may be required to ask under certain managed care plans, provider agreements, and hospital bylaws. n Before leaving on vacation, prepare a list of patients who are hospitalized or are in the midst of diagnostic work-up, or who have special medical problems or needs. Give this information to the covering physicians and document any specific advice you provide. n Inform the attending physicians or hospitalists of any hospitalized patients you are following about your coverage arrangements, and document the hospital chart to reflect these conversations. n Advise your patients of the coverage arrangements and give them the covering physicians names. n Make each hospital where you have on-call responsibilities aware of the dates of your unavailability and the identity and phone numbers of the covering physicians. Give similar notice to your answering service and office staff. Upon returning from vacation, promptly confer with all covering physicians. Document what you were told by the covering physicians about any significant developments in patients clinical course or treatment while you were away. Run down the patient list that you prepared before you left for vacation. Peruse all correspondence, phone messages, and lab reports. Review written follow-up orders and appointments or diagnostic studies scheduled by the covering physicians to ensure nothing is forgotten. Promptly deal with any patient who may have experienced an untoward event or medical complication while you were away. Depending on your medical specialty and practice environment, set aside time on your first day back to catch up, review and prioritize correspondence, review and return telephone messages, and attend to matters that require your immediate attention. This investment of time may seem like a luxury, but it will facilitate a smooth transition. Doing so could also prevent an inadvertent break in the continuity of care attributed to oversight or delay, rather than to an absence from the practice. Consider implementing these fundamental loss prevention measures for even brief periods when you are unavailable, such as observance of religious holidays, attending medical conferences, personal illness, or a long weekend. Unfortunately, vulnerability to claims is not diminished on these occasions. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit Cliff Rapp, BS Ed, LHRM, FL AHCA, HCRM, is vice president of Patient Safety at The Doctors Company. He is a licensed healthcare risk manager (LHRM) with more than 35 years of experience in the insurance industry, specializing in professional liability, medical and dental malpractice claims, loss prevention, and risk management. 10 Ohio Medicine The official publication of the Ohio State Medical Association

11 PARTNER SPOTLIGHT IS YOUR PRACTICE SAFE FROM IT RISKS? As practices continue to adopt increasingly complex health care applications and work to meet demanding regulatory requirements, it is critical to have a solid information technology (IT) foundation in place. Whether it is launching or expanding electronic health record (EHR) or transitioning to ICD-10, practices will encounter situations that require an IT plan capable of supporting varying needs. But how do you know if your practice is on the right path? The Ohio State Medical Association s Health Information Technology (HIT) Solutions program can help with Practice IT Check-Up, a new service designed to evaluate IT plans and educate practices on how to make adjustments. PARTNERSDIGEST We created this program to provide physician practices with an objective assessment of their IT environment, said Sarah Gaver, director of physician practice relations. The information will help practices understand the capabilities of their current program and empower practices to have meaningful discussions with their current IT providers. The Practice IT Check-Up is available free of charge for OSMA members and is offered through the OSMA s partnership with Elevation Healthcare, an Ohio-based company providing consulting, education, training, and professional development to practices and their physician, clinical, and administrative staffs in Ohio, Kentucky and Michigan. This is a no pressure way for practices to gauge current performance and future readiness for their ITrelated needs. The assessment is quick and easy, and will not be disruptive to your practice, said Gaver. For more information or to sign up for your free assessment, go to or contact the OSMA Knowledge Center at (800) or PREFERRED PARTNER REMINDERS Workers Compensation Group Rating Now Open, New Date for 2014 Enrollment for the 2015 Workers Compensation Group Rating Program is now open. OSMA member practices can save significantly on workers compensation premiums by participating in the program, which is administered by the OSMA s Preferred Partner, CompManagement, Inc., and sponsored by the Ohio Farm Bureau Federation. Due to earlier deadlines set by the Ohio Bureau of Workers Compensation, the enrollment deadline to participate this year will be in November. Due to this shortened schedule, now is the time to apply. Visit our website today at or contact the OSMA Knowledge Center at (800) or to learn more about the program and request a free quote. Provista Period 2 Group Buy Available through June 30 Practices enrolled in Provista can save up to 82% off list pricing through the period 2 group buy, which contains 29 categories covering a wide range of items including patient monitors, exam room equipment, laboratory equipment and furniture. To see the entire list or to get information on enrollment in Provista, go to ISSUE 2 11

12 DR. MARY J. WALL: TRAILBLAZER JUST THE 3 RD FEMALE LEADER IN OUR 168 YEAR HISTORY For Mary J. Wall, MD, JD, her dream of someday becoming a physician was born from a painful accident as a young child. When I was five years old I was outside playing with my brother who was four and workers were putting a new sewer system in, new piping, Wall recalls. I had a glass bottle, like an empty perfume bottle, one of my treasures because we didn t have a lot. And I tripped over this construction site, fell on the bottle and it cut an artery in my arm. It was a Sunday afternoon in a small town just north of Pittsburgh with no hospitals close. Francis Perry, MD, a surgeon who lived nearby, was summoned to treat Wall s wound. While he closed the gash in her upper arm, Dr. Perry told young Mary children s stories and jokes that eventually had the young girl smiling and laughing, pushing her fears aside. I remember how he made me feel and I said that day, I want to be a doctor like Dr. Perry, Wall said. Today, Wall is an accomplished diagnostic radiologist in Bellevue, Ohio on the shores of Lake Erie. She s a longtime member of the Ohio State Medical Association, the American Medical Association and the Radiological Society of America. She holds a law degree from Case Western Reserve University and is a member of the Ohio Bar Association, as well as, the American Bar Association. And she is also a military veteran, having served 13 years in the U.S. Army Active Duty and Reserves. In April, Wall became president of the Ohio State Medical Association, becoming only the third female to lead the statewide physicianled organization in its 168-year history. She takes over at a time when issues such as graduate education funding, payment reform and prescription overprescribing and abuse plague the healthcare industry. In my years of working with Dr. Wall I ve found her to be a tremendous leader intent on gathering quality information before taking decisive action, said D. Brent Mulgrew, the OSMA s executive director. She has a vision for the profession and for physicians in Ohio to improve quality and access to healthcare. And she s done it by balancing her family life, with her military career and with her professional life. Wall relishes the opportunity to be looked upon as a role model for other women in medicine but says she understands why few women have risen through the ranks of leadership at some medical organizations and health systems. It takes a lot of outside time to develop leaders in medical communities, to rise through the ranks of any profession actually, she said. For me it was difficult because I was a wife, my husband was an OB/GYN, I had two kids at home and I didn t have a lot of help. You have to decide where your priorities are. But I ve had a lot of great mentors, and many of them are males. In fact, one of her first mentors was a male her father. Not long after meeting Dr. Perry, Wall told her mother that she wanted to be a doctor. But her mother, a stay-at-home mom who was a trained nurse, knew that in the 1960s and 1970s there were few women in the male-dominated world of medicine and tried to encourage her oldest child and only daughter of five children to dream of a different career. My mom was very discouraging and said, Well, I don t know, Wall recalls. But my dad said, Well, I think you should be able to do whatever you want to do. Later as a teenager, Wall s mother took her to meet Elizabeth Vates, MD a small, frail woman with quite a story of her own to tell. Vates was the only woman in her medical class at the University of Pittsburgh in 1912 and went on to run a practice during World War I when her husband, also a physician, was drafted into the military. Dr. Vates was a pioneer a female doctor running a solo practice nearly a century ago. I remember mom driving me to an old house to meet this 92-year-old woman who still saw patients, Wall said. Mom took me there I think to either discourage me or to make sure I went into this with open eyes. By the time they left, Wall s career path was clear. She said, Let me tell you something, dear, don t let your mother discourage you. You need to see the possibilities. Don t let anyone hold you back. If you are really passionate about it, it will work out, Wall said. I was certain then that I wanted to be a doctor. Dr. Vates encouraged me. 12 Ohio Medicine The official publication of the Ohio State Medical Association

13 Wall now says, the rest is history. Today, Wall practices at North Central Radiology & Imaging in Bellevue. But when the conversation turns to diversity, Wall thinks the medical profession is most impacted both positively and negatively by far more than just gender. To me diversity is not only gender and it s not only about race. It could be social, cultural and socio-economic so that you get a variety of viewpoints to get people who can come together, she said. Organizations need to have that wider focus to make decisions that are more informative and stand the test of time. In fact, the cost of medical school is one of the issues that troubles Wall most. She worries that the price tag is so high now that even middle-class families won t be able to support a student through medical school. Each generation faces its challenges and the challenges for this generation are the economic charges, the cost of medical school, she said. It is so expensive to go to medical school now. There doesn t seem to be as many programs to borrow for medical schools these days. Still, Wall takes every opportunity she can to help women in medicine do what she did navigate having a career in medicine while being a wife and mother. One thing I talk to women about is that you have to have stewardship over your own careers, you have to keep your finger in the water so you are informed of what is going on, Wall said. If you have to conduct call-in meetings every once-in-a-while with your colleagues because you can t physically be there for the meeting then you do it to keep your finger in the water. You do it for your future because your kids aren t always going to be young, Wall continued. I m telling young women, your career has to be multi-dimensional. By: Reginald Fields Ohio Medicine Editor BIO Mary J. Wall, MD, JD HUSBAND: Frank Komorowski, MD, retired OB/GYN SONS: John Komorowski, fine wine expert and appraiser, resides in Burbank, Calif.; Michael Komorowski, Ohio University undergraduate 2014 ISSUE 2 13

14 1 The Ohio State Medical Association completed its Annual Meeting in April, tapping Mary J. Wall, MD, JD, as the association s president. Dr. Wall is only the third woman to lead the 168-year-old organization. 2 In her inaugural speech before nearly 300 physicians and medical students, Dr. Wall likened the challenges healthcare reform presents to doctors to the golden hour, that period when a trauma patient teeters perilously between living and dying. This is now our golden hour, the period of time when we ALL need to step up our game, bringing cogent and thoughtful discourse when we have been invited to participate, Dr. Wall told her audience. It is our professional imperative to participate in these venues, and to participate in a considerate, productive and constructive manner, forgoing pettiness, the sins of remote history, and personal agendas. 3 Dr. Wall rallied her professional colleagues to support the OSMA and bring constructive ideas to help move the association and their profession forward. It was once said, to whom much is given, much is expected. Thus, with opportunity for the OSMA also comes responsibility, accountability and a new order of advocacy, Dr. Wall said. The new model of advocacy requires direct physician participation, presence and input in the halls of policy promulgation. 1: Dr. Carl S. Wehri listens to a keynote speech during Friday s Symposium 2: Rebecca Kronauge (right) of South Dayton Acute Care Consultants was named OSMA Practice Manager of the Year 3: Dr. Peter Lafferty (left) of Riverside Radiology and Interventional Associates was named OSMA Innovator of the Year 4: Gov. John Kasich delivers speech after receiving the OSMA s Voice of Medicine Award during Saturday s House of Delegates meeting 4 Ohio Gov. John Kasich also addressed the OSMA s House of Delegates after members gave him a healthcare leadership award for his work supporting initiatives that drive improved healthcare outcomes, including supporting Medicaid expansion, expediting the medical licensure process and supporting measures to help end prescription drug abuse and opiate addiction. The OSMA also elected new district leaders and representatives for various American Medical Association posts. 14 Ohio Medicine The official publication of the Ohio State Medical Association

15 OFFICERS PRESIDENT: Mary J. Wall, MD, JD (automatic succession from President-Elect to President) PRESIDENT-ELECT: Robert E. Kose, MD, JD IMMEDIATE PAST PRESIDENT: Neal J. Nesbitt, MD (automatic succession from President to Immediate Past President) GEOGRAPHIC COUNCILORS DISTRICT 1: Robyn F. Chatman, MD DISTRICT 2: Evangeline C. Andarsio, MD DISTRICT 3: Susan Hubbell, MD DISTRICT 4: Anthony Armstrong, MD DISTRICT 5: Holly Thacker, MD DISTRICT 6: Carl J. Foster, MD DISTRICT 7: Andrew Thomas, MD DISTRICT 8: James Moore, MD AT-LARGE COUNCILORS (TWO-YEAR TERM) Brian Bachelder, MD, Akron Alice A. Dachowski, MD, Gallipolis Brian Santin, MD, Wilmington AT-LARGE COUNCILORS (ONE-YEAR TERM) Lou Ralofsky, MD, Sandusky Mark Stechschulte, MD, Columbus Scott Stienecker, MD, Lima AMA DELEGATION DELEGATES (JAN. 1, DEC. 31, 2016) DELEGATE: Evangeline C. Andarsio, MD DELEGATE: Robyn F. Chatman, MD DELEGATE: Lisa B. Egbert, MD DELEGATE: Richard R. Ellison, MD DELEGATE: Charles J. Hickey, MD DELEGATE: William C. Sternfeld, MD AMA DELEGATION DELEGATE (IMMEDIATELY - DEC. 31, 2014) DELEGATE: Evangeline C. Andarsio, MD AMA DELEGATION ALTERNATE DELEGATES (JAN. 1, DEC. 31, 2016) ALTERNATE DELEGATE: Anthony J. Armstrong, MD ALTERNATE DELEGATE: Tyler J. Campbell, MD ALTERNATE DELEGATE: David O. Griffith, MD ALTERNATE DELEGATE: Deepak Kumar, MD AMA DELEGATION ALTERNATE DELEGATE (IMMEDIATELY - DEC. 31, 2014) ALTERNATE DELEGATE: Deepak Kumar, MD AMA DELEGATION ALTERNATE DELEGATE (JAN. 1, DEC. 31, 2015) ALTERNATE DELEGATE: Regina Whitfield-Kekessi, MD 2014 ISSUE 2 15

16 : Gov. John Kasich (second from right) is joined by Dr. Neal Nesbitt, Dr. Mary J. Wall and the OSMA s Tim Maglione 6: Delegates listen during Saturday s House of Delegates meeting 7: Dr. Andrew Thomas (left) and Dr. Bruce Vanderhoff during Saturday s House of Delegates meeting 8: Dr. Annette Chavez (far right) speaks to female medical students and residents during Saturday s Women in Medicine networking event 9: Ohio Supreme Court Justice Judith French (right) pictured with Dr. Carl J. Foster and Dr. James D. Moore 10: Ohio Supreme Court Justice Sharon Kennedy with OSMA past president Dr. A. Burton Payne (center) and Mrs. Payne 11: Contributors to the OSMA PAC 12: Dr. Mary J. Wall (second from left) after she was inaugurated as OSMA president with, from left, former OSMA president Dr. Deepak Kumar, immediate past president Dr. Neal Nesbitt, and OSMA Executive Director D. Brent Mulgrew 16 Ohio Medicine The official publication of the Ohio State Medical Association

17 Medical Malpractice Suits Hit a 7-year Low in Ohio Thanks to Strong Tort Reform Laws Pushed by the Ohio State Medical Association The Ohio Department of Insurance released a report in April revealing the remarkable impact of medical malpractice tort reform in Ohio. Over the past seven years, the number of medical malpractice claims dropped an astounding 45 percent from 5,051 claims in 2005 to 2,773 claims in Moreover, the cost of medical professional liability insurance for physicians and surgeons during that time period has also declined. Both of these trends are great news for Ohio s patients and physicians. Declining insurance rates mean physicians in higherrisk specialties are more likely to practice in Ohio, affording patients here greater access to high quality health care. We knew that rates would decline when there was more predictability and stability in the medical liability insurance market, said OSMA s Senior Director of Government Relations, Tim Maglione. Seeing insurance rates go down every year for the last seven years is indeed proof that tort reform works. But to understand how Ohio has reached this point requires a look back just beyond a decade ago when the state s medical profession was teetering on disaster. Skyrocketing medical insurance was threatening to chase some physicians to other states and leave patients with scattered care, especially for high-risk specialty care. For example, rural family doctors who once delivered babies could no longer continue that procedure due to insurance costs, forcing expecting mothers in some Ohio counties to travel farther to see a doctor. The story of the Ohio State Medical Association s (OSMA s) successful campaign to change medical malpractice laws in Ohio was documented in Ohio Medicine s nd Quarter issue, celebrating the 10th Anniversary of tort reform. The article recounted the OSMA s leadership through grassroots rallies, legislative advocacy, and support of Supreme Court candidates who agreed to leave lawmaking in the hands of state legislators, not black-robed jurists. Basically we got our patients involved and when the patients 0.54% 1.26% 0.14% 18.82% 79.22% Claim not paid Claim Paid - Settlement Agreement Claim Paid - Alternative Dispute Alternative Claim Paid - Trial or Jury Verdict Claim Paid - Summary Judgement/Directed Verdict 2014 ISSUE 2 17

18 started getting involved and their voices started to be heard at the Statehouse and in the voting booth, before you knew it 18 laws had been changed in Ohio, Dr. Evangeline Andarsio, a Dayton OB/GYN, told Ohio Medicine in Andarsio spoke at a 2002 Statehouse rally that drew more than 3,000 doctors. It was a hard time but the OSMA really stepped up to the plate and I think people really saw the value of our organization. The OSMA s strategy worked in 2003, then-gov. Bob Taft signed a sweeping piece of tort reform legislation, known as Senate Bill 281. Before the OSMA rallied physician and patient advocates to support passage of SB 281 liability insurance rates soared higher each year increasing over 24% in 2003 and more than 27% in After the tort reform bill became effective and withstood legal challenges from trial attorneys, insurance rates began to stabilize, and then they fell. We now have one of the most stable medical liability climates in the country, Maglione, who was instrumental in the passage of SB 281, said. Physicians actually want to move to Ohio because they know our tort reforms are here to stay. The Present Despite falling insurance rates and declining numbers of lawsuits, it is clear that there is more to do, and the OSMA is committed to making our tort reform laws better. In 2012, less than 2% of all medical malpractice claims in our state ended in trial, jury, or judicial verdict judgments in favor of the plaintiff. In fact, nearly 80% of medical malpractice litigation ended without indemnity payments to plaintiff, and of the remaining claims, over 18% were settled out of court. This data shows physicians are being needlessly sued in a large fraction of claims made in our state. In an effort to prevent unwarranted lawsuits, the OSMA is championing new legislation known as House Bill 276. HB 276 contains two small but important changes to our state s medical liability laws. The first reform in the bill updates Ohio s I m Sorry law to allow health care professionals to have a broader conversation with a patient following an adverse event but protects that conversation from later being introduced into evidence as an admission or statement against interest. Ohio s current I m Sorry law provides that expressions of apology or sympathy made by a health care provider are inadmissible as evidence of liability in civil actions regarding an unanticipated outcome of medical care. Unfortunately, since admissions of fault are not expressly provided for in the I m Sorry statute in the same way as apologies or expressions of sympathy, there is a grey area in the law that potentially allows a plaintiff to interpret or confuse an apology with an admission of fault. While a health care provider might offer words intended as an apology, a Rate Change for Top 5 Med-Mal Insurance Companies 30.00% 25.00% 20.00% 15.00% 10.00% 0.00% -5.00% % % 27.20% 24.10% 6.40% 0.70% -0.50% -1.10% -3.20% -3.60% -9.10% -7.40% -7.40% Year 18 Ohio Medicine The official publication of the Ohio State Medical Association

19 plaintiff might hear an admission in those same words. Because of this grey area, many providers aren t comfortable having a conversation with a patient or a patient s family about unforeseen events that may have occurred. Although the I m Sorry law is intended to foster communication during unfortunate circumstances, the narrowness of the statute leaves many patients and patient families wondering, What really happened? HB 276 eliminates this grey area, and by doing so, opens the lines for honest discussion between patients, families, and health care practitioners. The OSMA is confident that this change will help to prevent needless lawsuits. The second reform in HB 276 prohibits the use of insurer payment policies and guidelines from being used to establish the standard of care and state they cannot be used to establish a legal basis for negligence or the standard of care to determine medical liability. care insurers. The OSMA has concerns that payment policies that adjust or restrict reimbursement to health care providers and hospitals could be used in legal proceedings to indicate medical negligence. To alleviate these concerns, HB 276 makes it clear that payment guidelines and performance standards adopted by the Centers for Medicare and Medicaid Services (CMS) and private insurers cannot be used in legal proceedings to establish the standard of care. This legislation will prevent claims from being needlessly filed when an insurance provider simply hasn t paid for health care services. HB 276 is still pending in the legislature. By: Marisa Weisel Manager, Advocacy and Policy Ohio State Medical Association This new provision was added in light of recent payment reform activities occurring across public and private health DrConnect. Continuous connection to your patients care. Learn more ccf.org/drconnect CCECC 2014 ecc Campaign_8x5.25_OM-99.indd 1 5/5/14 1:03 PM 2014 ISSUE 2 19

20 MEMBERPROFILE 5 QUESTIONS WITH ALICE DACHOWSKI, MD GENERAL SURGERY HOLZER CLINIC Our New Season, New Priorities segment continues in this issue of Ohio Medicine. At the annual business meeting in April, the Ohio State Medical Association shared its new vision, mission, values statement, and strategic priorities with members, dignitaries, and others in attendance. Now hear from Dr. Alice Dachowski as she explains in her own words how the OSMA s strategic priorities benefit Ohio doctors. What does the Ohio State Medical Association mean to you as a practicing physician? For me, the OSMA is absolutely central to everything I do as a practicing general surgeon in a multi-specialty group in rural southeastern Ohio. It has given me a sense of community with other physicians regardless of their specialty, type of practice, status, or place of employment. Being an OSMA member gives me the privilege of being a part of a community of physicians and a feeling that we re all in it together one voice, speaking on behalf of our profession and our patients. In what ways does the Ohio State Medical Association support Ohio physicians? The commitment the OSMA has to educating our physicians has been amazing. The OSMA provides credited continuing medical education at a variety of sites throughout the state. The OSMA has been able to partner with our healthcare system to provide our team physicians and staff with the tools they need to adapt to the changes in healthcare, whether it be coding, keeping up to date on the prescription drug abuse problems in our area, or staying current on advocacy matters and legislation directly affecting physicians and the practice of medicine. What s the single biggest threat to the physician and the physician occupation and how can the OSMA help combat this threat? I think the single biggest threat to physicians in Ohio today is fear and uncertainty. Fear as a result of the change and chaos that s transcending on us as we try to revolutionize healthcare in the state and throughout the nation. There are so many external forces pulling physicians and their patients in many directions that we really need an organized mechanism to help keep us on course, to be our voice, to keep us in alignment, and to advocate for our needs. Keeping Ohio doctors informed, safeguarding the profession, and continuing to be a strong and unwavering advocate on the issues affecting Ohio doctors is how the OSMA combats this threat and alleviates some of the uncertainty in the industry today. Why is it important to be a member of the OSMA now more than ever before? Now more than ever before, physicians need to be members of the Ohio State Medical Association because if we don t protect our own interests, who will? Who s going to speak up for our profession, for our patients and for the many needs that we have to promote quality and valuedriven healthcare? Something that s really near and dear to my heart is the need to collaborate with other healthcare systems and healthcare providers. Organized medicine at the state level, as well as partnerships with the Ohio Department of Health, the Ohio Hospital Association, state politicians, and various specialty societies are critically important, so all can address the issues impacting healthcare delivery in Ohio. The OSMA is highly connected to these organizations and entities and it is through our member affiliation with the OSMA that we too are connected. In relation to the vision of the OSMA, how important is it for the OSMA to be about the business of bringing physicians together for a healthier Ohio? The Ohio State Medical Association has been in the business of bringing physicians together to promote a healthier Ohio since 1847, a long history and long traditions. The OSMA has been the instrument which brings Ohio physicians together to promote a healthier state, to represent physicians on advocacy matters, and to make physicians better at what they do. As a physician who practices in rural southeastern Ohio, the prescription drug abuse problem is massive and widespread. We rely heavily on the Ohio State Medical Association for advice, council, advocacy and other resources to combat this issue. The OSMA has been a welcomed resource delivering just-in-time education to our team physicians so they are equipped with the tools and insight to help patients and families facing hardship as a result of the opiate drug abuse problem. The Ohio State Medical Association is perhaps the greatest tool that we have to bind and bring together all physicians throughout the state for one common need to protect the physician s occupation and to advocate on behalf of the physician, patient and practice of medicine. Perhaps the biggest thing I value most in being a physician is the sanctity between the doctor and the patient. With all the chaos in healthcare, the doctor and patient relationship needs to be strong. That relationship is also an important one in which the physician draws the patient into the engagement to accept some responsibility for their own health and the care they receive. It is also important for our next generation of physicians to understand early on in their careers the importance of the physician/patient relationship and to get patients actively involved in their own care. The Ohio State Medical Association helps to ensure the physician/patient relationship remains strong and is truly committed to preserving this relationship. To watch the OSMA video and hear more from Dr. Dachowski and other Ohio physicians, visit our website: 20 Ohio Medicine The official publication of the Ohio State Medical Association

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