Post on 06-Oct-2018
February 4-8, 2015 Hyatt Regency Mission BaySan Diego, California
2015 OPSC Annual Convention
syllabus
WEDNESDAY
* California Pain / End-of-Life Care | ^ California Radiology/X-Ray
Osteopathic Physicians& Surgeons of California
2015 H StreetSacramento, CA 95811
www.opsc.org
Phone: (916) 822-5246Fax: (916) 822-5247
Presentations included in this Syllabus are current as of publication date. Presentations modified after submission for publication
will be posted on the 2015 Annual Convention and Exposition web siteas they are provided to OPSC.
PLEASE NOTE: This PDF Syllabus contains bookmarks and hyperlinks on the Table of Contents for ease of navigation. Click on the presentation title or page number to jump to the appropriate page. There are fillable notes forms for each presentation. If you take notes, BE SURE TO SAVE YOUR WORK BEFORE CLOSING THE FILE!
At the request of our presenters the PDFs have security freatures to disallow content extraction or manipula-tion of the slides.
WEDNESDAY, FEBRUARY 4, 2015Total Health Makeover ............................................................................................................................. 7Presented by Marilu Henner
Robotics in Neurosurgery ........................................................................................................................11Presented by Dan Miulli, DO, FACOS
Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function .....................34Presented by Joseph Zammuto, DO
ACGME-AOA Continuous Board Certification ..............................................................................................76Presented by David Connett, DO, FACOFP, dist
THURSDAY, FEBRUARY 5, 2015Pulmonary Nodules^ .............................................................................................................................137Presented by Abraham Pera, DO, FAOCR
Point of Care Ultrasound in Emergency Departments and Outpatient Settings^ ........................................196Presented by Robert Husband, DO
Cannabinoids: More than Marijuana - What you need to know and were never taught in medical school ....200Presented by Jeff Lapoint, DO
Trigeminal Neuralgia^ ...........................................................................................................................204Presented by Dan Miulli, DO, FACOS
Covered California: 2015 Update ............................................................................................................252Presented by Alesia Wagner, DO, FACOFP
CONTINUED NEXT PAGE...
THURSDAY, CONTINUED
The Shoulder: 2 View or Not 2 View* .......................................................................................................294Presented by Alexandra Myers, DO
Introduction to ICD-10: A Guide for Providers ..........................................................................................323Presented by Deb Kuehn, CPC, CMRS
FRIDAY, FEBRUARY 6, 2015Caring for Our Homeless Veterans ..........................................................................................................357Presented by Hieu Hoang, DO, MPH
Practice Development in the Changing Healthcare Environment .............................................................361Presented by Tom Horowitz, DO
Opioid Addiction and Buprenorphine Use* ..............................................................................................394Presented by Mark Eastman, DO
Legal Medicine Hot Topics ......................................................................................................................419Presented by David Canton, DO, MPH, JD
Changing Employment: Making the Most Out of an Unfortunate Situation ...............................................457Presented by Alesia Wagner, DO, FACOFP
Concierge Medicine: To Live or Die in Private Practice ..............................................................................477Presented by Randall West, DO, FAAFP
General Introduction to Biofeedback .....................................................................................................489Presented by Frank DeGregorio
* California Pain / End-of-Life Care | ^ California Radiology/X-Ray CONTINUED NEXT PAGE...
FRIDAY, CONTINUED
Difficulties in Diagnosing Melanoma: How Dermoscopy Can Help .............................................................493Presented by Ashfaq Marghoob, MD
Stone Disease^ .....................................................................................................................................497Presented by John Grimaldi, DO
Erectile Dysfunction for the Internist .....................................................................................................521Presented by John Grimaldi, DO
SATURDAY, FEBRUARY 7, 2015Osteopathic Approaches to Chronic Pain* ...............................................................................................545Presented by Brian Loveless, DO
The Power of Self-Healing .....................................................................................................................567Presented by Fabrizio Mancini, DC, FICC, FACC
Osteopathic Considerations in Infections of the Respiratory Tract ............................................................612Presented by Melissa Pearce, DO, C-NMM/OMM
Inflammation or Infection…?* .............................................................................................................735Presented by Steve Lee, DO and Mario Perez, DO, AAHIVS
Clinical Research ...................................................................................................................................739Presented by Joel Barra, BSBM, CCRP
When Do I Need a Geriatric Consult? .......................................................................................................743Presented by Sunil Singhania, DO
Uncovering the Non-Opiate Candidate Patient* ......................................................................................771Presented by Lisa Pitino, DO
* California Pain / End-of-Life Care | ^ California Radiology/X-Ray CONTINUED NEXT PAGE...
SATURDAY, CONTINUED
Managing the Problem Opioid Patient * .................................................................................................838Presented by Wade Wong, DO, FACR, FAOCR
SUNDAY, FEBRUARY 8, 2015Therapeutic Lifestyle Changes: The New Standard? ............................................................................... 1026Presented by Ken Browning, DO
Coding and Documenting in Managed Care .......................................................................................... 1088Presented by Nupur Kumar, DO, MPH
The Modern Practice: Or how to make it easier on you… and your staff .................................................. 1118Presented by Jim Lee, DO, AAHIVS
Primary Care of the HIV Patient ........................................................................................................... 1147Presented by Jim Lee, DO, AAHIVS
High Altitude Medicine at the Top of the World ..................................................................................... 1177Presented by Jo Ann C.Pullen, MD
* California Pain / End-of-Life Care | ^ California Radiology/X-Ray
wednesday,February 4, 2015
WEDNESDAY, FEBRUARY 4, 2015: 1:30pm - 2:30pm
Total Health MakeoverPresented by Marilu Henner
OPSC’s 54th Annual Convention and Exposition Syllabus 8
PRESENTATIONLearning Objectives andSelf ASSESSMENT questions
LEARNING OBJECTIVES SELF ASSESSMENT QUESTIONSSelf assessment questions not available at time ofpublication.
Learning objectives not available at time ofpublication.
OPSC’s 54th Annual Convention and Exposition Syllabus 9
WEDNESDAY, FEBRUARY 4, 2015: 1:30pm - 2:30pm ..................................................................................................................................... Total Health Makeover | Presented by Marilu Henner
Presentation not available at time of publication. RETURN TO TABLE OF CONTENTS
OPSC’s 54th Annual Convention and Exposition Syllabus 10
WEDNESDAY, FEBRUARY 4, 2015: 1:30pm - 2:30pm ..................................................................................................................................... Total Health Makeover | Presented by Marilu Henner
RETURN TO TABLE OF CONTENTSPresentation not available at time of publication.
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm
Robotics in NeurosurgeryPresented by Dan Miulli, DO, FACOS
OPSC’s 54th Annual Convention and Exposition Syllabus 12
PRESENTATIONLearning Objectives andSelf ASSESSMENT questions
LEARNING OBJECTIVES SELF ASSESSMENT QUESTIONSSelf assessment questions not available at time ofpublication.
1. Describe reasoning for use of robotics in Neurosurgery 2. Determine risks factors for using robotics in Neurosurgery
3. Describe how communication about robotics in Neurosurgery improves the physician patient relationship and experience
OPSC’s 54th Annual Convention and Exposition Syllabus 13
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Robotics in Neurosurgery
Dan Miulli, DO, FACOS Arrowhead Neurosurgery
OPSC’s 54th Annual Convention and Exposition Syllabus 14
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Disclosure I have: • No Commercial Interest or support • No Financial relationships with outside individuals or
companies including individual benefits by receiving a salary, royalty intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected
• No Conflict of Interest
OPSC’s 54th Annual Convention and Exposition Syllabus 15
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Objective
• Describe reasoning for use of robotics in Neurosurgery
• Determine risks factors for using robotics in Neurosurgery
• Describe how communication about robotics in Neurosurgery improves the physician patient relationship and experience
OPSC’s 54th Annual Convention and Exposition Syllabus 16
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Cultural Barriers
• Language Barrier could led to delay – availability of translators crucial
• Personal Beliefs creating treatment issues – concern regarding medications & treatments – necessitates detailed explanations
• Ethno cultural Beliefs that delay treatment – concern regarding procedures at certain ages
OPSC’s 54th Annual Convention and Exposition Syllabus 17
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Robotics
• Improve patient outcomes
• Improve patient experience
• Improve healthcare costs
• Brain transplants
OPSC’s 54th Annual Convention and Exposition Syllabus 18
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
OPSC’s 54th Annual Convention and Exposition Syllabus 19
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Limits
• 1980’s • Microscope,
magnification, light, movement
• Fixed reference – stereotactic frame
OPSC’s 54th Annual Convention and Exposition Syllabus 20
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Stereotaxis • A surgical technique using
imaging to precisely locate in 3D an anatomical site to which a surgical instrument is directed
• Minimally invasive surgical intervention using 3D coordinate system to locate small targets inside the body and to perform on them some action – 1st in 1908 at University College
London Hospital – Sir Victor Horsley, neurosurgeon,
and Robert H. Clarke, a physiologist – Cartesian (three-orthogonal axis)
system
OPSC’s 54th Annual Convention and Exposition Syllabus 21
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Improve Imaging
• CT Scan • MRI
OPSC’s 54th Annual Convention and Exposition Syllabus 22
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Neurobot
• Telecontrol through endoscope
OPSC’s 54th Annual Convention and Exposition Syllabus 23
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Mazur
• soda can sized SpineAssist Robot was the first FDA approved robotic system for spinal surgery
OPSC’s 54th Annual Convention and Exposition Syllabus 24
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Control
OPSC’s 54th Annual Convention and Exposition Syllabus 25
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Telesurgical
OPSC’s 54th Annual Convention and Exposition Syllabus 26
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
DaVinci Robot
OPSC’s 54th Annual Convention and Exposition Syllabus 27
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
OPSC’s 54th Annual Convention and Exposition Syllabus 28
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Surgical Time
OPSC’s 54th Annual Convention and Exposition Syllabus 29
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
Costs
OPSC’s 54th Annual Convention and Exposition Syllabus 30
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
ERROR RATE
OPSC’s 54th Annual Convention and Exposition Syllabus 31
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
IMPROVEMENTS
OPSC’s 54th Annual Convention and Exposition Syllabus 32
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
OUTCOMES
OPSC’s 54th Annual Convention and Exposition Syllabus 33
WEDNESDAY, FEBRUARY 4, 2015: 2:30pm - 3:30pm ......................................................................................................................... Robotics in Neurosurgery | Presented by Dan Miulli, DO, FACOS
RETURN TO TABLE OF CONTENTS
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm
Professionalism: The Relationship with State Medical Boards and Their Disciplinary FunctionPresented by Joseph Zammuto, DO
OPSC’s 54th Annual Convention and Exposition Syllabus 35
PRESENTATIONLearning Objectives andSelf ASSESSMENT questions
LEARNING OBJECTIVES SELF ASSESSMENT QUESTIONS1. Describe the composition and responsibility of the board
2. Describe the licensing and disciplinary process
3. Identify ways to avoid attention from the board
4. Provide resources for additional information on future changes
1. What is the OMBC composition? a. 10 DOs and 10 Public b. 4 DOs and 2 Public c. 5 DOs and 4 Public
2. How was the OMBC established? a. Statute b. Lottery c. Initiative
3. What year was the OMBC established? a. 1921 b. 1922 c. 1923
4. Who does the OMBC protect? a. Nurses b. Doctors c. Patients
5. Which is not a Physician Competency? a. Patient Care b. Medical Knowledge c. Practice-based learning and improvement d. Interpersonal and communication skills e. Professionalism f. Systems-based practice g. ICD-10
6. Which is not unprofessional conduct? a. Professional misconduct b. Substandard care c. Inappropriate prescribing
d. False advertising e. Discharging a patient from your practice
7. What is the greatest source of complaints? a. Anonymous b. Family member c. Patient d. Malpractice e. Other
OPSC’s 54th Annual Convention and Exposition Syllabus 36
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Professionalism: The relationship with state medical boards and
their disciplinary function
The Osteopathic Medical Board of California
Current and New activities for the Future.
OPSC’s 54th Annual Convention and Exposition Syllabus 37
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Goals/Objectives
• Describe composition and responsibility of the board
• Describe the licensing and disciplinary processes
• Identify ways to avoid attention from the board
• Provide resources for additional information
OPSC’s 54th Annual Convention and Exposition Syllabus 38
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
• Board composition– Nine members– Three Year Length of term– OSTEOPATHIC PHYSICIANS regulated by
the board– FIVE Physicians/FOUR Public members– Gubernatorial appointment
OPSC’s 54th Annual Convention and Exposition Syllabus 39
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
• The Board was not established by statute, rather by an Initiative Act.
• Established by Osteopathic Initiative Act of 1922
• * Amended by the State electorate in 1962• Mission of the board is to protect the
public.• Duties & responsibilities of the board
OPSC’s 54th Annual Convention and Exposition Syllabus 40
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Teaching on medical licensure and regulation
Source: 2007 LCME Annual Medical School Questionnaire
126 LCME-accredited medical schools
Number of US Medical Schools Teaching on Medical licensure/regulation
Included in required course Included in elective course
70 19
Good News: 71% of medical schools report teaching on the topic of medical licensure and regulation
OPSC’s 54th Annual Convention and Exposition Syllabus 41
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Teaching on medical licensure and regulation
Source: 2007 AAMC Medical School Graduation Questionnaire
Question# 11; 12,512 respondents
Do you believe that the time devoted to your instruction in the following area was inadequate, appropriate or excessive?
Medical licensure/regulation
Inadequate Appropriate Excessive
61.4% 38.3% 0.3%
Bad News: Most medical students feel inadequately informed on issues relative to medical licensure and regulation
OPSC’s 54th Annual Convention and Exposition Syllabus 42
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Licensure Evaluate applicants’ fitness to practice
— Medical education and training— Examination of cognitive and clinical skills necessary for the independent
practice of medicine— Character— Prior disciplinary action
Regulation Establish standards for physician licensure and practice
Discipline Take appropriate action against individual physicians’ licenses for
unprofessional, incompetent or unlawful practice of medicine
State Medical Boardsa triad of functions for public protection
OPSC’s 54th Annual Convention and Exposition Syllabus 43
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Professionalism
Source: 2007 AAMC Medical School Graduation Questionnaire
Question# 16: Indicate whether you agree or disagree with the following statement about your preparedness for beginning a residency training program; 12,524 respondents
“I understand the ethical and professional values that are expected of the profession.”
Strongly Agree Agree No Opinion Disagree Strongly Disagree 56.2% 41.1% 2.4% 0.2% 0.1%
Graduating medical students are confident in their understanding of the tenets of the medical profession
OPSC’s 54th Annual Convention and Exposition Syllabus 44
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Physician Competencies(Source: ACGME/ABMS)
1. Patient Care2. Medical Knowledge3. Practice-based learning and improvement4. Interpersonal and communication skills5. Professionalism6. System-based practice
OPSC’s 54th Annual Convention and Exposition Syllabus 45
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Definitions
• Medical practice (defined)• Unprofessional conduct (defined)
– Professional misconduct– Substandard care– Inappropriate prescribing– False advertising– Etc.
OPSC’s 54th Annual Convention and Exposition Syllabus 46
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Statistical Data
• Licensees: 15,000• Number of complaints: 700• 4.6%
OPSC’s 54th Annual Convention and Exposition Syllabus 47
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Disciplinary Process
Complaint
Investigate CloseContinue Investigation
Warning
Resolve by ConsentSummary Suspension
Investigation Committee
Consent Parameters
Decision
Hearing
Optional Appeal: Administrative Review Board
OPSC’s 54th Annual Convention and Exposition Syllabus 48
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Disciplinary Process
Complaint received
Investigation/review
Dismissal Charges filed/Formal complaint process
Dismissal Board action
OPSC’s 54th Annual Convention and Exposition Syllabus 49
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Complaint Process
• Outline of the Board’s complaint process
OPSC’s 54th Annual Convention and Exposition Syllabus 50
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
History of Complaints
10000
12000
14000
16000
18000
20000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
0
100
200
300
400
500
600
700
800
900
1000
Licensees
Complaints
OPSC’s 54th Annual Convention and Exposition Syllabus 51
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Sources of Complaints
24, 3%108, 13%
339, 41%101, 12%
257, 31% AnonymousFamily MemberPatientMalpracticeOther
OPSC’s 54th Annual Convention and Exposition Syllabus 52
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Complaint categories
Other jurisdiction 39 1.8%Incomp. / Unethical 706 33.3Unprofessional 700 33.0Illness 56 2.6Non-jurisdictional 20 0.9Medical records 99 5.0Addiction 34 1.6Prescribing 287 13.5Sexual misconduct 35 1 6
OPSC’s 54th Annual Convention and Exposition Syllabus 53
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Case Studies
OPSC’s 54th Annual Convention and Exposition Syllabus 54
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Impaired Physicians Program (IPP)
• Contracted Vendor: Maximus, Inc.(800) 522 9198 Phone• Osteopathic Medical Board, Diversion
Evaluation Committee(3) three licensed D.O.’s
• California Code of Regulation; Title 16, Division 16, Article 12.5, Sections 1660,1660.2,1660.4,,1661,1661.2,1661.4,1662
OPSC’s 54th Annual Convention and Exposition Syllabus 55
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Medical board goal
“Rehabilitate, when possible, persons who are impaired or who practice medicine unethically or below minimal standards of care, and prohibit persons who have not been rehabilitated from practicing medicine.”
Source: State Medical Board of Ohio
OPSC’s 54th Annual Convention and Exposition Syllabus 56
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
0
5
10
15
20
25
30
35
40
45
50
2002 2003 2004 2005 2006 2007
Impairment Actions
Impairment Action
OPSC’s 54th Annual Convention and Exposition Syllabus 57
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
0
5
10
15
20
25
30
35
Negligence /IncompetenceFraud
Impairment
Other
InappropriateprescribingSexual misconduct
Records
Violation of P/O
Final Disciplinary Actions by Type of Misconduct in 2007
Source: State medical board of ___.
As
% o
f all
final
dis
cipl
inar
y ac
tions
OPSC’s 54th Annual Convention and Exposition Syllabus 58
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Compliance Monitoring
• Over 40 licensees currently monitored by the Board (On Probation)
• Currently 16 Participants in Diversion program. Primarily impairment cases
• Usually monitored for a minimum of 5 years for diversion participants.
OPSC’s 54th Annual Convention and Exposition Syllabus 59
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Reporting Requirements
• Reference Business and Professions Code 800 for Reporting Requirements.
• http://leginfo.legislature.ca.gov/faces/codesdisplayText.xhtml?lawCode=BPC&division=2.&title=&part=&chapter=1.&article=11.
OPSC’s 54th Annual Convention and Exposition Syllabus 60
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Serious Misconduct
• Negligence/Incompetence• Impairment• Sexual abuse• Fraud• Inappropriate prescribing
OPSC’s 54th Annual Convention and Exposition Syllabus 61
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
The Investigation
• Medical Records– Medical Coordinator review
• Interview• Background Checks• Expert Opinions• Closed• Investigation Committee
OPSC’s 54th Annual Convention and Exposition Syllabus 62
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Investigation Committee
Possible recommendations1. Closure2. Further investigation3. Administrative warning4. Impairment review5. Hearing6. Summary suspensionConsent Parameters
OPSC’s 54th Annual Convention and Exposition Syllabus 63
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Board Hearings• Hearing committee of 9• Administrative law judge• Court reporter• Attorneys• Parties• Witnesses/evidence
• Not bound by strict evidentiary rules
• Standard of proof:– Identify preponderance, clear
and convincing or other
ACTORS
PROCESS
OPSC’s 54th Annual Convention and Exposition Syllabus 64
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Board Decisions
• Censure and reprimand• Suspension (actual/stayed)• Probation (monitoring)• Limitation of license• Revocation• Monetary fine• Education/Training • Community Services• Dismissal
OPSC’s 54th Annual Convention and Exposition Syllabus 65
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Administrative Review Board
• Established by…• Review board composition Board has
medical Consultant who reviews complaints. If further review necessary, case sent to specialty expert.
• Expert Reviewers under contract with Board.
• Process: Refer to Osteopathic Medical Board’s Complaint Process.
OPSC’s 54th Annual Convention and Exposition Syllabus 66
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Physician Participation
• Board chair, board staff (if applicable)• Board members• Adjudicatory committees• Medical coordinators• Expert consultants• Administrative warning• Physician monitoring/supervision
OPSC’s 54th Annual Convention and Exposition Syllabus 67
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Specialties at Risk
• Internal Medicine• Family / General Practice• Psychiatry• OB / GYN
Source: ___ board. Based upon disciplinary sanctions taken for sexual violations, 1997-2007
OPSC’s 54th Annual Convention and Exposition Syllabus 68
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Communications
Graduating medical students are confident in their ability to communicate effectively
Source: 2007 AAMC Medical School Graduation Questionnaire
Question# 16: Indicate the degree of preparedness for entering a residency training program. 12,527 respondents
“I have the communication skills necessary to interact with patients and health professionals.”
Strongly Agree Agree No Opinion Disagree Strongly Disagree
60.6% 36.6% 2.3% 0.3% 0.1%
OPSC’s 54th Annual Convention and Exposition Syllabus 69
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
National Data: Board Actions by Type, 1991-2006
336 39
9 626
584
584
611 73
975
373
166
764
7 706
640 76
379
170
9
3767
3838
3944
4015 41
69 4590
5502
5344
4867
280
4 2
971
308
1 3
571
381
3 3
821
372
8
0
1000
2000
3000
4000
5000
6000
7000
1991
: 3,14
0
1992
: 3,37
0
1993
: 3,70
7
1994
: 4,15
5
1995
: 4,39
7
1996
: 4,43
2
1997
: 4,46
7
1998
: 4,52
0
1999
: 4,56
9
2000
: 4,61
1
2001
: 4,66
2
2002
: 487
5
2003
: 523
0
2004
: 626
5
2005
: 613
5
2006
: 557
6
Non-Prejudicial Prejudicial
Total Actions
Source: Federation of State Medical Boards
OPSC’s 54th Annual Convention and Exposition Syllabus 70
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
1024.7974.2
929.1
697.5
514.1
316.4236.1
25
125
225
325
425
525
625
725
825
925
1025
Unprofessional Conduct NegligenceSubstance Abuse Controlled Substance ViolationsFraud Sexual MisconductFailure to Maintain Adequate Medical Records
National Data: Basis for Board Actions against Physicians, 1997-2006
Neg
ligen
ce
Unp
rofe
ssio
nal C
ondu
ct
Subs
tanc
e Abu
se
Con
trol
led
Subs
tanc
e V
iola
tions
Frau
d
Sexu
al
Mis
cond
uct
Failu
re to
Mai
ntai
n A
dequ
ate
med
ical
Rec
ords
Source: Federation of State Medical Boards
OPSC’s 54th Annual Convention and Exposition Syllabus 71
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
How Often Do Physicians Get Disciplined by State Licensing Boards?
~750,000 licensed physicians in the U.S.
2,250 physicians disciplined annually (0.3%) – over a ten year period
OPSC’s 54th Annual Convention and Exposition Syllabus 72
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Grounds for Discipline
Grounds for action, including…• Standard of care violations• Inappropriate prescribing• Breaching professional ethics
Source: Identify relevant statute/code
OPSC’s 54th Annual Convention and Exposition Syllabus 73
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Source: Teherani A, Hodgson C, Banach M, Papadakis M. “Domains of Unprofessional Behavior During Medical School Associated with Future Disciplinary Action by a State Medical Board.” Academic Medicine 2005; 80(10):S17-S20
Behavioral domains associated with subsequent discipline by a state medical broad
• Poor reliability and responsibility
• Lack of self-improvement and adaptability
• Poor initiative and motivation
OPSC’s 54th Annual Convention and Exposition Syllabus 74
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
For further information
• Board website: www.ombc.ca.gov• Board phone numbers:
phone 916 928 8390; fax 916 928 8392• Email contact: Osteopathic@dca.ca.gov• Board’s physical address: 1300 National Drive, Suite 150 Sacramento, CA 95834-1991
OPSC’s 54th Annual Convention and Exposition Syllabus 75
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
RETURN TO TABLE OF CONTENTS
* California Pain / End-of-Life Care
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm
ACGME-AOA Continuous Board CertificationPresented by David Connett, DO, FACOFP, dist
OPSC’s 54th Annual Convention and Exposition Syllabus 77
PRESENTATIONLearning Objectives andSelf ASSESSMENT questions
LEARNING OBJECTIVES SELF ASSESSMENT QUESTIONS1. Understand the factors leading to the ACGME Single Unified Pathway
2. Understand the number of applicants applying to ACGME from offshore medical schools, AOA schools, IS MD Medical Schools and Foreign Medical Graduates
3. Understand the current number of PGY 1 AOA and AC GME positions available for residencies in the United States
4. Understand the current issues with Maintenance of Certification with ABMS
5. Introduction to concept of Continuous Certification/Recertification
1. The major factor in curtailing the growth of graduate medical education is: a. CMS capping residencies b. Medical staff concerns with malpractice or productivity c. Hospital administration concerns with financials d. ACGME lack of programs for GME growth
2. The total number of PGY 1 of Combined AOA and ACGME Residency positions in the United States a. 20,000 b. 33,000 c. 50,000 d. 90,000
3. The projected number of graduates from LCME (MD) Schools in the United States in 2013 were: a. 20,000 b. 30,000 c. 50,000 d. 91,000
4. The projected number of graduates from COCA (DO) Schools in the United States in 2013 were: a. 6900 b. 10,000 c. 15,000 d. 20,000
5. According to AAMC (Association of American Medical Colleges Table 40) the number of LCME Medical applications applying to ACGME programs a. 20,055 b. 34,705 c. 35,467 d. 56,532 e. 91,999
6. According to AAMC (Association of American Medical Colleges Table 40) the number of US Caribbean Medical Schools applications applying to ACGME programs a. 20,055 b. 34,705 c. 35,467 d. 56,532 e. 91,999
7. According to AAMC (Association of American Medical Colleges Table 40) the number of combined foreign medical graduates and Caribbean applicants applying the unused 5000 ACGME PGY 1 positions a. 20,055 b. 34,705 c. 35,467 d. 56,532 e. 91,999
8. 50% of all residencies in the United States are in what time zone? a. Pacific/Arizona b. Mountain c. Central d. Eastern
9. What percentage of osteopathic residents who graduate from ACGME programs take the DO/osteopathic boards? a. 20% b. 40% c. 60% d. 80%
OPSC’s 54th Annual Convention and Exposition Syllabus 78
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
AOA-ACGME Single Unified Pathway-Continuous Medical
Education David A. Connett, DO, FACOFP
President – Osteopathic Physicians and Surgeons of California
Vice Dean – College of Osteopathic Medicine of the Pacific
1
OPSC’s 54th Annual Convention and Exposition Syllabus 79
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Disclosures
• No financial disclosures
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OPSC’s 54th Annual Convention and Exposition Syllabus 80
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Objectives 1. Understand the factors leading to the ACGME
Single Unified Pathway 2. Understand the number of applicants applying
to ACGME from offshore medical schools, AOA schools, IS MD Medical Schools and Foreign Medical Graduates
3. Understand the current number of PGY 1 AOA and ACGME positions available for residencies in the United states
4. Understand the current issues with Maintenance of Certification with ABMS
5. Introduction to concept of Continuous Certification/Recertification
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OPSC’s 54th Annual Convention and Exposition Syllabus 81
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
FACTORS LEADING TO THE DEVELOPMENT OF SINGLE UNIFIED ACCREDITATION SYSTEM
4
OPSC’s 54th Annual Convention and Exposition Syllabus 82
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Self-Assessment Questions
• The major factor in curtailing the growth of graduate medical education is: – CMS capping residencies* – Medical staff concerns with malpractice or
productivity – Hospital administration concerns with financials – ACGME lack of programs for GME growth
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OPSC’s 54th Annual Convention and Exposition Syllabus 83
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Residency Development Shortage
– Cooper Report 2007
6
OPSC’s 54th Annual Convention and Exposition Syllabus 84
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Institute of Medicine Report GME Funding 2014
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OPSC’s 54th Annual Convention and Exposition Syllabus 85
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Types of Residency “Match” for Osteopathic Medical Students
• Military - December • Urology – January • NMS/AOA Match - February • NRMP match and SOAP – March
– “All-In” Policy 2013 – Residency not Fellowship
• San Francisco Matching Program-Varies by Specialty
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OPSC’s 54th Annual Convention and Exposition Syllabus 86
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Osteopathic Medical Students Residency Placement 2012
29%
12% 40%
12% 5%
2%
DO 2012 Residency Choice
AOA Internship ACGME Dual Govt, VA Uncertain
Source: http://www.aacom.org/data/classsurveys/Documents/2011-12_Graduating_Summary.pdf
9
OPSC’s 54th Annual Convention and Exposition Syllabus 87
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Accreditation Counsel for Graduate Medical Education (ACGME)
• ACGME Board of Directors by 2015 – American Board of Medical Specialists – American Hospital Association – American Medical Association – Association of American Medical Colleges – Council of Medical Societies
• The Accreditation Council for Graduate Medical Education (ACGME) is
the body responsible for accrediting the majority of graduate medical training programs (i.e., internships, residencies, and fellowships, aka subspecialty residencies) for physicians in the United States. It is a nonprofit private council that evaluates and accredits medical residency and internship programs. The ACGME was founded in 1981 and was preceded by the Liaison Committee for Graduate Medical Education, which was established in 1972. The ACGME currently oversees the post-graduate education and training for all MD and the majority of DO physicians in the United States. (Wikipedia)
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OPSC’s 54th Annual Convention and Exposition Syllabus 88
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
ACGME Transition – Next Accreditation System (NAS)
• 1999 - introduced 6 domains of clinical competency – 1. Medical Knowledge – 2. Patient Care – 3. Professionalism – 4. Interpersonal Communication – 5. Practice-based Learning: personal – 6. System-based Practice: system
• 2009 restructuring begins based on educational outcomes in these competencies.
• July 2013 The result of this effort is the Next Accreditation System (NAS), scheduled for phased implementation beginning in 2015.
11
OPSC’s 54th Annual Convention and Exposition Syllabus 89
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
ACGME – Next Accreditation System
The aims of the NAS are threefold: 1. to enhance the ability of the peer-review system
to prepare physicians for practice in the 21st century,
2. to accelerate the ACGME’s movement toward accreditation on the basis of educational outcomes, and
3. to reduce the burden associated with the current structure and process-based approach.
12
OPSC’s 54th Annual Convention and Exposition Syllabus 90
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
November 2011 – ACGME Rule Change
13
OPSC’s 54th Annual Convention and Exposition Syllabus 91
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
2011 Next Accreditation System Implications for DO Grads in AOA GME
• Requiring an ACGME-accredited residency program as a prerequisite for clinical education for entry into an ACGME-accredited residency program – This would limit a DO who completed an AOA-accredited
internship from proceeding to an ACGME program unless they repeated their internship year in an ACGME-accredited residency program.) Five states currently have licensing requirements for AOA residency – MI, PA, WV, FL, OK
• Requiring an ACGME-accredited residency program (not an AOA Residency) as a prerequisite for clinical education for entry into an ACGME-accredited fellowship program. – Impact Areas (IM/Surgical Specialties, PC Fellowships) thought
to be only 8% of the osteopathic profession
14
OPSC’s 54th Annual Convention and Exposition Syllabus 92
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
2011 Unintended ACGME Program Effect
1. Exclusion of DO Students into some ACGME clerkship opportunities - VSAS
2. DO’s residency preceptors with AOA Boards could not participate in active teaching in ACGME programs to include DO residents
3. Selection bias began for DO’s into residencies
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OPSC’s 54th Annual Convention and Exposition Syllabus 93
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
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OPSC’s 54th Annual Convention and Exposition Syllabus 94
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Self-Assessment Questions
• The number of graduates from COCA (DO) Schools in the United States in 2013 were: – 5100* – 10,000 – 15,000 – 20,000
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OPSC’s 54th Annual Convention and Exposition Syllabus 95
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Self-Assessment Questions
• The number of graduates from LCME (MD) Schools in the United States in 2013 were: – 20,000* – 30,000 – 50,000 – 91,000
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OPSC’s 54th Annual Convention and Exposition Syllabus 96
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Self-Assessment Questions
• The total number of PGY 1 (1st year) of Combined AOA and ACGME Residency positions in the United States – 20,000 – 33,000* – 50,000 – 90,000
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OPSC’s 54th Annual Convention and Exposition Syllabus 97
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
DO/MD Graduates 2013
AOA ACGME
Number PGY 1 Residency Training Positions
2900 30,000
AOA DO LCME MD
Number Medical School Graduates 5154
20,055
Surplus PGY-1 Positions 0 7691 20
OPSC’s 54th Annual Convention and Exposition Syllabus 98
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Self-Assessment Questions
• 50% of all residencies in the United States are in what time zone? – Pacific/Arizona – Mountain – Central – Eastern*
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OPSC’s 54th Annual Convention and Exposition Syllabus 99
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Self-Assessment Questions
• According to AAMC (Association of American Medical Colleges Table 40) the number of combined Foreign Medical Graduates and Caribbean applicants applying the unused 7691 ACGME PGY 1 positions – 20,055 – 34,705 – 35,467 – 56,532 – 91,999*
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OPSC’s 54th Annual Convention and Exposition Syllabus 100
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
AAMC Table 40 2013
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OPSC’s 54th Annual Convention and Exposition Syllabus 101
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
AAMC Table 40 2013 ERAS Applicants for Remaining 7691 PGY-1 Position
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OPSC’s 54th Annual Convention and Exposition Syllabus 102
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Residency Maldistribution
– Maldistribution of AOA and ACGME Residencies 50% of all Graduate Medical Education (GME) is in the eastern time zone; MD or DO
– Western University is the leader for either MD or DO schools in residency development
– 1100 AOA Approved Programs – DO exclusive programs
– 10,000 ACGME Approved Programs – DO’s eligible to apply
25
OPSC’s 54th Annual Convention and Exposition Syllabus 103
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Anticipated Reality – 2015 & Beyond
Unified ACGME
Number of Programs 10,000 +
Number Total Residents 123,000+
Number of Total Specialties 135 + 2
26
OPSC’s 54th Annual Convention and Exposition Syllabus 104
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
October 24, 2012 Announcement • ACGME, AOA,
AACOM have entered into an agreement to pursue a Single Unified Accreditation System for GME programs in the USA beginning in July 2015
27
OPSC’s 54th Annual Convention and Exposition Syllabus 105
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
AOA-ACGME Specialty Societies Collaborated -2013
• Crosswalk of Residency Standards between AOA and ACGME programs began: – Family Medicine – Internal Medicine – Emergency Medicine – General Surgery – Orthopedic Surgery – Obstetrics and Gynecology – Transitional Year
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OPSC’s 54th Annual Convention and Exposition Syllabus 106
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Summer 2013
• June 14 – ACGME announces “conclusion of negotiations for MOU” and awaits decision of AOA BOT/HOD, AACOM in July
• July 19 – AOA announcement …“unsuccessful in reaching MOU w ACGME for a unified GME accreditation system.
• July 23 – ACGME announces “…failure to form an ACGME accreditation system that includes AOA and AACOM is regrettable……ACGME will proceed with keeping its promise …to implement The NAS.
• July 30 – “Final” ACGME/AOA Joint Mtg
29
OPSC’s 54th Annual Convention and Exposition Syllabus 107
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Fall 2013 • October 21, 2013
– ACGME has delayed implementation date of the revised Common Program Requirement until 2016
– Fellowship programs are allowed to select “exceptionally qualified applicants” who completed residency training in non-ACGME programs, including physicians who completed prior training in AOA-approved residency programs.
– Individual Residency Review Committees are allowed to grant exceptions at the fellowship level and not require prior that residency training have been completed in ACGME or Canadian programs.
• Winter/Spring 2014 – AOA will move toward a PBAS “PERFORMANCE BASED
ACCREDITATION SYSTEM” – implementation Summer 2014
30
OPSC’s 54th Annual Convention and Exposition Syllabus 108
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
February 2014 – MOU Approved
• “The Board of the American Osteopathic Association, the Board of the Accreditation Council for Graduate Medical Education (ACGME), and the Board of the American Association of Colleges of Osteopathic Medicine (AACOM) reached an agreement (Memorandum of Understanding) to work together to prepare future generations of physicians.”
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OPSC’s 54th Annual Convention and Exposition Syllabus 109
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
July 2014 AOA House of Delegates • When fully implemented
in July 2020, the new system will allow graduates of osteopathic and allopathic medical schools to complete their residency and/or fellowship education in ACGME-accredited programs and demonstrate achievement of common milestones and competencies.
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OPSC’s 54th Annual Convention and Exposition Syllabus 110
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Memorandum of Understanding
• ACGME Board of Directors by 2015 – American Board of Medical Specialists – American Hospital Association – American Medical Association – Association of American Medical Colleges – Council of Medical Societies – American Osteopathic Association – American Association of Colleges of Osteopathic Medicine
• Equal Representation on the ACGME Board of Directors with bylaw change to allow AOA and AACOM by July 2015
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OPSC’s 54th Annual Convention and Exposition Syllabus 111
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
ACGME Board Composition • AOA
– Karen Nichols, DO – David Forstein, DO
• AACOM – Clint Adams, DO – Gary Slick, DO
• The other 5 organizations have 4 Board Members: – AMA – AHA – CMSS – ABMS – AAMC
• Public Director- 3 • Director at Large- 2 • Chair of the Council of
Review Committees Chair • Fed Gov Representatives
– VA – Bureau of Health
Workforce at the Health – Resources Service
Administration • Vice President DO
Pending
August 20, 2013 34
OPSC’s 54th Annual Convention and Exposition Syllabus 112
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Memorandum of Understanding
• Residency Review Committees providing Residency oversight – Osteopathic “distinctive” programs – Osteopathic representation on all residencies DO’s
• AOA programs must apply over 5 years for full ACGME certification – automatically preliminary certification
• AOA Boarded Program Directors not guaranteed same status as ABMS Board Certified DO’s
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OPSC’s 54th Annual Convention and Exposition Syllabus 113
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Proposed Timeline to July 2015
• Spring 2013 - Questions to be resolved – Certification for DO’s (AOA v ABMS) – Role for DIO/DME – OPTI structure as Institutional Sponsor – Number of Program Directors/program – All GME open to all Med school grads (LCME,
COCA, Int’l) – Observers at ACGME & AOA meetings
36
OPSC’s 54th Annual Convention and Exposition Syllabus 114
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Further Negotiations • All current AOA GME programs will be deemed “pre-
accredited” by ACGME – must apply • AOA Credentials will be deemed on par with ACGME
– COMLEX = USMLE licensing exams for residency application • 70% of ACGME programs accept DO licensing exam • All DO’s eligible to take MD licensing exam USMLE
– AOA Certification = ABMS Certification • Currently not for Program Directors with AOA Boards • Negotiations with Individual Specialty Colleges
– AOA Training = ACGME for fellowship training provided AOA program pre-accredited by ACGME
• Single Match –not currently being discussed 37
OPSC’s 54th Annual Convention and Exposition Syllabus 115
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
ACGME-AOA NEXT STEPS AND CONCERNS
38
OPSC’s 54th Annual Convention and Exposition Syllabus 116
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Concerns
• AOA Board Certification and AOA Membership • Maintenance of Licensure and Maintenance of
Certification • Osteopathic Physicians access to Surgical Specialties • Viability of Osteopathic Residencies
August 20, 2013 39
OPSC’s 54th Annual Convention and Exposition Syllabus 117
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Self-Assessment Questions
• When given a choice what percentage of osteopathic residents who graduate from a dual accredited ACGME/AOA program take the DO/osteopathic boards? – 20%* – 40% – 60% – 80%
1/20/2015 40
OPSC’s 54th Annual Convention and Exposition Syllabus 118
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
AOA vs. ABMS Board Certification • AOA Board Certification
– Currently in dual accredited programs both in family medicine and in internal medicine those graduates with the DO degree only 20% take the AOA boards.
– Over 60% of osteopathic student graduates take ACGME residencies - almost none take the AOA boards.
• Survey DO graduates in Dual Accredited Programs: – ABMS Boards
• Greater “value” regarding employment options and hospital privileges • 10 year re-certification versus 7 year re-certification
– DO Boards Participation • Potential for any academic career • Perceived loyalty to the profession • MD’s not invited • AOA Board certification = AOA membership – OPSC HOD
OPSC’s 54th Annual Convention and Exposition Syllabus 119
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Board Certification - ABMS and AOA
• AOA Boards – Bureau of Osteopathic
Specialists – 18 Individual Boards but
all report to AOA
• Recertification 7 years • MD’s not eligible
• ABMS Boards – 24 Boards Individual
Companies
• Recertification up to 10 years – continuous of certification
• ABMS added (MOC) Maintenance of Certification
August 20, 2013 OPTI - West 42
OPSC’s 54th Annual Convention and Exposition Syllabus 120
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
AOA vs. ABMS Board Certification • ABMS Boards
– Significant dissatisfaction by current members – ABIM instituted significant changes to its MOC
process on January 1, 2014. The modifications apply to all physicians, including those who received life-time certification prior to 1990 (“grandparents”), and mandate completion of any MOC activity every two years, accumulation of 100 MOC “points” distributed between Part II and Part IV activities within five years, completion of patient survey and patient safety activities, and passing a secure examination every 10 years.
OPSC’s 54th Annual Convention and Exposition Syllabus 121
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
American College of Cardiology Response to MOC - President
• “it is important to share the results of a member survey commissioned by ACC and distributed through our state chapters in the spring of 2014. The survey was completed within four weeks by over 4,400 members (12 percent of the total solicited). Nearly 90 percent of respondents opposed the changes to MOC, citing, among multiple concerns, higher than expected costs. Nearly a third of respondents indicated that the changes will affect their future career plans and will likely accelerate career decisions such as early retirement, part-time work, or transition to non-clinical work.”
OPSC’s 54th Annual Convention and Exposition Syllabus 122
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Association of American Physicians and Surgeons MOC Law Suit
AAPS Takes MOC to Court Jul 31, 2014
July 28, 2014 update: A Wall Street Journal Article of July 21, 2014 reports: "The ABMS also says it has arranged with some 32 major health systems, including the Mayo Clinic and M.D. Anderson Cancer Center, for their own in-house quality improvement projects to satisfy some MOC requirements for their doctors." This reported statement by Defendant ABMS is contrary to its position in this case, which is that hospitals are somehow acting independently of ABMS in imposing MOC requirements. Read more in the AAPS July 28 letter to the U.S. District Court: http://aapsonline.org/AAPSvABMS-july-28-2014-letter.pdf
OPSC’s 54th Annual Convention and Exposition Syllabus 123
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
ABMS Changes
OPSC’s 54th Annual Convention and Exposition Syllabus 124
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Medical Knowledge Growth Exponential
• Medical knowledge today doubles every 1.8 years as of 2015.
• It is predicted that medical knowledge will double every 48 days by 2018.
• Current solution by ABMS method of Maintenance Of Certification does not keep up with the knowledge growth yet it has substantially increased the costs and burden of recertification.
OPSC’s 54th Annual Convention and Exposition Syllabus 125
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Current AOA Boards
• Do not reflect Scope of Clinical Practice – Geriatrics under Family Medicine spend time with studying
Pediatrics and Obstetrics – Is not flexible for changes in practice such as urgent care or
administrative medicine
• Does not allow MD’s to be Board Certified
August 20, 2013 OPTI - West 48
OPSC’s 54th Annual Convention and Exposition Syllabus 126
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Proposal - Alternate MOC
• AOA create an alternate pathway to Maintenance Of Certification which combines continuous certification with recertification.
• Those enrolled in the alternate pathway to MOC will maintain a lifetime certification provided they are compliant with the monthly certification modules.
• Customize Board Certification based on current practice of medicine – not scope of practice during residency training.
OPSC’s 54th Annual Convention and Exposition Syllabus 127
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Adaptive Intelligent Learning Engine
• RealizeIt Software – • Disclosures – None Personally – WesternU Dental
Program • Developed in association with Stanford Medical
School with Western University School of Dentistry for Head and Neck Anatomy class
• Adaptive Intelligent Learning Engine – Personalizes Learning Experience – mapping the knowledge base of each user.
OPSC’s 54th Annual Convention and Exposition Syllabus 128
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Adaptive Intelligent Learning Engine
• Realize It Video If Time Permits
OPSC’s 54th Annual Convention and Exposition Syllabus 129
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Adaptive Intelligent Learning Engine
• Initially tests knowledge and based on your response, “maps” your knowledge through learning nodes
OPSC’s 54th Annual Convention and Exposition Syllabus 130
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Adaptive Intelligent Learning Engine
• Provides customized course material to assure compliance to maintain competency based on testing responses
• Provides a continuous “mapping of knowledge” throughout career
OPSC’s 54th Annual Convention and Exposition Syllabus 131
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Continuous Board Certification
• “Node Concept” can subdivide knowledge requirements and customize for each physician’s practice – Gerontology – no node for pediatrics and obstetrics – Allopathic physicians- no node for osteopathic
manipulative medicine – Outpatient physicians – exclude hospitalist and intensivist
curriculum and assessment
• Provide continuous certification for those providers both MD and DO who never completed a residency
OPSC’s 54th Annual Convention and Exposition Syllabus 132
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Continuous Board Certification • “Knowledge Mapping” of both physician and profession
– Provides evidence based analysis for continuing medical education for both state and national societies
– CME can provide on-site skills assessment – OSCE’s • Specialty Societies provide content for teaching with
potential interprofessional collaboration between specialties – Example - Diabetes modules by both internal medicine and
family medicine • Specialty Boards continue assessment integrated with
Adaptive Intelligent Learning Engine • Continuous update of knowledge-based curriculum with
the advances in medicine
OPSC’s 54th Annual Convention and Exposition Syllabus 133
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Current Proposal - Benefits • Continuous certification with specific learning nodes
using the adaptive intelligent learning engine is not easier but more relevant to current practice pattern
• Repatriation of DO graduates from ACGME programs to become AOA board-certified
• New DO or MD graduates of new ACGME to have improved method of (AOA) board certification
• Opportunity for growth of the AOA profession by allowing allopathic physicians currently ABMS boarded to take continuous certification modules
• Theoretically would provide better patient safety/care due to the evolving real-time curriculum and assessment modules
OPSC’s 54th Annual Convention and Exposition Syllabus 134
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
Proposed Solutions
• AOA Develop Boards provide DO’s with Continuous Certification if participate Lifetime Board Certification
• AOA Develop new Boards with ability to Board
57
OPSC’s 54th Annual Convention and Exposition Syllabus 135
WEDNESDAY, FEBRUARY 4, 2015: 5:00pm - 6:00pm ........................................................... ACGME-AOA Continuous Board Certification | Presented by David Connett, DO, FACOFP, dist
RETURN TO TABLE OF CONTENTS
2015Fall Conference
September 11-13
Monterey Plaza Hotel400 Cannery Row
Monterey, CA 93940
www.opsc.org/event/FC15
2015Fall Conference
September 11-13
Monterey Plaza Hotel400 Cannery Row
Monterey, CA 93940
www.opsc.org/event/FC15
2015Fall Conference
September 11-13
Monterey Plaza Hotel400 Cannery Row
Monterey, CA 93940
www.opsc.org/event/FC15