august 2013 newsletter

The Lane County Medical Society gratefully acknowledges the following upcoming
September 10 meeting sponsors
President: Peter Kosek, MD
President Elect: Mark Meyers, MD
Past President: Byrke Beller, MD
Secretary-Treasurer: Andrew Gilchrist, MD
Secretary-Treasurer Elect: Julie Hughes, MD
Chief Executive Officer/Managing Editor: Candice J. Barr
Layout/Design: Lindsay Larson
The Official Publication of the Lane County Medical Society
990 West Seventh Avenue • Eugene, Oregon 97402 • (541) 686-0995 • FAX (541) 687-1554 • E-mail: lcms@riousa.com • Website www.lcmedsociety.com
august 2013
OF INTERESTTo Lane County Physicians
LCMS Physician Wellness Program — Confidential Counseling
Call LCMS M-F @ 541-686-0995 or the 24-Hour Support Line @ 541-345-2800

OF interest, august 2013
LANE COUNTY MEDICAL SOCIETY
3
At this writing, the
77th
Legislative
session is nearing
Sine Die (end of
session). There
is disagreement
whether or not
significant reforms
were made to
PERS or taxes
and the “grand
bargain” is now
a distant memory
in the halls of the
capitol. However, a victory for healthcare
was achieved with the passage of HB
5030-A, the Oregon Health Authority
budget, providing the CCO with certainty
regarding funding of the Oregon Health
Plan for the next biennium. The budget
includes a reduction (2 percentage points
below predicted growth) in per capita
health care costs through improved quality
of care. That is below the growth rate of
years past and shows Oregon is proving
itself to be a leader in holding down costs
while improving care. Additionally, $30m
in transformation funding was included
which will provide to Trillium $1.5 to 3.0
million earmarked for innovative pro-
grams aimed at assisting us in healthcare
transformation.
Prior to the 2013 Legislative session I
worked with Trillium staff to develop a
Legislative Agenda which included house
and senate bills we either supported, op-
posed or were “watching.” Our agenda
placed the OHA budget as our number
one priority. Central to the budget was the
renewal of the Provider Tax, HB 2216,
which was delayed until late in the ses-
sion. Below is a partial list of bills that
I thought would be of special interest to
Trillium providers, a description of the
legislative intent and where they are in the
Legislative process.
Support
HB 2216 Provider Tax
This bill extends the collection of hospital
assessment (revenue stream used since
2003 to help finance Medicaid services)
through 2015. (Signed by Governor)
SB 132 Immunization
Changed the requisite for parents to opt
out of immunizations by requiring that
they watch an educational video or receive
information from their healthcare provid-
er. Prior to SB 132 parents could simply
sign a form that said they had a religious
or philosophical objection. A similar bill
when passed in Washington state reduced
immunization opt outs by 25%. This is
a significant public health issue in Lane
County. The low immunization rate also
negatively impacts our HEDIS scores and
reduces Medicare payment rates for our
providers. (Signed by Governor)
SB 483 Adverse Health Incident
This bill was a compromise and first step
toward true medical liability reform. Al-
lows patients (except inmate) and health
care facilities or providers, among others
to file notice of adverse health incident
with Oregon Patient Safety Commission
(OPSC). (Signed by Governor)
SB 724 Air Conditioner Bill
The bill provides a funding mechanism
for non-medical services necessary to
maintain health and contain costs. It is
called the “air conditioner” bill because
the Governor often uses the example of
a patient with congestive heart failure
whose readmission rate decreased because
of the purchase of an air conditioner for
her apartment. There is still work to be
done with CMS to fully implement the
needed changes. (Signed by Governor)
Oppose
SB 373 Oral Health
Required Coordinated Care Organiza-
tion to provide oral health care through
contracts with Dental Care Organizations
(DCOs) until 2017. This bill also required
Trillium Talks: Legislative Update
By Terry W. Coplin, CEO
Terry W. Coplin
Continued on page 22

4
OF INTEREST, august 2013
Continued on next page
Trust to Improve Coordinated Care
You might think that lack of trust between
physicians, hospitals and payers is so
embedded that better solutions to health-
care delivery will be slow. Most prefer
constructive change as a result of local
solutions, rather than change imposed
from the outside. Yet, the devil is in the
proverbial details. The way forward,
however, begins with us.
Last month, Trillium Community Health
Plan invited community healthcare
leaders, providers and payers to a
program led by the Executive Director
for the Center for Healthcare Quality
and Payment Reform. His presentation
generated energy in the room, as he dem-
onstrated a financial model to improve
patient outcomes, pay for physicians, and
higher margins for hospitals.
The mood shifted when he stated that
implementation required active commu-
nication among all stakeholders (physi-
cians, hospitals, payers and patients)
to define changes needed in delivery of
care. As the audience palpably felt that
such communication would be difficult,
the seasoned presenter asked what obsta-
cles prevented necessary communication.
Lack of trust was the common concern
blocking desired results.
The Blind Men and the Elephant
The parable of the six blind men and
the elephant reminds us that, “To learn
the truth, we must put all the parts
together. “ One blind man, who touched
the elephant’s ear, thought, this animal
could fly. Another man, who touched the
elephant’s leg, and thought the animal
was an extremely large cow. Although
Trust Us!
By Deborah Munhoz, a Certified Physician Development CoachTM
Women Physicians Meet Monthly
All women physicians are invited to an informal gathering of peers.
Come network, have fun and hear what other female physicians are
experiencing as they manage life as a practicing or retired physician.
Facilitated by• : Deborah Munhoz, Certified Physician Development Coach
Date• : Wednesday, August 14th
, 6:00-8:00 PM
Location• : Private home patio party
RSVP and Location• : (541) 687-5856 or go to
www.PureSuccessCoaching.com/LCMS

5
“He is the best physician who is the
most ingenious inspirer of hope.”
Samuel Taylor Coleridge,
1875-1912
Continued from previous page
each perspective was understandable, the
individual views were incomplete.
Certainly, challenges in healthcare are as
large and varied as the elephant’s body.
Usually, we lean toward negative, rather
than positive, assumptions about oth-
ers when perspectives differ from our
own. Our inclination to believe that the
perspective we hold is the truth can result
in behaviors that erode trust, such as
describing a physician administrator as
having “gone to the dark side!”
The First Law of Trust
As insufficient trust is an obstacle, it is
helpful to view trust as manageable. The
surest way to build more trust is to extend
more trust to others. The circular reason-
ing that some people are not to be trusted
lies at the core of why low trust is a
vicious cycle.
The First Law of Trust is that trust is
reciprocal. If you are not happy about the
level of trust, find creative ways to show
more trust in others. Even small gestures,
which may seem trivial, usually work to
signal your intention. To show higher trust
in individuals:
• Stop micromanaging, and let people
use their initiative.
• Publicly eliminate a procedure that no
longer is useful.
• Cancel a report that no one reads.
• Unlock the supply cabinet.
The reciprocal nature of trust holds true
for teams and meetings. To create a more
trusting environment:
• Establish guidelines, and set parameters
• Forget titles, degrees and distinctions.
• Allow open communication.
• Align with successful people and
teams.
• Use conflict resolution to foster
teamwork.
It is up to each of us to break the cycle
of lack of trust. The principle works at
work, as well as at home. What you get
out of the change is in proportion to what
you put in. Although it takes courage to
change old habits, the payoff is immense.
The challenges of cost-effective, quality
care require the best ideas and a collab-
orative effort. By intentionally building
trust, we can find a way to balance chal-
lenges and stay personally at peace with
our decisions.
Deborah Munhoz, a Certified Physician
Development CoachTM
, helps busy physi-
cians create success and fulfillment in
medicine and their personal lives. Call
(541) 687-5856 or get free resources at
www.PureSucessCoaching.com
Two sessions with Deborah are now includ-
ed in the Physician Wellness Program.

6
Physician Wellness Program Donor List
The Lane County Medical Society
Foundation thanks the following donors,
whose gifts or pledges are shown below.
As of July 15, 231 donors have contrib-
uted or pledged a total of $391,870 to the
Foundation. The Lane County Medical
Society extends our grateful appreciation
to all donors for your generosity. We are
also grateful that LCMS members are
finding value in the program, which is
now being used weekly.
$150,000
PeaceHealth Oregon Region
$25,000
McKenzie-Willamette Medical Center
PacificSource Charitable Foundation
$15,000
Oregon Medical Group
$10,000
McKenzie-Willamette Medical Staff
Oregon Medical Education Fun
$5,000-$9,999
Candice Barr & Darryl Larson
Deborah Dotters M.D. & Vern Katz M.D.
Julie Hughes, M.D. & David Hughes
Gary LeClair, M.D. & Janice Friend
Oregon Urology Institute†
$2,500–$4,999
Joseph Arpaia, M.D.
Gillian Betterton, M.D.
Ray Englander, M.D. & Libby Englander
Mike Herz, M.D. & Sandy Herz
Gregory Moore, M.D. & Emily Moore
Jaswinder Singh, M.D.†
$1,000–$2,499
Harry Adamo, M.D.
John Allcott, M.D.
Bryan Andresen, M.D. &
Pamela Andresen, M.D.
Michael Balm, M.D.
Richard Barnhart, M.D.
Byrke Beller, M.D.
Lorne Bigley, M.D. &
Beth M. Moore, M.D.
Douglas Bovee, M.D.
Ann Bowers-Quesada, M.D. &
Tony Quesada
Glenn S. Buchanan, M.D.
Richard K. Bylund, M.D.
Win & Judy Calkins
Paula Ciesielski, M.D. &
Michael Ciesielski*
Lee Davidson, M.D. & Kari Davidson◊
Melissa DeFreest, M.D. & Eric DeFreest
Dan Dietel, M.D.
Magha Dissanayake, M.D.
Juanita Doerksen, M.D.
Tom Dreyer, M.D.

7
Larry Dunlap, M.D.
Melissa Edwards, M.D. †
Sylvia Emory, M.D.
Ralph Fillingame, M.D. &
Bonnie Fillingame
I. Howard Fine, M.D.
Sharon Flynn, M.D. & Rebecca Flynn
Julie B. Gemmell, M.D.
Andrew Gilchrist, M.D. &
Dena Putnam, R.N., B.S., M.B.A
Doherty Gilchrist, M.D.
Geoffrey Gill, M.D. &
Katie Swank, M.D.
Steven Goins, M.D. & Catherine Nelson‡
Andrea Halliday, M.D.
Julie Haugen, M.D.
Mark Heerema, M.D.
Winnie Henderson, M.D.
Holly Jo Hodges, M.D. & Ed Hodges*
Blaine Hoskins, M.D. & Nancy Hoskins
Kathleen Jackson, M.D.
Robert Jacobson, M.D.
Martin Jones, M.D. & Gayle Landt
Paul Kaplan, M.D.
Daniel Kerrigan, M.D. & Janis Kerrigan
Rick Kincade, M.D.
Gregory Knecht, M.D. & Marilyn Knecht
Christine Kollmorgen, M.D.‡
PeterKosek,M.D.&MarionDiermayer,M.D.
Christianne Kratka, M.D.†
Reed Kratka, M.D.†
Jennifer Lamberg, M.D.
Brick Lantz, M.D.
Samuel Lau, M.D.
Randy Lewis, M.D. & Lo Lewis†
Lipa – Lane Individual Practice Association
John Lipkin, M.D. & Barbara Lipkin
Mark Litchman, M.D. & Marie Litchman
Alexandre Lockfeld, M.D. &
Joanne Carlson, Ph.D.◊
Mark Lyon, M.D.
Nathan Markowitz, M.D.†
Louis A. Marzano, M.D.
Stephen McGirr, M.D. &
Susan Polchert, M.D.
Mark Meyers, M.D.
Helen Miller, M.D.
Shadi Miller, M.D.
Craig G. Mohler, M.D. & Julie Mohler†
Stewart Mones, M.D.
Lynn Morris, M.D. & Don Morris
Fran Munkenbeck, M.D. & family
Steve Neubauer, M.D.
David Nichols, M.D.†
Oak Street Medical / Oregon Allergy Assoc.
Jocelyn Park, M.D. & Thomas Park
Barry Perlman, M.D.
Daniel L. Phillips, M.D.
Lisa Pomranky, M.D.
Charlotte Ransom, M.D.
Troy Richey, M.D. & Kathryn Richey†
Candice Rohr, M.D. †◊
Jim Salerno, M.D. & Paula Salerno
Roger Saydack & Elaine Bernat
Stephan Schepergerdes, M.D. &
Donna Byrne
Marc Schnapper, M.D. &
Tina Schnapper, M.D.
Donald Schroeder, M.D.
Wendy Shumway, M.D.
Charles Stanton, M.D.
Tamara Stenshoel, M.D.†
Ron Stock, M.D. & Deb Stock
Jason Tavakolian, M.D.
Don Teal, M.D. & Judy Teal

8
Suzanne Temple, M.D., and Ben Temple
Jenny Ulum
Chip Zachem, M.D.†
$500–$999
Patricia Ahlen, M.D.
David Donielson, M.D. &
Heather Henderson, Ph.D.†
Kent Fergusson, M.D. &
Kris Fergusson 
Stan Filarski, M.D. & Connie Filarski
Peter Ganter, M.D. &
Kristina Ganter, D.P.T.†
Rudolf Hoellrich, M.D. & Terri Hoellrich
John Hunts, M.D.
Hugh Johnston, M.D.
James Kiley, M.D. &
Julia Sunkomat, M.D.
Martha MacRitchie, M.D.†
William Maier, M.D. & Kathleen Black
James Manwill, M.D.
Gregg Melton, M.D. & Kathy Melton
Lee Michels, M.D. & Mary Jean Michels
Gordon Miller, M.D.
Dwayne Rice, M.D. & Bette Rice
Joseph Sage, M.D.
Tom Seddon, M.D.
Robert Tearse, M.D.
Jennifer Tufariello, M.D.
H. Douglas Walker, M.D.
Sandra Jones Wu, M.D.
to $500
Anonymous
Diane Baird, M.D.
Herbert C. Baker, M.D.
Tamara Barstow, M.D.
Paul Benda, M.D.
Paul Bouressa, M.D.
Robert Brasted, M.D.
Phyllis Brown, M.D.
Terry Copperman, M.D.
William Cox, M.D.
Karen Crocker-Wensel, M.D.
Tracy & Beth DePew
John Dunphy, M.D.
Leita Dzubay, M.D.
Jon Ekstrom, M.D.
Latham Flanagan, Jr., M.D. & Jane Flanagan
Gerald Fleischli, M.D. & Linda Fleischli
Deborah Fuerth, M.D.
Scott Halpert, M.D.
Allen Harlor, M.D.
Stephanie Harris, M.D.
Mark Heerema, M.D.
William Hemphill, M.D.
Lauren Herbert, M.D.
Elizabeth Heskett, M.D.
Sarah Holexa, M.D.
F. Jeffrey Joehnk, M.D.
Peter Kay, M.D.
Steven Koester, M.D. &
Christine Koester
Catherine Kordesch, M.D.
George Larson, D.O.
Robert Litin, M.D.†
Lussuria Salon (Elisha Johnson)
Kevin Marks, M.D.
Winston E. Maxwell, M.D.
Richard Mentzer, M.D.
Dieter Morich, M.D.
Chris Noonan, M.D.
Steven Ofner, M.D. & Jacqueline Ofner
Leslie Parker, M.D.
Daniel Paulson, M.D.
Leslie Pelinka, M.D.
Gregory Richterich, M.D.
Thomas Roe, M.D.

11
Medically At-Risk Driver Program for Medical Professionals
History and Background
In 1999, the Oregon Legislature’s
concern about aging drivers resulted
in authorization for DMV to study the
effects of aging on driving ability. An
Older Driver Advisory Committee
was convened and concluded that
chronological age alone does not
represent a valid or reliable criterion for
assessing the risk of being involved in
a motor vehicle accident. Similarly, the
presence of various medical conditions
does not support the conclusion that a
driver lacks the ability to safely operate a
motor vehicle.
The work of this group and a subsequent
Medical Work Group resulted in a change
in the mandatory reporting program.
Prior to June 1, 2003, DMV’s mandatory
reporting program required the reporting
of any person “diagnosed as having a
disorder characterized by momentary
or prolonged lapses of consciousness
or control that are or may become
chronic.” The new mandatory reporting
program for medically at-risk drivers is
impairment-based and requires reporting
of severe and uncontrollable impairments.
The underlying policy of these rules on
medically at-risk drivers is to preserve the
independence, dignity and self-esteem
that results from providing one’s own
mobility, so long as it is possible to do so
without risk to oneself or others. It is also
our objective to support the relationship
between a primary care provider (PCP)
and a patient. A PCP may assist a patient
in recognizing diminishing driving skills,
leading to self-regulation or driving
cessation as the patient’s condition
requires.
Reporting Requirements
In accordance with Oregon laws, the
purpose of the Oregon DMV Medically
At-Risk Driver Program (a.k.a., At-Risk
Driver Program) is to identify and address
drivers whose medical conditions or
impairments affect their ability to safely
operate a motor vehicle. Oregon law
requires that certain physicians and other
health care providers report persons age
14 and older to DMV who have certain
functional and/or cognitive impairments
that are severe and uncontrollable, and
as such are likely to render it unsafe
for them to operate a motor vehicle.
This process represents the mandatory
reporting component of the At-Risk
Driver Program, which became effective
on June 1, 2004. Even if the patient has
voluntarily agreed to give up driving, the
mandatory reporter is required to report
when the impairment meets the threshold.
Reports must be submitted using the
“Mandatory Impairment Referral” (DMV
Form 735-7230), downloadable at odot.
state.or.us/forms/dmv/7230.pdf. Once
reported, a driver may be required to
retake vision, knowledge and drive tests
in order to demonstrate their ability to
safely operate a motor vehicle. In some
cases, the driver may also be required to
provide current medical information.
There may be options available to prolong
safe driving. The AMA’s “Physician
Guide to Assessing and Counseling Older
Drivers” (ama-assn.org/go/olderdrivers)
can assist you with this responsibility.
Patients may be counseled to restrict
their driving to familiar routes and
daylight hours. AARP sponsors a driver
safety program (aarp.org/home-garden/
transportation/driver_safety). A driver
rehabilitation specialist can conduct
an independent driving analysis and
recommend adaptive devices.
After Reporting
Upon receipt of a “Mandatory
Impairment Referral,” DMV will
thoroughly review the report. In most
cases the individual reported will have
their driving privileges suspended. DMV
sends a Notice of Suspension by mail.
The suspension is effective five days
from the date on the notice. The report
submitter will be notified only if the
reported individual is not suspended.
Once an individual has been suspended,
they can contact DMV and request the
opportunity to take vision, knowledge
and drive tests. For cognitive impairments

12
and certain functional impairments,
DMV’s Medical Determination Officer
will review the medical and driving
records of the individual to determine
if the driver should be tested. If tested,
an individual must pass all three tests to
get their driving privileges reinstated (in
full or on a restricted basis). The Medical
Determination Officer will decide under
what conditions driving privileges may
be reinstated based upon the medical
information provided. The individual’s
primary care provider will be notified if
their driving privileges are reinstated.
A reported individual can also request
a hearing to appeal a suspension.
Suspension notices from DMV provide
instructions for this process.
A reported individual can also give up
their driving privileges and request a
“quit driving” identification card.
1. Cognitive impairments that are required to be
reported include attention, judgment and problem-
solving, reaction time, planning and sequencing,
impulsivity, visuospatial, memory, and loss of
consciousness or control. Functional impairments
that are required to be reported include vision,
peripheral sensation of extremities, strength,
flexibility, and motor planning and coordination.
(OAR 735-074-0110)
2. “Severe” means that the impairment substantially
limits a person’s ability to perform activities of
daily living, including driving, because it is not
controlled or compensated for by medication,
therapy, surgery or adaptive devices. “Severe” does
not include a temporary impairment for which the
person is being treated by a physician or health
care provider and which is not expected to last
more than six months. “Uncontrollable” means the
impairment cannot be controlled or compensated
for by medication, therapy, surgery, or adaptive
devices. (OAR 735-074-0080)
Helping Your Patients Retire From Driving
Do you have patients who can no longer safely drive? You can help them “retire”
from driving.
Your patient may qualify for a no-fee “quit driving” ID card that is good until the expiration
of the license being surrendered. Please note that if your patient’s license is within 3 months
of expiration, it may be more beneficial for them to get an ID card with an 8-year renewal.
Otherwise your patient will have to go through this process again once their driver
license expires.
You can help your patient apply for a “quit driving” ID card by:
1. Downloading and assisting your patient with completing the “Surrender of Driving
Privileges” (DMV Form 735-7206).
2. Downloading and assisting your patient with completing the “Driver License/Permit/
Identification Card Application” (DMV Form 735-173).
3. Finding the closest DMV office for your patient to visit in order to complete the
application process.
4. Informing your patient that they will need to provide DMV with the “Surrender of Driving
Privileges” form, the “Driver License/Permit/Identification Card Application,” and their
driver license.
5. Ensuring your patient understands that they will also need to present DMV with proof of
legal presence, identity, date of birth and current residence address. And lastly, they will have
their picture taken.
In addition, it may be a good time to remind your patient that they will need alternative
transportation from the DMV office, since they will be surrendering their driving privilege
during that visit, in accordance with OAR 735-062-0135(2).
If your patient has a medical condition or health problem that makes it unable for them to
physically go to a DMV office, you can help them by:
1. Downloading and assisting your patient with completing the “Surrender of Driving
Privileges” (DMV Form 735-7206).
2. Calling DMV headquarters at (503) 945-5114 on behalf of your patient to request a “Valid
with Previous Photograph” (VWPP) packet. This packet will be emailed to you or your
patient.
3. Preparing a letter verifying that your patient has a medical or health condition that
prevents them from applying for the “quit driving” ID card at a DMV office. This letter must
accompany the VWPP application.
4. Assisting your patient with completing the VWPP application.
5. Making copies of your patient’s proof of legal presence, identity, date of birth and current
residence address. Copies of these proofs must accompany the VWPP application.
6. Mailing the completed packet to: DMV, Driver Issuance Unit, 1905 Lana Ave. NE, Salem,
OR 97314. Incomplete packets will be returned to the patient at their address on record.
To regain driving privileges after surrendering their license, under OAR 735-062-0135(7), a
driver must reapply for the privileges and establish eligibility and qualification as provided
by law, including payment of all required fees. They must:
• Have a current medical clearance on file with DMV’s Driver Safety Unit;
• Not be suspended, cancelled, revoked or otherwise withdrawn in Oregon or any
other jurisdiction;
• Surrender their Oregon ID card;
• Complete the “Driver License/Permit/Identification Card Application”
(DMV Form 735-173);
• Provide proof of legal presence, identity, date of birth and current residence address;
• Pass all tests (vision, knowledge, and drive);
• Pay testing and original issuance fees, and;
• Have their photo taken.
Courtesy Oregon DMV. Reprinted with permission. For additional information: www.
oregon.gov/ODOT/DMV/pages/at-risk_program_index.aspx
To place an ad in the
next issue of
Of Interest, call
LCMS today at
541.686.0995
or email
lcms@riousa.com
advertise

13
New Members
Derek Davenport, MD
Pediatrics
Oregon Medical Group
4135 Quest Dr.
Eugene, OR 97402
Tel: 541-461-8006
Fax: 541-463-2197
Marissa Simard, MD
Radiology
920 Country Club Rd., Ste 100A
Eugene, OR 97401
Tel: 541-242-4162
Fax: 541-345-2358
Sohee Williams, MD
OB/GYN
Pacific Women’s Center
10 Coburg Rd., Ste 100
Eugene, OR 97401
Tel: 541-342-8616
Fax: 541-686-4814
Tracy Hardwick, MD
Family Medicine
3915 River Rd.
Eugene, OR 97404
Tel: 541-688-9140
Fax: 541-689-0049
Change of Telephone Number
William Hinz, MD
Rheumatology
1007 Harlow Rd. Ste 210
Tel: 541-741-0387
Fax: 541-242-4634
No Longer Practicing in Lane
County
Matthew R. Keller, DO
Anesthesiology/Pediatrics
Kalispell, MT
Daniel Bustos, MD
Opthalmology
Moved out of state
LCMS New Members and Member Changes Reduced Credit Card Processing
Fees Available to LCMS Members
One of your many LCMS member
benefits includes a reduced rate for
credit card processing at your medical
practice through Siuslaw Bank, an
LCMS-endorsed business. Siuslaw’s
rate consists of a per-transaction fee of
fifteen cents ($0.15) plus one-quarter
percent (0.25%). For example, the fee
for a $500 transaction is $1.40 ($0.15
plus $1.25 (0.25% x $500)). To have your
office’s credit card terminals set up for
this service, or for more information,
call Jason Weller, Merchant Services
Manager, at 541-342-4000. To qualify
for these rates, let Jason know that you
are a member of LCMS.
In addition, if your office handles
recurrent monthly billing, Siuslaw
also offers a software-based virtual
terminal called Global Gateway. All it
takes to use this service is a computer
with internet access. Setup is $35 and
the monthly fee is $20. Contact Jason
Weller for details.

14
One of the more popular Super Bowl com-
mercials in recent years depicts a group of
cowboys on the range, driving the herd to
its destination. Rather than cattle, though,
the cowboys are tending to cats.
The ad, which promoted a technology ser-
vices company, probably elicited chuckles
from a few physician leaders. They might
have seen parallels to their practices,
where proposing change among a group of
doctors can be a challenging task.
“It’s kind of like herding cats, because
physicians are all such independent
people,” said William G. Gamel, MD,
CEO of TMF Health Quality Institute, a
Texas quality improvement organization
for Texas. “Time is money, so you have to
show how they’re going to benefit from
the change.”
Persuading physicians, and to a lesser
extent staff, to embrace a new idea can
be like trying to convince the Tasmanian
Devil to stop spinning and walk. Doc-
tors are always in a flurry of activity, and
chances are, a change is just going to slow
them down.
But by appealing to physicians’ intelli-
gence, offering proof of the benefits and
involving doctors in the decision-making
process, group leaders have been able to
spearhead change in their practices. The
same principles apply to a group of any
size, although it’s obviously easier to get
a small group together for a meeting, doc-
tors said. But having a smaller group does
not guarantee you’ll reach an agreement,
they said.
Whether you’re trying to adopt an office
policy or purchase a six-figure electronic
medical record system, you need physi-
cian buy-in to phase in the initiative
smoothly. The problem is that because of
their skill, talent and knowledge, physi-
cians generally are even more resistant
to change than the general population,
said Craig Samitt, MD, an internist and
chief operating officer of Fallon Clinic, a
260-physician multispecialty group based
in Worcester, Mass.
“Simply being a charismatic leader might
not work,” Dr. Samitt said.
Several years ago, Fallon Clinic under-
went a transformation that focused the
group more on service and applied bench-
marks commonly used in other industries
to measure performance.
The vision necessitated ground-level
changes among physicians and staff. The
magnitude of the change usually helped
determine the strategy clinic leaders
used to persuade physicians. About four
years ago, for example, the clinic simply
required physicians to start using the voice
mail system, but it took more inclusive
approaches when it came time to address
global issues, Dr. Samitt said.
“Doctors appreciate constant communi-
cation, and inherently, they want to do
the right thing,” Dr. Samitt said. “If you
essentially just said to me that you want
to improve on X but didn’t offer any evi-
dence for why, I would challenge you.”
That’s what makes data so important,
consultants said. If you’re trying to show
your partners why the practice needs a
new ultrasound machine, you should put
together a profit-and-loss projection for
the equipment and collect information
that proves it will be a clinical benefit for
patients, they said.
Not only does the presentation have to
Agent for Change: Doctors Must Buy Into Shifts in Practice
Persuading physicians and staff to adopt new ideas can be challenging, but collecting
data and seeking help in decision-making can aid the process.
By Mike Norbut, amednews staff

15
be well prepared, but it also has to be
well timed, said Kathy Bowman Atkins,
president of the Lattitude Group, a busi-
ness consulting and coaching firm based
in Greensboro, N.C.
Introducing the idea well before your
target implementation date gives doctors
“more touch points” as well as time to di-
gest the information, she said. A business-
style SWOT analysis, which analyzes the
project’s strengths, weaknesses, opportu-
nities and threats, can make the idea easier
to embrace, she said.
“Most doctors are analytical people,”
Bowman Atkins said. “So if you can
work through that and show a return, both
quantitative and qualitative, they might be
more apt to accept it.”
Staff likely will follow the physician’s
lead, said Elaine Berke, founder and presi-
dent of EBI Consulting in Westport, Mass.
Conversely, while staff members don’t
wield the same power in the group as a
physician, they certainly can influence the
doctors, so it’s important to keep them
informed of pending changes, she said.
Front office staff might spend the most
time working on a new practice manage-
ment system, for example, so their com-
fort level is key to the project’s success.
“[Staff members] will keep their grum-
blings to themselves, but they’ll ask things
like, ‘Do we really have time for this?’
“Berke said.” You have to be prepared for
those questions.”
Seeking involvement
Of course, doctors will be more likely
to embrace an idea if they have been in-
volved in its formation, experts said. Larg-
er groups generally will form committees
to address certain topics, while smaller
groups simply might have all partners
meet regularly, with different physicians
taking the lead on varying projects.
When Lexington Clinic, a multispecialty
group with 160 physicians in Lexington,
Ky., began looking into buying an EMR a
few years ago, it started by using a steer-
ing committee to investigate the project’s
feasibility.
As the idea grew legs and moved into an
implementation stage, the group phased
it in by first installing the system at pilot
sites, where enthusiastic supporters could
work through the kinks, said Michael
McKinney, MD, an internist and pediatri-
cian with the group.
“A lot of times, the groups we set up are
made up of people interested in the proj-
ect,” Dr. McKinney said. “The good side
to that is they are very enthusiastic, but
the bad part is you could lose the views of
the people who aren’t enthusiastic.”
The way to avoid further alienating
resisters is by educating them about the
project and engaging them to help pick
out the flaws, physicians said. Not only
will doctors be more tolerant when issues

16
arise, but their input also will help solve
problems more quickly, they said.
“A lot of doctors feel when a decision
is made, it will be forced down their
throats,” said David Delaney, MD, a criti-
cal care physician at Beth Israel Deacon-
ess Medical Center in Boston and vice
president and chief medical officer of
MedAptus, a health technology company.
“But if you feel like you’re part of the
team, when you have any hiccup along the
way, you’re engaged and you want to
help fix it.”
When resistance persists
Despite your best planning and involve-
ment efforts, you might not be able to win
over everyone to your idea immediately. If
you laid the right foundation, though, the
politics of the situation might work itself
out over time.
Within every group, you will have early
adopters, resisters and doubters, consul-
tants said. Rather than taking on the ada-
mant opposition, you should try to sway
those on the fence and let peer pressure
run its course, they said.
Letting the group police itself is one of sev-
eral strategies Fallon Clinic uses when it’s
trying to spearhead change, Dr. Samitt said.
Adopters, enthusiasts and anyone who was
intimately involved with the project com-
mittee naturally will spread their support
through the group, which will filter down
to the doubters and eventually the resisters.
It’s a word-of-mouth, one-on-one method
of persuasion that can have a more power-
ful effect on a group than a top-down
announcement, he said.
Dr. Samitt said the group pulls several
other “levers” as it sees fit. A short-term
option of persuasion is data comparing
physicians who have adopted a proposed
strategy to those who have not to prove
financial benefits. A longer-term strategy
involves actually recruiting new physi-
cians to the group who will “embrace
change, so the resistance gets diluted,” Dr.
Samitt said.
Once you have successfully persuaded
partners to embrace a new idea, of course,
your credibility is at stake.
If you don’t deliver on your promise
or if the project doesn’t meet physician
expectations in a reasonable amount of
time, you could hinder your chances of
spearheading further change, said Bart
Asner, MD, CEO of Monarch HealthCare,
an Irvine, Calif.-based IPA representing
1,800 physicians.
Monarch had to sell its contracted physi-
cians on the Integrated Healthcare Assn.’s
Pay for-Performance plan, which involves
six of the largest health plans in Cali-
fornia. Through gradual education and
soliciting input, the IPA convinced doctors

17
to be a part of the program, “and now
they’ve gotten their bonus checks, so they
feel good about it,” Dr. Asner said.
“You can’t make idle promises, and you
can’t overpromise,” he said. “Physicians
have been so beaten down in so many
areas that they’re naturally skeptical.”
And yet physician leaders understand that
above all, doctors would just like respect
and open lines of communication.
“Physicians want a seat at the table,”
Dr. Delaney said. “Communication is
everything.”
ADDITIONAL INFORMATION:
Persuasion strategies
Physician leaders have a number of levers to
pull when trying to spearhead change in their
practices:
1. Set a clear, consistent, unwavering vision of
the future.
2. Set clear goals and priorities.
3. Physicians love data, so give it to them.
4. Physicians are inherently competitive and
want to know if they are the top performers.
5. Money motivates, but don’t go overboard.
6. Change your recruiting strategies so that
over time, the resistance in the group will be
diluted.
7. Let the group police itself.
8. Cite competitive threats. Show how not
changing can adversely affect revenue.
9. Sometimes you need to make the change a
requirement; other times, you can trust physi-
cians will choose the best path.
10. Provide the tools to help them make the
change.
11. Finally, if all 10 prior strategies have not
worked, perhaps that physician is not a good
cultural fit.
Source: Craig Samitt, MD, chief operating of-
ficer, Fallon Clinic, Worcester, Mass.
When to spearhead change
There are many scenarios where the art of
persuasion is necessary, including:
Implementing a new electronic•
medical record system.
Adding an ancillary service.•
Altering office hours.•
Changing an office policy.•
Introducing a new compensation•
formula.
“Unfortunately what is little
recognized is that the most
worthwhile scientific books are
those in which the author clearly
indicates what he does not know;
for an author most hurts his readers
by concealing difficulties.”
Evariste Galois, 1811-1832

19
When payments started going down for
many of the services provided by Florida
Cardiac Consultants, the six-physician
independent practice in Sarasota needed to
increase the number of office visits with-
out running doctors ragged. They came
upon a radically simple idea: Let physi-
cians do tasks only they can perform, and
leave the rest to everyone else.
As a result, office visits increased 65%
from 10,890 in 2005 to 17,928 in 2011,
with only one physician added in the
interim. “This is much more efficient,”
said Mark Spetsios, the practice’s
administrator.
The topic of delegation is coming up as
small practices look for ways to see more
patients without straining themselves, and
as more payment models reward doctors
for preventive care, care coordination
and quality, analysts said. A study in the
September/October Annals of Family
Medicine showed the effect of putting
the physician in a supervisory role in
tasks such as patient education, behavior-
change counseling, medication adherence
counseling and protocol-based services to
non-physician staff.
Researchers created simulation models
incorporating estimated times to pro-
vide acute, chronic and preventive care
services at recommended levels and took
into account the potential for delegation
to other practice staffers. Physicians who
delegated 77% of preventive care and
47% of chronic care could provide servic-
es for a panel of 1,947 patients. Physicians
who passed on only 50% of preventive
care and 25% of chronic care could handle
a panel of 1,387 patients.
Although the study noted the average pan-
el size per doctor is 2,300 patients — and
growing — they said the numbers make
clear that physicians will serve themselves
and their patients best if they enlist non-
physician staff as much as possible. They
said a doctor with a 2,500-patient panel
trying to accomplish all recommended
services without delegation would have to
see patients for 21.7 hours per day.
“We need to figure out how we’re going
By Victoria Stagg Elliott, amednews staff
Study Quantifies Practice Boost from Physicians Delegating Tasks
Delegation to nonphysician staff is pitched as an effective way, particularly in
small practices, to see and treat more patients

21
to provide primary care to the population
that needs it, and this means figuring out
how to share the care with other people in
the practice,” said Thomas Bodenheimer,
MD, MPH, lead author and a professor
in the Dept. of Family and Community
Medicine at the University of California,
San Francisco.
Most physicians already hand off at least
some duties. What researchers advocate
is looking to see whether delegation can
go further. Diagnosis, assessment and
many procedures would remain in the
physician’s hands, but supporters of this
approach say teams should meet to discuss
how tasks could be divvied up appropri-
ately. Discussion should take into account
what nonphysician staffers already do,
how new duties may fit in and what the
limits of respective licenses allow. Physi-
cians also should be comfortable with
giving up tasks.
A doctor with 2,500 patients without del-
egating services would have to work 21.7
hours per day
The goal is not to overburden staffers or
take away jobs from physicians but to
allow doctors to care for more patients.
Some practices may find it cost effec-
tive to hire additional personnel. For
example, Florida Cardiac Consultants
hired 10 nurse practitioners and physi-
cian assistants.
“As a team, discuss care-coordination
tasks to be done and take a divide-
and-conquer approach to all tasks,”
said Joseph Scherger, MD, MPH, vice
president for primary care and academic
affairs with Eisenhower Medical Center
in Rancho Mirage, Calif. Dr. Scherger
said he delegates as many tasks as pos-
sible to medical assistants, nurses and
others at the practice. “Like any created
system, the form follows from the func-
tions to be done.
“It’s still the physician’s responsibil-
ity for everything that is done. We’re
not shirking the responsibility. It’s your
team, but we need to step back from all
the work and be way more selective as to
what the doctor does.”
The impact of delegation is getting more
attention because it is viewed as a critical
component of team-based care models,
such as the patient-centered medical
home. Finding ways to increase physi-
cian panel size is considered particularly
important, because 30 million people are
expected to become newly insured under
the Affordable Care Act. And an aging and
increasingly obese population also will
raise demand for services. The physician
supply, however, is projected to fall short.
The American Medical Association and
many medical societies support some
form of a physician-led team-based care
model to address the problem.
“As the report illustrates, physician-led
health care teams can help meet the surge
in demand as millions of Americans ob-
tain health insurance and can access on-
going health care,” said AMA President
Jeremy A. Lazarus, MD. “Physicians
and other health professionals have long
worked together to meet patient needs
for a reason: The physician-led team
approach to care works. Patients win
when each member of their health care
team plays the role they are educated and
trained to play.”
ADDITIONAL INFORMATION:
Web link: “Estimating a Reasonable Patient
Panel Size for Primary Care Physicians With
Team-Based Task Delegation,” Annals of Fam-
ily Medicine, September/October (www.ncbi.
nlm.nih.gov/pubmed/22966102/)
Continued from page 19
Study Quantifies
Practice Boost
Instead of throwing away your
old cell phone, iPod, voice
recorder, PDA, calculator, or
digital camera
Donate them
and give crucial services for
seniors, children and homeless
families.
Call NextStep 541-686-2366 to
learn more about this program.

22
that we contract with every DCO in our
service area (there are 4) before adding to
our provider base. This bill would have
delayed oral health integration into the
CCO and limited our ability to provide
access to dental services. Trillium along
with other CCOs opposed it. (The bill died
in committee).
HB 2090 7-11 Drugs Carve Out
The original intent of the bill would have
repealed the operative date provision for
OHA to continue to use practitioner-man-
aged prescription drug plans for coverage
in MAP on and after 1/2/14. It required
the use of a plan for mental health drugs
subject to specified exceptions. 7-11 (pri-
marily anti-psychotic) drugs were carved
out of the legislation, largely because
pharmaceutical companies were opposed.
Trillium supported the bill but opposed
the carve out. We will be working with
our local Legislators to propose a pilot
project in Lane County for the next ses-
sion. (Signed by Governor)
Watching
HB 2902 Pay Parity
The bill’s original intent was to provide
equal pay for health practitioners. It
required insurers to reimburse physician
assistants and certified nurse practitio-
ners in independent practice at the same
rate as a physician for same services. A
compromise between OMA and ONA was
achieved and reimbursement rates were
set at 85% in metro areas and up to 100%
in rural areas. (Signed by Governor)
SB 604 Credentialing
Requires the Oregon Health Authority to
establish a statewide information/database
system to provide credentialing organiza-
tions (e.g. hospitals and health plans) ac-
cess to information necessary to credential
health care practitioners. Operative date is
2017. (Signed by Governor)
The 77th
Legislative session required a
great deal of compromise on both sides of
the aisle. That is the nature of Legislative
sessions. Many issues were controversial
and because of ideological differences
consensus was either difficult or impos-
sible. However, one thing is clear; CCOs
and healthcare transformation are still at
the forefront of legislative action. Trillium
is especially appreciative of the work of
our Lane County Legislators including
Representatives Nathanson, Hoyle and
Lively for their work in helping Trillium
meet the goals of the triple aim: better
care, better health and lower cost.
Terry W. Coplin is the Chief Executive
Officer for Trillium Community Health
Plan, the Coordinated Care Organization
in Lane County.
Trillium Talks

23
Vacation Rentals Professional Services
For Lease or Sale
Professional Services
Statements and conclusions of authors
or advertisers that are published in the
Society newsletter are solely those of
the authors or advertisers and do not
necessarily reflect Lane County Medical
Society policy or position. Advertising
statements are expected to be factual;
however, the Medical Society makes no
representation or warranty as to their
accuracy or reliability. Advertisements
published in the newsletter or annual
directory do not imply approval or
endorsement (unless expressly stated),
but represent solely the viewpoint of the
advertiser or their agent.
PRN (Perfect Remedy Network)
This valuable component of the
Physician Wellness Program
offers members a timesaving
connection to recommended
businesses & services in Lane County.
Go to www.lcmedsociety.com
No guarantees but reference checked.
SUNRIVER: 3BR/2BA (KQQ) plus
twin airbeds. 3 Decks, BBQ, Wi-fi, 3 flat
screens/movies, bikes, hot tub, fireplace.
Open concept, new kitchen. $185+tax/
cleaning. No smk/pets. Contact Candice
Barr, after 5 PM at candice@riousa.com.
SUNRIVER: 3 br + loft. Sleeps 10.
Bicycles, hot tub, cable, TV/VCR with
2nd TV for gaming. Beautiful volcanic
rock fireplace. Well-behaved pets ok.
Mavericks membership (new fitness
club). No smoking. Inquire about rates
from Matt or Jackie: 541-687-8895.
CUSTOM SUNRIVER HOME: 3 BR, 3
BA, den with Q futon + loft. Sleeps 8-10.
4 flat screen TV’s, 2 DVD players, Wi-
Fi, new gas cooktop, gas barbeque, hot
tub, private setting by Nat’l forest. Daily
SHARC facility passes for 8! $225 (incl.
tax & SHARC) + cleaning. No smk. Call
Berkmans – 541-686-8798 or Deatons –
541-485-4837.
1810 M ST, SPRINGFIELD.
Approx. 3,900 sq. ft. zoned mixed-use
commercial. Owner is a licensed agent
in OR. Windermere Real Estate Lane
County, 541-912-2029.
ARTHRITIS THERAPY CENTER
is Eugene-Springfield’s provider of
therapy services dedicated specifically
to people with OSTEOARTHRITIS,
RHEUMATOID DISEASES and
FIBROMYALGIA. Focused practice
delivers superior long-term outcomes
since 1998. Therapy services covered by
majority of private health insurers. Laurie
Reed, Occupational Therapist. 74 E. 18th
Ave., Suite 7, Eugene, OR 97401. Phone:
541-343-1925. Fax: 541-343-4545.
PAIN MANAGEMENT PARTNERS,
LLC now hiring physicians: DO, FP,
Primary, pain management or headache
specialist and a nurse practitioner.
Contact: JGratton@wpainmanage.com.
Physician Wellness
Program Donor List
Jennifer Soyke, M.D.
Jan H. Stafl, M.D.
Fay Sunada, M.D.
Michelle Taube, M.D.†
Frank N. Turner, M.D. & Pam D. Turner
James Unger, M.D.
Josephine Von Hippel, M.D. &
Peter Von Hippel, Ph.D.
Kathleen Wiley, M.D. &
Robert Carolan, M.D.
Paul Wilson, M.D. & Jean Wilson
Scott Williams, M.D.
Lorna Wong, M.D.
* in honor of colleagues and future physicians
 in memory of John Bascom, M.D. &
Ruth Bascom
‡ in memory of Andrew Bourne, M.D.
in memory of David Brooks, M.D.
in memory of Michael Eustis, M.D.
† in memory of Olof Sohlberg, M.D.
◊ in memory of Larry Vinis, M.D.

Lane County Medical Society
990 W. 7th Avenue, Eugene, OR 97402
Change Service Requested
PRSRT STD
US POSTAGE
PAID
EUGENE, OR
PERMIT NO. 921

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