December 5-8, 2002
IOMS Annual Winter CME Meeting
Oakbrook Hills Resort
Oak Brook, Illinois

Phase II now is to develop functioning committees and districts. We have had great leadership within these committees with their chairmen:

Education: 
Donald Johnston, DO, Mattoon

Legislative: 
Gary Knepp, DO, Eureka

Membership: 
Teresa Hubka, DO, Chicago

Our financial health has improved so that the implementation of the Strategic Plan is possible. However, we need more member volunteers to carry out the many projects that each committee has developed. We can DO more, if YOU simply call us (800 621-1773, ext. 8174), email us or contact us via the Web site (www.ioms.org).

Purdue Pharmaceuticals, in conjunction with the IOMS, Illinois State Medical Society, and the Illinois Academy of Family Physicians, has provided an educational grant to develop much-needed educational seminars dealing with chronic pain. These seminars will begin this summer in various locations in Illinois with AOA Category I CME.

During this quarter, we have developed an improved relationship with the Illinois State Medical Society and currently have several joint projects. Because of our mutual issues with legislation, we believe the IOMS and the ISMS can work together for the benefit of both organizations.

We have met with the leadership of Midwestern University - Chicago College of Osteopathic Medicine, in an attempt to improve relations and support our osteopathic students. We will participate in the annual White Coat Ceremony, Family Day and graduation exercises. We have an excellent student, Nancy Wasserbauer, who has served as a member of our Board of Trustees. We will provide a delegation to the AOA House of Delegates, which will be held July 19-21 in Chicago. During this meeting, the IOMS will support the state's position with the AOA.

Richard Feely, DO, has served as the IOMS representative to the Medicare Advisory Committee for seven years and we are thankful for his conscientious attendance. We are further pleased that James Arons, DO, has accepted this new appointment and will represent his profession.

Over the next few months, expect information concerning our Winter Symposium and Educational Seminars, which will be held at the Oak Brook Hills Resort Dec. 5-8. Last year we had a fantastic convention, and I expect that the Educational Committee will put together an even better program this year.

We want to know when osteopathic physicians have successes and special notations. So let us know if you or one of our family receives recognition: we want to know, so that We Can DO More. 

Robert G. Good,
DO President

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This conference has been designed to reach out to DO educators interested in learning more about end-of-life topics and in bringing the DO difference to end-of-life treatment. The conference will offer up to 30 CME credits. 

Registration information is posted on the front page of the AOA Web site at http://www.aoa-net.org. You may share this information with any physicians you think might be interested or direct inquiries to me at Ext. 8006. 

Shelley Morrison
AOA Manager,
Division of Public Health

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This year's SIH/SIU Health Policy Institute, which will focus on patient safety and medical errors, is scheduled for May 30 -31. For additional information go to: http://www.law.siu.edu/events/HealthPolInst/2002/Index.htm

In December the AOA responded to proposed amendments to the Nursing and Advanced Practice Nursing Act as well as the Medical Practice Act. The AOA requested that per our Non-Physician Clinician policy, CRNAs be supervised by licensed physicians as opposed to "collaborating". The Dept. of Profession Regulation opted not to change the existing language. 

Linda L. Mascheri
AOA Director, Division of State Government Affairs

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Chicago College of Osteopathic Medicine Report

Chicago College of Osteopathic medicine students responded to Self magazine's erroneous December article regarding how to choose a primary care physician with a letter on behalf of all students of the college. The letter was written by Dan Logan, MS-II and next year's CCOM Student Council President, and was unanimously supported by the CCOM Student Council. The council has not received a response to the letter. 

This year's CCOM Family Day was held on March 16. Family Day is a recently rekindled tradition when students have the opportunity to spend a fun-filled day with their loved ones and thank them for all of their support. Families were invited to campus for morning presentations, breakfast and campus tours. 

In the evening, the festivities continued with dinner and dancing. Thanks to Dr. Teresa Hubka for joining us for this very special event. 

The MS-IIs are busy planning several important events. First and foremost, studying for COMLEX-I. Secondly, the MS-IIs are busy planning the last CCOM only White Coat Ceremony, scheduled for May 4. We look forward to having the Illinois Osteopathic Medical Society present at this event. 

Finally, Basic Science Day is scheduled for May 12. This is the traditional day on campus when MS-IIs plan festivities to celebrate the end of the Basic Science Years. 

Several CCOM students traveled to Washington, D.C., for Student DO Day on the Hill on April 11. During this time small groups visited the Congress regarding student issues. The event was a wonderful experience for all who attended. 

At the end of our school year, we have the opportunity to thank the leaders of our classes and special interests groups as well as our graduating seniors. The annual leadership awards banquet was held April 19 and the annual Senior Banquet will be held on May 30. 

Graduation will be held on June 1 on campus. We are proud of our graduating colleagues and wish them well. Special congratulations to Jessica Zuzga, this year's CCOM Student DO of the Year.

Nancy Wasserbauer, MS-III
CCOM Student Council President

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By Jacquie Goetz 
AOA Staff Writer 

Dr. Ronald R. Burns, DO, testified on the dangers of prior authorization of prescriptions for Medicaid patients during a March 12 hearing of the Illinois House of Representatives' Committee on Appropriations--Public Aid. Illinois is the 19th state in which Dr. Burns has provided such testimony. 

A bill introduced in the Illinois House in January would have mandated that physicians who care for Medicaid patients obtain prior authorization to prescribe medications not on the state's list of approved drugs. 

Although the bill died in committee, the Illinois Department of Public Aid was considering implementing the rules it contained without legislative approval, explained Dr. Burns, who practices family medicine in Orlando, Fla. "My testimony before the Committee on Appropriations was preemptive," Dr. Burns noted. "The bill died, but I and others who testified wanted to make sure that it doesn't rise again."

Personal experience 
A member of the State of Florida Medicaid Formulary Study Panel from 1999-2000 and Florida's Medicaid Pharmacy and Therapeutics Committee from 2000-01, Dr. Burns is well-versed on the dangers that prior authorization would pose for Medicaid patients. 

For the past three years, Medicaid beneficiaries in Florida have felt the impact of state cost-cutting legislation that forces pharmaceutical manufacturers participating in the state's Medicaid program to discount their medications even more than the federal government mandates. Pharmaceutical companies that do not comply have had their products removed from the state's list of approved medications. Physicians who want to prescribe medications excluded from the approved list must obtain prior authorization from the state Medicaid program. 

"What state government leaders across the nation don't understand is that by implementing this kind of policy, they are inadvertently increasing healthcare costs, as many patients who don't receive the most appropriate medication end up hospitalized," said Dr. Burns, who is the second vice president of the Florida Osteopathic Medical Association. "Prior authorization may reduce drug expenditures, but in the long run, it results in far more costly treatment via emergency department visits and hospitalization." 

In addition, prior authorization creates an administrative burden for both physicians and Medicaid carriers. 

The authorization process is onerous, costly and potentially dangerous to patients, notes Dr. Teresa A. Hubka, DO, who also attended the committee hearing. 

"Physicians are hindered from prescribing the most appropriate medication," explained Dr. Hubka, the immediate past president of the Illinois Osteopathic Medical Society. "Patient care is compromised, and the results can be devastating. The defeated proposal was aimed at saving money when the focus should have been on saving lives and improving quality of life for our patients."

Dr. Burns' role 
Dr. Burns' experience with Medicaid stretches back to his days as a family medicine resident at Orlando (Fla.) General Hospital, (now known as Florida Hospital East Orlando), where he saw between 30 and 40 Medicaid patients every day. 

Dr. Burns ended up serving as chief resident, and he later became a co-director of Orlando General's family practice residency program. In these positions Dr. Burns was exposed to the administrative side of Medicaid. 

"At Orlando General, between 70 percent and 80 percent of our residency patients were on Medicaid," Dr. Burns estimated. "Medicaid patients tend to have more co-morbidities than the average patient, and they often aren't able to survive step therapy."

Physician's obligation 
"As a physician, I have a responsibility to provide insight on prior authorization," Dr. Burns said. "If we educate medical students, interns and residents in a restrictive environment such as this policy mandates in Florida, they learn to limit the use of certain drugs. That's unethical. Students, interns and residents won't get clinical experience with the newest technology agents. 

"When physicians are continually pressed to modify their behavior, eventually they are going to prescribe the medications that are the most hassle-free to obtain. Often those won't be the best medications." According to Dr. Burns, healthcare is like a balloon. 

"If you squeeze it, it's going to bulge somewhere," he maintained. "If you limit access to quality healthcare, you are going to increase administrative costs. The administrative burden will become unbearable. This policy encourages physicians to leave the Medicaid system. They can take only so much. 

"Only two ways exist to reduce healthcare costs: aggressive disease management and continuity of care. When you have access problems, you have gaps in care that will lead to increased costs."

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Chicago Tribune; Chicago, Ill.; April 7, 2002 By Bonnie Miller Rubin, Tribune staff reporter

Editor's note: Under the New Mexico law, psychologists there must complete at least 450 hours of coursework and a 400-hour practicum supervised by a physician. They must also pass a national certification exam. Then they are eligible for a two-year license allowing them to prescribe under the supervision of a physician. After two years, the psychologist's record must pass an independent peer review before he or she may prescribe independently.

(Copyright 2002 by the Chicago Tribune) Now that New Mexico has decided to allow specially trained psychologists to prescribe medicine, activists hope Illinois will follow suit, arguing that the scarcity of psychiatrists in rural areas limits access to drugs that have become integral to treating mental illness. 

Psychologists, unlike psychiatrists, are not medical doctors, and therefore cannot prescribe the drugs that have proved so effective in alleviating the symptoms of depression, schizophrenia and other diseases. Psychiatrists are bitterly opposed to expanding prescriptive privileges, saying patients' health and safety would be put at risk. 

A bill on the issue was introduced without success in Springfield earlier this session. But encouraged by New Mexico's new law, passed last month, advocates here say they plan to ratchet up their lobbying efforts and bring their case to the public. 

"New Mexico passing this legislation just gives new life to this issue," said state Sen. Carol Ronen (D-Chicago), the bill's sponsor. "This is not a radical notion. It's not a scary notion.... In no way does it put people's health in jeopardy." 

In Illinois, she and other advocates said, more than half the counties have no psychiatrist at all, compromising the quality of mental health care. 

"It's a public health issue," said Marlin Hoover, president of the Illinois Psychological Association, which represents 1,300 psychologists statewide. "It's an idea whose time has come."

Medical risks feared 
The American Psychiatric Association sees New Mexico as a potentially dangerous "legislative experiment"-especially in medically complex cases, said Dr. Richard Harding, a child psychiatrist in Columbia, S.C., and president of the group. 

"This is not about giving a mildly depressed patient some Prozac," he said. "What happens when you have a bipolar or schizophrenic patient who suffers from hypertension? Diabetes? Alzheimer's? What about drug interactions? Everyone will be happy until things go bad ... and, in medicine, things can go bad very quickly." 

Many states, including Illinois, allow nurse practitioners and optometrists to prescribe drugs. The difference, said critics of the new law, is that it is done under the eye of a physician, whose name also appears on the prescription. If the psychologists-who usually have advanced degrees in therapy, not medicine-are willing to put similar safeguards in place, the proposal might be regarded differently, Harding said. 

Leon Jackson, a clinical psychologist in Springfield, has invested about 450 hours and $30,000 in training to immerse himself in every aspect of medication, even though he cannot write a single prescription. 

"I did it because I wanted to take better care of my patients," said Jackson, who has a PhD and has been practicing psychology for 35 years. 

But such training pales before the real thing, doctors said. 

"No psychologist-designed crash course in drug prescribing can substitute for a psychiatrist's medical education and residency training," said Dr. Kenneth Busch, a Chicago psychiatrist and president of the Illinois Psychiatric Society. 

Beyond patient care, both sides accuse each other of trying to protect their financial interests. 

The two professions often work together to shape treatment. Patients suffering depression, anxiety or other emotional problems often see a psychologist, who then refers them to a physician for medicine. 

With both steps handled by one provider, treatment could be more efficient and easier for the patient, said Hoover, who practices in Orland Park and has studied the issue for seven years. 

"The doctors will tell you that our motivation is economic, but it's really about continuity of care," Hoover said. "We need to get the message out to legislators and the public that this can be done safely ... and that there are psychologists who are willing to take the additional training in order to make services more widely available."

Defense agency a role model 
Under the New Mexico law, psychologists must complete at least 450 hours of coursework and a 400-hour practicum supervised by a physician. They must also pass a national certification exam. Then they are eligible for a two-year license allowing them to prescribe under the supervision of a physician. After two years, the psychologist's record must pass an independent peer review before he or she may prescribe independently. 

The training model is based on one used by the Department of Defense, which has allowed military psychologists to prescribe since 1991. Ten students went through the program, seven of whom continue to have prescriptive authority. An independent evaluation of the program in 1998 by the American College of Neuropsychopharmacology found that all 10 graduates "filled critical needs and performed with excellence wherever they were placed," said Capt. Mark Paris, a deputy director at the department. 

Experts say New Mexico was a logical pioneer for change. Although 72 percent of the population lives outside of Santa Fe and Albuquerque, only 18 psychiatrists practice beyond those city limits. Waiting time for an appointment can range from six weeks to five months. 

In Illinois, the picture is not much brighter, experts said. Fifty-four out of 102 counties have no psychiatrists and 17 have only one. 

In Springfield, Jackson has seen the problem firsthand. There isn't a "handful of psychiatrists between here and Cairo," he said. 

The American Psychiatric Association agrees there is a gap in service. Even so, it says the solution is not to grant prescriptive authority to those without medical training, but to expand funding for the National Health Service Corps and encourage more physicians to practice in rural areas. 

"We know access is abysmal," said Randy Wells, director of the Illinois chapter of the National Alliance for the Mentally Ill. "But we have many counties where you can't find a thoracic surgeon and we don't give the job to a [licensed practical nurse]." 

Another advocacy group, the Mental Health Association of Illinois, has not taken a position, but Chief Executive Officer Jan Holcomb hopes the two professional groups can manage to lower the rhetoric. 

"We have a lot of issues-funding cuts, lack of insurance coverage...and infighting is not going to help the consumer," Holcomb said. "It will only further stigmatize mental health care."

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Legislation 

The Illinois Osteopathic Medical Society was represented by Teresa A. Hubka, DO, FACOOG, FACOG, and staff at the DO Day on the Hill on April 18. The team lobbied for professional liability insurance reform in response to rising malpractice insurance rates in many states, including Illinois. It has caused physicians to cut back on the services they provide, close their practices entirely, and/or move to states with affordable rates. All of these actions affect area residents. 

The team visited the offices of U.S. Reps. William Lipinski and Rod Blagojevich as well as U.S. Sens. Peter Fitzgerald and Richard Durbin. While there are several legislative solutions proposed in the House and Senate, we believe that a proposal by Reps. James Greenwood (R-PA) and Christopher Cox (R-CA) is the best solution. It is critical that you contact your legislators and advise them to co-sponsor and support this bill. To find your congressional representative, visit the web at: http://www.elections.state.il.us/dls/pages/DLSAddresscrit.asp.  

While visiting the capital, Dr. Hubka attended a fund-raiser hosted by the Osteopathic Political Action Committee (OPAC) for American Osteopathic Association member and osteopathic family physician John Redwine, DO. According to "The Cook Political Report," Dr. Redwine is "a frontrunner" as one of four Republican candidates on the ballot in Iowa's 5th Congressional District open-seat race, where the June 4 primary "is the whole enchilada." 

Dr. Redwine is the only candidate in this race with a healthcare background. When elected, Dr. Redwine will be an immediate authority and resource to his fellow members of Congress on healthcare issues, as one of only a handful of physicians and the very first osteopathic physician to serve in Congress in the modern era. To learn more about Dr. Redwine's congressional campaign, please visit http://www.johnredwine.com. 

As part of the D.C. activities, Suzanne Ashby, DO, IOMS Intern/Resident Representative, attended the Council on Health Related Policies.

Membership 

In an effort to increase membership, the Membership Committee, chaired by Dr. Theresa Hubka, will examine a recent statistical analysis to better focus on membership recruitment and retention. 

Data indicates that of the 1526 DOs in Illinois, 222 are active IOMS members. District One includes the largest portion of IOMS members (69.8 percent), followed by District 4 (9.9 percent), District 3 (9 percent), District 2 (6.3 percent) and District 5 (5 percent). The majority of DOs are male (69.4 percent). IOMS male members make up the majority, albeit a larger portion (76.1 percent) of membership. The majority DOs are members are Family Practice physicians (42.5 percent); the same is true for our members (51.4 percent). 

The Membership Committee and the Education Committee will consider these figures in planning future CMEs that outreach to members throughout Illinois, and that focus on Family Practice issues. As part of this effort, three Regional Pain Management Dinners/Lectures have been scheduled in Chicago, Champaign and DeSoto, Illinois (see page 2). 

Other Committee efforts include additional member benefits, which will be featured in an upcoming newsletter. As part of the Committee's effort to increase student involvement, Dr. Hubka addressed first and second year medical students and their families in March at Family Day, sponsored by the Chicago College of Osteopathic Medicine. Membership applications are always available at our website at http://www.ioms.org -- sign up your associates.

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