AOA’s Problematic Response to President Trump’s Executive Order

Friend of IP4PI, Richard Koss, D.O., writes in:

Below is the response from the AOA regarding the recent presidential executive order regarding Medicare.

Well they do make some accurate points towards the end of the letter there are many problems and issues that need to be brought out.

First. The federal government like most of America do not know what a DO or osteopathy is. Since this is a presidential executive order, does the President of the United States even know what osteopathy is? I doubt it! therefore the bureaucrats in Washington DC will not pay attention to this letter.

Second. The AOA does not speak for the 145,000 DO’s in this country. They can only speak for their membership which at this point is below 30% of all DO’s. since the AOA has not brought this information out to the membership and asked for support they cannot speak for any DO at this point. Likewise only 15% of MDs belong to the AMA. And again the AMA cannot speak for the vast majority of physicians in this country. Yet they do.

Third. Where in this response letter does the AOA expound on the difference between allopathic and osteopathic physician’s? And show our superiority in quality, cost containment etc. based on OSTEOPATHIC PRINCIPLES! Where does the AOA champion the use of osteopathic manipulative medicine in the care for seniors.

Interstate licensure Compact…NO!

Continue reading

Resolved: End Re-certification Abuse

Resolution on Re-Certification Sent to NJAOPS HOD

To:       Robert Bowen, Executive Director, NJAOPS

Paul Morris, D.O. Speaker of the House, NJAOPS
Robert Pedowitz, D.O.,President, NJAOPS
Michelina Desantis, D.O., President-Elect, NJAOPS
Ira Monka, D.O., Member, AOA Board of Trustees
Al Talone, D.O., Chairman, JOPAC

Re:        Proposed Resolution on Re-Certification

Date:    Feb 10, 2016

RESOLUTION

Whereas Board Certification was always intended to be a one time accomplishment based upon completion of a course of intensive training, clinical experience and study, followed by an examination and Continue reading

How to return healthcare to real healing

“Osteopathic family physicians have always had patient centered medical home practices. We don’t need insurance or government bodies to certify us for money. We also shouldn’t be forced to sell patient and physician private data for money. we shouldn’t be forced to work for hospital systems due to complicated cronyism federal law. DPC Direct primary care changes 70 years of insurance and government lies and deceit back to the privileged individual patient-physician relationship.” Craig M. Wax DO

Back to Puke, Purge and Blister ?

Since 1888 when the first Osteopath put forth the Principles of Osteopathy and a comprehensive therapeutic program that was much more than puke, purge and blister which was the practice of “Medicine” at that time and as a result was run out of Kansas and went to Kirksville MO where he established the first College of Osteopathy and after 6 years began the American Osteopathic Association which is now in the process of ending the degree of DO and sending all graduates of DO colleges of Osteopathic Medicine to ACGME programs approved by the ABMS and they will certified by the ABMS boards and there will be no more Osteopaths.

I am astounded by the apathy of practicing DO;s and an apparent lack of concern. There are many who think that they should unite with the Allopaths especially in acquiring Board certification. I have been a DO

since 1961 and was a practicing “Internist followed by cardiology and then an MD fellowship in rheumatology completed in 1971. In this time I have been threatened by a malpractice suit 5 times and these were never litigated. I practice rheumatology full time and will do so until my demise. We practice the highest standards of healthcare provision and currently have students rotating from 3 DO schools and 2 MD schools. The
students are astounded by the way we practice as we practice Osteopathy that is far advanced from that which is currently taught at Osteopathic Colleges of Osteopathic medicine. They are seeing patients that revere our way of practice.

We are putting all we can muster in establishing The American Association of Osteopathic Physicians and plan on being Osteopaths in our organization. We have established American Boards of Osteopathic Specialties to provide certification in all specialties. We are interested in how many may join us.

Charles L. Clay DO

I’m a DO, and it is a beautiful thing. We must keep our identity.

Dr. Gina Reghetti shares her thoughts on preserving the practice of osteopathic medicine and formation of an alternative D.O. board:

We must fight the system that wants to change a good thing. Osteopathy needs to stay unchanged, and it needs to be practiced as it was practiced in the past, without insurance involvement because it is the big corporate insurance companies that just couldn’t understand our language so they have attempted to destroy it. Harvard has dealt us serious blows because it’s the allopathic profession that is clueless to the medical practice of Osteopathy, yet they are the ones in positions to judge, and define reimbursement for an area of medicine that they just don’t know. We are not allopathic physicians, and we never will be, and never care to be so we need to stop holding DOs to the same standards as the MDs were trained. We are not trained the same that is why we don’t take the same boards; we are very different!

We must keep our identity especially when big government and national medical organizations are forcing us down one pathway. Continue reading

AOA Empire as a Regulatory Agency

Bob Maurer, D.O. writes:

To My Fellow Osteopathic Physicians: It is incredible how dysfunctional many of the AOA administrative departments have become. One of the biggest problem with the AOA is the empire that John Crosby built over the past ten years. It is an empire that the AOA directors do not recognize and do not know how to dismantle.

A prime example is the AOA administrative leader who told us that a lecture on the use of the new defibrillator was inappropriate for practicing osteopathic physicians.

The AOA has become a regulatory agency of its own, many times more dangerous than our own federal and state governments. It is overloaded with top level administrators, many of whom have the sole function of creating regulatory requirements that are detrimental to you and I and our fellow AOA members. Continue reading

ALL DOs must read this now prior to AOA delegates mtg July 18, 2014

CLICK HERE to download this letter and table of resolutions in PDF format.

Dear Osteopathic physician,​​​​​ 7/10/2014

In recent years the American Osteopathic Association (AOA) has strategically traded away their responsibility to their constituent members bringing government and insurance industry regulation ever increasingly in between the physician and the patient. They have done so, in favor of corporate strategies and business models that have eroded patient quality of care, decreased physician efficiency, sacrificed private practice, buried physician offices in paperwork, and cost physicians tremendous expense and anxiety. Through all of this they have not only not provided additional benefit to the patient population but they have detracted from it. The result of their negotiations and agreements has been a collapse of healthcare delivery under the heavy hands of mandatory enforcement, the advancement of third party intervention, the reduction of patient contact time, the reduction of net income to physicians, the decrease in access to quality care for patients and the massive increase in bureaucracy. All this has added great expense for all premium payers and physicians while new corporate structures and businesses are created from that drain on healthcare delivery. They are about to now give away our professions control over our unique educational paradigm and in the contract, force us to give away our uniqueness and our more comprehensive educational requirements, our training sites, and our control of post graduate education to an organization that has no concept of the educational deficit they have regarding our approach to health rather than disease. Our original article “Saving Private Osteopathic medicine,” has been denied JAOA publication for over two years by AOA corporate leadership who are afraid to debate and answer memebership DOs questions. One author, George Watson DO died fighting the process. Read it here: Saving Private Osteopathic Medicine https://ip4pi.wordpress.com/2013/03/31/saving-private-osteopathic-medicine-2/

The proposed ACGME merger, is actually a takeover of OGME that will leave our profession without any autonomy in graduate medical education and will result in the loss of practice autonomy and eventually our Osteopathic schools through the process as it is no laid out over the next 5 years to 2020. This was written about extensively by Norman Gevitz PhD, Osteopathic historian and researcher. http://www.oucom.ohiou.edu/hpf/pdf/bios%20april%202014/2014-AODME%20Presentation%20The%20Unintended%20Consequences%20of%20the%20ACGME%20Merger.pdf

The House of Delegates (HOD) and all practicing DOs must demand the AOA stop their policies toward ACGME merger as proposed, OCC/MOC, MOL, and they must begin to support their osteopathic physician membership unconditionally against ALL competing interests.

Please read 10 point questions below that have been asked of the AOA for answers they have continued to not answer for 3 years this September 2014. If any of the questions raise your “index of suspicion”, contact your AOA State Delegates immediately and prior to the meeting next week, beginning Friday, July 18. The COMPLETE 168 resolutions pending are at the following link: http://www.osteopathic.org/inside-aoa/events/annual-business-meeting/house-resolutions/Pages/default.aspx Please read them and decide for yourself what you might be for or against.

A bulleted list below, of some of the relevant resolution agenda numbers and titles will be followed by recommendations “for or against” them in reference to a large body of physicians in the trenches whose voices are not being listened to by any of the “elected authorities for which our dues pay”.

We as individual Osteopathic Physicians, Osteopathic State Associations members, and as diplomates of Subspecialty Colleges, must take action to change AOA policy direction. Our Osteopathic practice of medicine, our patient populations and our ability to support our families hang in the balance.

10 questions for the AOA that remain un-answered by any executive officer thus far:

1. Why is AOA forcing ACGME merger (takeover of OGME)? What alternatives have also been explored? Why would any organization walk away from millions in government funding that maintain our own unique OGME?

2. Why is AOA pursuing osteopathic continuous certification and maintenance of certification (OCC/MOC) when they are time and money prohibitive for DO physicians? Osteopathic CME has always been flexible and more than adequate.

3. Why is AOA pursuing maintenance of licensure (MOL) against state board autonomy, DO state association preferences and physicians professional independence?

4. Why is AOA not fighting NP and PA expanding practice rights in each state? They are practicing medicine independently in increasing numbers of states without having to complete a full curriculum in medicine. That is condoning malpractice.

5. Why do AOA publications refuse to publish any articles that discuss or question AOA actions and policy?

6. Why is AOA embracing all HHS/CMS policies even before they are written, like pay for performance (P4P) when these policies are being used to deny payment to good practicing physicians instead?

7. Why is AOA complicit in the financial capture of medicine by so-called “stakeholders;” insurance companies, hospital health systems, government, HIT and corporate interests and insistent on excluding patients and physicians in private practice as stakeholders at all?

8. Why is AOA complicit in the regulatory capture of the practice of medicine by government, thus losing all true Osteopathic practice, their professional integrity, and our entire DO professions underpinnings?

9. Why doesn’t the AOA present it’s member DOs with all options of practice including private direct pay options where the patient-physician relationship is paramount and sacrosanct?

10. Why doesn’t the AOA support private independent Osteopathic Medical practice against the competing interest of all others?

40 of the most relevant resolution proposed follow. Please review those of interest to you and make your opinion(s) known to our representative this week.

RES. #

Title

FOR

AGAINST

H-201

Increase in Graduate Medical Education Training Opportunities

FOR

 

H-202

Ensuring Adequate Resources to the Future of Osteopathic Medicine

FOR

 

H-203

Osteopathic Medical Education

FOR

 

H-204

Reversal of Needs Assessment Requirement for CME Programs

FOR

 

H-205

Assure Graduate Medical Education Residency Positions to Graduates of U.S. Medical Schools

FOR

 

H-206

Goal of Osteopathic Graduate Medical Education

FOR

 

H-207

LCME Admission to AOA Residency Programs

FOR: WITH TIME REQUIREMENTS OF EQUIVALENCY IN OPP AND OMT TRAINING

 

H-211

Maintaining the Integrity and Mission of Colleges of Osteopathic Medicine (COM) and University Health Science Centers (UHSC) Granting the Doctor of Osteopathic Medicine Degree (DO) H279-A/09

FOR

 

H-215

Graduate Medical Education – Training Of Us Medical School Graduates (H315- A/09)

FOR

 

H-216

State Mandated Continuing Medical Education Requirements

FOR

 

H-218

Blue Ribbon Commission Report

FOR

 

H-304

Government Funding for Hospitals Not Accepting COCA Students

FOR

 

H-340

Unionization Of Physicians (H233-A/09)

 

AGAINST

H-347

Opposition to Implementation of ICD-10

FOR

 

H-348

Osteopathic Physician Compensation Tied to Patient Satisfaction Surveys

FOR

 

H-404

Correction of Public Information about the Osteopathic Profession

FOR

 

H-500

AOA Constitution & Bylaws – AOA Executive Director – Title Change

 

AGAINST

H-603

Opposition to Maintenance of Licensure

FOR

 

H-604

Dissemination of Evidence Based Osteopathic Medicine

FOR

 

H-607

Government Intervention in Private Practice H213-A/09 (H219-A/04)

FOR

 

H-609

Centers for Medicare and Medicaid Services (CMS) Communications With Physicians H216-A/09 (H222-A/04)

FOR

 

H-627

Industry Transparency Standards (H326- A/09)

FOR

 

H-632

Centers for Medicare and Medicaid Documentation Regulations

FOR

 

H-636

BSGA Report on H-623-A/2013 Opposition to Maintenance of Licensure

DEMAND ACTION ON THIS. PUT IT TO A VOTE

 

H-637

Collaboration to Protect the Integrity of the Physician Testing Process for Unlimited Licensure (H327-A/09)

 

AGAINST LETTING AMA RUN OUR TESTING

H-800

Unified Graduate Medical Education Accreditation System

 

AGAINST

H-801

AOA/AACOM/ACGME Single Unified Graduate Medical Education Accreditation System

FOR

 

H-802

AOA/AACOM/ACGME Single Accreditation System For GME

 

AGAINST

H-803

NJAOPS’ Support For ACOFP Resolution “AOA/AACOM Unified Residency Accreditation System”

WITHDRAWN

 

H-804

AOA / ACGME

FOR

 

H-805

Participation in AOA ACGME Merger

????

???? STOP THE MERGER

H-806

Accepting AOA Board Certification in AOA ACGME Merger

???FOR AOA RECOGNITION AS EQUIVALENT

???STOP THE MERGER AS IT IS PROPOSED

H-807

AOA / ACGME

FOR

 

H-808

Single Graduate Medical Education Accreditation System

???? AOA DOES NOT HAVE THE CAPACITY TO DO THIS

??? STOP THE MERGER AS PROPOSED

H-809

Unified Graduate Medical Education Accreditation System

 

AGAINST

H-810

Support of Unified Graduate Medical Education

 

AGAINST

H-811

Creation of an Osteopathic Emphasis Track for the Unified Graduate Medical Education (GME) System

 

AGAINST: THE EDUCATIONAL REQUIREMENT STANDRDS ARE LOWER THAN THOSE OF A FULL TIME OSTEOPATHIC STUDENT. UNACCEPTABLE

H-812

AOA/AACOM Unified Residency Accreditation System

FOR

 

H-813

AOA/AACOM Single Accreditation System

FOR

 

 

DOsCOMITT – DOs Committed to Osteopathic Medicine Today and Tomorrow

Craig M. Wax DO corresponding author
Carlisle Holland DO
Dane Shepherd DO
Richard Koss DO
David Zeiger DO
George Watson, DO, Emeritus
Steven Horvitz DO
David Dornfeld, DO
Robert Maurer, DO
Albert Talone DO
Brad Kline, DO
Gina Reghetti DO
Michael Ward DO
Kelli Ward DO
Charles J. Smutny III DO, Editor

 

 

When will the ACOFP decide to start advocating for physicians?

Dr. Henwood:

I just read the email report about the future of physician payments:

Will you be discussing how performance measures takes time and energy away from patient care?

Will you be discussing how it is third party performance measures that you are endorsing which takes away from patient care and raises greatly the cost of business in a practice?

Will you be discussing how many physicians are terminating their contracts with insurers and working directly with patients to avoid the intrusions into patient care?

Will you be discussing how many physicians are planning to retire early because they are tired of dealing with third parties and just want to be physicians who treat their patients?

If you do not discuss any of the above issues then you are missing the boat.

As an Osteopathic physician, and as my father who was an Osteopathic physician before me, we did not go into practice to work for government or third parties.

When will the ACOFP decide to start advocating for physicians, instead of abdicating our authority and treatment choices to third parties?

I would be happy to discuss any of the above matters with you at any time.

Please call me at my office.

Dr. Steven Horvitz

henwood

Letter to AOA on ACGME merger: Problem & new solution

Dear AOA Pres. Dr. Vinn, et al.

This letter is in regard to, “Single accreditation for MDs and DOs by 2020,” in family practice news this month. We have been told by former AOA President Dr Ray Stowers that in recent years Osteopathic schools proliferated too quickly and created the need for more residencies than AOA could supply and government could fund. We were then told last year that the only solution would be to combine our Osteopathic GME with allopathic MD ACGME. In the article Dr. Vinn states, “… But Osteopathic training programs will still retain their unique focus.” He goes on to say, “this is an opportunity to both reinforce and proliferate or principles.” The question I raise is how is it possible to train, reinforce our principal teachings, philosophy and skills while not experiencing the potential disaster of the California experience of 1960?

As a product of, and believer in Osteopathic principles, schools, internships, residency training, postgraduate fellowships and CME, I believe our programs offer unique and distinct advantages over the other possibilities that exist. This unique Osteopathic approach to training, education and practice must be maintained for the betterment of human health. Under the plan to merge osteopathic graduate medical education with ACGME we would be absorbed, overrun and thereby changed to accommodate only the allopathic practice model.

Osteopathic graduate medical education has always strived for independence and excellence. This merger of programs would be a catastrophic mistake in the history of osteopathic medicine. Our DO distinctiveness would disappear from the practice of medicine of the merger goes to completion. The logical sequellae of the merger would be the loss of Osteopathic Medical philosophy in practice, as well as, all of our DO program directors will lose their jobs by the merger completion date of 2020.

I offer the DOs COMITT alternate plan to save Osteopathic training programs: The first step would be control of and smart steady growth of osteopathic schools, not uncontrolled proliferation. Osteopathic training programs produce diverse physicians with a large number of primary care specialty physicians including family medicine, pediatrics, gynecology, etc. The second step is the AOA to bring the data of our current primary care programs’ output to the government authorities and Congress that authorizes money for training programs. If we can mount a organized and cogent movement to convince the Congress and government leaders to champion the cause of primary care specialty training, they will support it for the good of the country’s health and their own political goals. Please consider this approach previous to your acceptance of the ACGME merger program which would destroy our osteopathic integrity.

http://www.familypracticenews.com/single-view/single-accreditation-for-mds-and-dos-by-2020/882f1fd642fed66cceba959c2629d65a.html

Best wishes for good health,
Craig M. Wax, DO
Family physician, Editorial Board of Medical Economics
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS
Twitter @drcraigwax
Independent Physicians For Patient independence @IP4PI
IP4PI.wordpress.com

My MOC/OCC AOA ACOFP letter

ABOFP & ACOFP
330 East Algonquin Rd. Ste. 6
Arlington Heights, IL 60005

AOA
142 East Ontario St.
Chicago, IL 6061
October 31, 2012

Dear Osteopathic colleagues,

As actively practicing Osteopathic Family Physicians, we all believe in lifelong learning from our patients, experience, readings and personalized elective coursework. Traditionally, our process has included 4 years of college, 4 years of osteopathic medical school, 1 year of internship (PGY I) and at least 2 years of additional residency(PGYII, PGYIII) or a minimum 3 years residency post graduate training. After completion of the academic and practical curriculum, a physician passes a board exam to gain lifelong board certification with no expiration. For every three year cycle after that, a physician had to complete CME credits to indicate hours of practice experience, teaching students and residents, home reading study and personal choice of formal CME programs. This curriculum allowed flexibility, personalization and relative economy for each practicing physician as they could choose the courses within the AOA categories.

Osteopathic family medicine residencies developed in the 1970s. In the 1980’s, physicians who didn’t complete a family medicine residency were allowed to be “grandfathered in,” and become board certified without having completed 3 years of residency training. They gained all the rights and privileges of board certification and continued with their 3 year CME cycle.

Starting for ABOFP/ACOFP family medicine completing residency in 1997, each physician now had to be recertified by taking another board exam every 8 years (time limited certification). This cost physician’s additional time and money. Physicians board certified previous to 1997, even those “grandfathered in,” were still lifetime certified and never had to spend their time and money pursuing board recertification. This is discrimination against those who rightfully completed family medicine residency by those in leadership positions who themselves were “grandfathered in,” and not actually residency trained. Their previous training, although at least 3 years less than those who were residency trained, apparently have omnipotent superior lifetime skills and don’t require additional testing to maintain their board certification.

Starting for this same group of ABOFP/ACOFP board certified family physicians who completed residency in 1997, there is an additional maintenance of certification/osteopathic continuous certification (MOC/OCC) procedure that becomes mandatory on January 1, 2013. MOC/OCC now demands that in addition to all the foregoing time, retesting procedures and expenses, residency trained physicians must additionally enter patient data on two time periods to somehow measure a physician’s skill and participate in an online procedure requiring many hours and cost an additional $3,000 at minimum. This is burdensome, expensive and not statistically proven to improve care. Further, it does stand to generate significant money profit for the ABOFP, ACOPF and AOA which makes it a conflict of interest. Furthermore, once again, those board certified previously to 1997 in osteopathic family medicine, remain lifelong board certified without additional testing or the requirements of MOC/OCC. This too is discrimination against those who have spent the time, effort and money pursuing residency training and initial testing for board certification.

All requirements for all practicing DOs should be consistent throughout and not required for some but not others. All MOC/OCC roads seem to lead to MOL – maintenance of licensure and the regulatory capture of osteopathic medicine. As a practicing osteopathic family physician, I refuse to participate in MOC/OCC and time delimited certification as they are:

1. MOC/OCC and time delimited certification are only required for those board certified finishing residency on or after 1997 and not required for those board certified finishing residency prior to 1997.

2. MOC/OCC and time delimited certification are not required for those who did not complete residency, but “grandfathered in,” to board certification.

3. MOC/OCC and time delimited certification are burdensome in practice by taking time away from disappearing patient care time.

4. MOC/OCC and time delimited certification takes time away from disappearing personal health and family time.

5. MOC/OCC and time delimited certification are not statistically proven to improve care.

6. MOC/OCC and time delimited certification are based on a discriminatory procedure that exempts residency trained physicians who completed training before 1997.

7. MOC/OCC and time delimited certification are based on a discriminatory procedure that exempts non-residency trained, “grandfathered in,” physicians who were in practice prior to 1997.

8. MOC/OCC and time delimited certification are financially burdensome to practicing osteopathic family physicians.

9. MOC/OCC and time delimited certification creates and maintains new procedures the ABOFP, ACOPF and AOA will gain significant sums of money from and is therefore a conflict of interest.

10. MOC/OCC may be used by insurance companies to discriminate against DOs on payments and network participation

11. MOC/OCC may be used by hospitals to discriminate against DOs for staff privileges.

12. MOC/OCC may lead to MOL and the regulatory control of osteopathic medicine.

13. MOC/OCC and time delimited certification are unreasonably burdensome in a physician’s time and money that is threatens their rightful practice of Osteopathic family medicine. This violates the Osteopathic oath of Andrew Taylor Still, DO that we all pledged to uphold, that even the AOA, “never by word or by act cast imputations upon them (DOs) or their rightful practices.”

Best wishes for good health,

Craig M. Wax, DO

Residency trained, Osteopathic Family Physician

Host of Your Health Matters on Rowan Radio 89.7 WGLS FM

Medical Economics Editorial Board Member