Monday
Feb212011

Member News

GOVERNOR'S ADDRESS:  Education took center stage during Gov. Doug Ducey’s Monday State of the State address.   He called on the Arizona Legislature to join him in giving public-school teachers a raise, expanding all-day kindergarten in low-income areas, and adopting other policies he said will help poor Arizonans.  He did not outline how he would pay for his 15 new education proposals other than vowing not to raise taxes.

He proposed:

  • Increasing teacher salaries by a couple percentage points.
  • Offer a $1,000 signing bonuses for teachers who pursue careers in low-income schools.
  • Expansion of full-day kindergarten in lower-income areas.
  • Called on the state's public universities and community colleges to create a program known as the Arizona Teachers' Academy to erase debt for students who commit to teach in Arizona public schools.

Other issues:

  • Continue work on federal legislation that would revisit the idea of restructuring the 9th Circuit so that the state could count on swifter and more efficient judicial service.
  • Expansion to two years of the cash benefit the state pays low-income families, as long as recipients are actively looking for work.
  • Under his proposal, Ducey would revert the TANF (welfare) program back to two years.  Arizona currently has a one-year limit.
  • Ax certain state licensing fees for those who are living in poverty and want to start new careers.
  • Reduce "job-killing” regulations by wiping out 500 total regulations by the end of the year.

Health Issues

  • Wants one hour of the forty physician CME hours be dedicated to the subject of drug addiction.
  • The governor proposed the state test all babies for Severe Combined Immuno Deficiency, a rare genetic disorder that can be deadly if not detected.
  • Called on Congress to focus on “replace” for the ACA as well as the law’s repeal.
  • Issued a new executive order allowing inmates with an addiction and leaving prison the chance to enter a treatment program to help during the transition.

Read more about his address here.   

PIMA DERMATOLOGY OPENS NEW SATELLITE CLINIC:  Pima Dermatology is accepting patients at their new TMC Rincon Health Campus, 10350 East Drexel Road, Suite 120 from 8 a.m.-5 p.m. each Thursday.  Matthew Beal, MD and physician assistant Jennifer Allison, will be alternating assignments at the new facility.  

Services include skin checks for suspicious lesions, moles and possible skin cancer. Treatment and assessment of many skin conditions such as acne, psoriasis, eczema, rashes, rosacea, warts and other dermatology services are available.  Call 795-7729 to schedule an appointment.

Dr. Beal joined Pima Dermatology and PCMS in 2013. Allison is licensed by the Board of Medical Examiners and has practiced at Pima Dermatology for 15 years. 

TMC’S MEGA RAFFLE RETURNS:  Tucson Medical Center’s TMC Mega Raffle is back for its fifth year. The 2017 event will award more than 5,600 prizes, with net proceeds benefiting patient care programs and services. Tickets are available to the public beginning Thursday, Feb. 9.

This year there are two grand prize packages. The first is an elegant A.F. Sterling custom home located in the 253-acre Stone House community, adjacent to the Santa Rita Mountains or the winner can choose the cash option of $600,000. Grand prize #2 is a 2017 Lincoln Continental plus cash or $150,000 cash.

Each raffle ticket has a one in 20 chance of winning a prize. Participants that enter before  midnight, March 9, will be eligible to win the two Early Bird prize packages both valued at more than $60,000. Early Bird prize #1 is a 2017 Toyota 4Runner 4x4 SR5, a six-night luxury vacation package for two to explore the Greek Islands and $16,000 in cash. Early Bird prize #2 is the 2017 Toyota Avalon XLE, a five-night retreat at the luxurious Moorea Manava Beach Resort and Spa, plus $15,500 in cash.

In addition to the Grand Prize and Early Bird packages, the 50/50 raffle is back, which totaled $595,880 last year. Participants will also be eligible to win a host of new cars, luxury vacation packages, cash prizes along with a popular selection of electronics, jewelry, and home accessories.

The final cut-off for purchasing tickets is Thursday, March 30. Grand prize winners will be announced by early April.

Tickets are $100 each with a limited number of three-ticket packages available for $250. To purchase tickets, visit www.TMCmegaraffle.org or call (800) 395-8805.

LEGISLATIVE REVIEW OF 2017 SUNRISE APPLICATIONS BEGINS:  Arizona law (A.R.S. § 32-3104, 32-3105) requires health professions seeking regulation or an increase in scope of practice to submit a written report (sunrise application) on or before September 1 to the President of the Senate and the Speaker of the House of Representatives.

The report is reviewed by a Health Committee of Reference which will make a recommendation whether the health profession should be regulated or whether a request for an expanded scope practice be approved. There are several factors that must be addressed in sunrise applications including how the proposal will protect and benefit the public as a result of the new regulations or expanded scope of practice.

There are nine sunrise applications submitted for the upcoming legislative session:

Proposed Regulation of Health Profession

Applicant - Arizona Community Health Workers Association

Establish voluntary certification and standardization of practice for community health workers

Applicant - Art Therapy Association

Establish licensure of the practice of art therapy

Applicant - Dental Care AZ

Establish licensure and regulation of dental therapists

Applicant - Lauren Moore - Phlebotomist

Establish phlebotomy as a specialty to allow independent billing

Proposed Scope of Practice Expansion

Applicant - Arizona Pharmacy Association

  1. Allow pharmacists to administer oral fluoride varnish to eligible patients according to national guidelines.
  2. Allow pharmacists to administer the Tuberculin Skin test (TST) and interpret the results for the purposes of referral for treatment following a positive test according to national guidelines.
  3. Allow pharmacists the ability to prescribe over the counter nicotine replacement products as well as FDA approved prescription products indicated to aid in smoking cessation treatment for eligible patients according to national guidelines.
  4. Allow pharmacists the ability to prescribe FDA approved prescription medications to eligible patients testing positive for influenza or strep throat consistent with current clinical guidelines.
  5. Allow pharmacists the ability to extend a routine, non-controlled, chronic medication for an additional 30-60 days.

Applicant - Arizona Naturopathic Medical Association

Allow intravenous administration of antibiotics

Applicant - Arizona Naturopathic Medical Association

Allow ability to sign medical exemptions for students from Arizona K-12 school immunization requirements

Applicant - Certified Registered Nurse Anesthetists

  1. Remove the “direction and presence” requirement to provide analgesic services
  2. Clarify the ability to “prescribe” a medication instead of “order” a medication; applicant states this will restore the ability to prescribe analgesics and is not a scope of practice expansion

Applicant - The Core Institute

Allow doctors of podiatric medicine to perform amputation of toes, would still exclude foot and leg.

GARCIA ANNOUNCES DEPARTURE:  Dr. Joe G.N. “Skip” Garcia announced his decision to step down in January as the senior vice president of UA health sciences. The position has oversight of the Tucson and Phoenix medical schools.  His announcement follows the summer announcement by UA President Ann Hart her intention to leave in 2017.

LEGISLATIVE HEALTH COMMITTEE APPOINTMENTS ANNOUNCED:  The following House and Senate members will serve on their respective health committees during the 2017 session. 

House Health Committee

Chair – Heather Carter, R-LD15

Vice Chair – Regina Cobb, R-LD5

Jay Lawrence, R-LD23

Tony Rivero, R-LD21

Maria Syms, R-LD28

Michelle Udall, R-LD25

Kelli Butler, D-LD28  

Oteniel Navarrete, D-LD30

Pamela Powers Hannley, D-LD9

Senate Health and Human Services Committee

Chair – Nancy Barto, R-LD15

Vice Chair – Kate Brophy McGee, R-LD28

Debbie Lesko – R-LD21

Steve Montengro, R-LD13

Kimberly Yee, R-LD20

David Bradley, D-LD 10

Katie Hobbs, D-LD 24

PRE-MED STUDENT MENTORING:  The UA Pre-Health Advising office offers an internship called Med Mentor for undergraduates in Tucson. Through this internship, students have the opportunity to experience hospital, specialty, and group practice settings, develop mentoring relationships with health care professionals and explore career options. The success rate of admission into medical schools for the students who participate in this internship is more than 90%. The students are carefully screened for maturity, professionalism, capability and because they have demonstrated a commitment to becoming excellent physicians. They have been selected from a large pool of applications as this is one of the most sought-after internships on campus. These students understand the value of your time and experience and are thrilled to observe and learn from you. If you are a participating physician, you would host 2 students, one at a time, during the months of Feb-April, 2017. The first student would be with you for 6 weeks beginning Feb. 1 and the second would begin with you in mid-March through the end of April.  If you are interested in joining or learning more about the program, please contact Vanessa Perez at VanessaPerez@email.arizona.edu.

FINAL MEDICARE FEE SCHEDULE:  The Centers for Medicare and Medicaid Services (CMS) has made considerable changes to policies in its proposed Medicare Physician Fee Schedule (MPFS) with the release of its final rule. Learn more at AMA Wire.

ABOR ENDS UA-PHOENIX INVESTIGATION:  Arizona Regents announced it was ending its independent investigation into the circumstances surrounding the departures of Dr. Stuart Flynn, longtime dean of UA's Phoenix medical school, and a half-dozen leaders on his management team.  The announcement came after a closed-door meeting last week.  Following the announcement members of the media and Arizona Medical Association requested to see a copy of the final report but the request was denied.  You can find more at:

Arizona Republic story here.  Arizona Daily Star story here

MACRA FINAL RULE RELEASED:  The Centers for Medicare and Medicaid Services (CMS) released the final version https://qpp.cms.gov/education of its physician Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced SGR and moves physicians to a value-base payment system. The law takes effect on January 1.    

The new rule provides more flexibility, lessens reporting burdens and provides training for physicians in practices with 15 or fewer doctors.  For more information click here.  

GOVENOR ISSUES EXEC ORDER TO LIMIT OPIOID SCRIPS:  Gov. Ducey issued an executive order requiring the Directors of the Arizona Health Care Cost Containment System (AHCCCS) and the Arizona Department of Administration (ADOA) to adopt policies and rules to limit the initial fill of opioid prescriptions to no more than seven days and limit initial and subsequent opioid prescriptions for minors to no more than seven days, except for cancer, chronic conditions and traumatic injuries, for individuals on AHCCCS and state employee health plans.

ArMA is seeking physician input about how this new directive will impact patient care.  To comment please contact Pele at pele@azmed.org or (602) 347-6910, or Ingrid Garvey at igarvey@azmed.org or (602) 347-6905.

ARE THE PROMISES OF ACOs PANNING OUT?  Vitalyst Health Foundation, in their new report titled The Progress and Promise of Accountable Care Organizations, offers a look at the standing and role of ACOs in Arizona. Lead author, Palmer Evans, MD interviewed ACO leaders throughout the state for the report. National studies indicate that the most successful ACOs to date are physician-owned or led. The report offers key observations from ACOs and other health care leaders on what is and is not working in ACO implementation, as well as offering strategies to improve ACOs, specifically payment/delivery reform. Download the complete report or summary here.

CMS ISSUES NEW PHYSICIAN FEE SCHEDULE:  In early July, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017.  

Among other changes, the proposal will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities and expands the Diabetes Prevention Program. 

For more information on the proposed rule go here:

NEW OCR GUIDANCE ON RONSOMWARE PUTS PRESSURE ON PROVIDERS:  The Department of Health and Human Services’ Office for Civil Rights (OCR) has recently release new HIPAA guidance on the risks of being victimized by file-encrypting malware. 

Under the new guidelines if any healthcare organization’s computers are infected with ransomware the government considers it a data breach thereby triggering HIPAA’s breach notification provisions which include notifying effected patients. OCR’s guidance release underscores the seriousness of the situation and the providers’ responsibility in preventing and recovering from such attacks.

For more information about attack prevention and recovery go here

HHS ANNOUNCES NEW ACTIONS TO COMBAT OPIOID EPIDEMIC:  U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced several new actions the department is taking to combat the nation’s opioid epidemic.

The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain. In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

The actions build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities: 1) improving opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of naloxone to reverse opioid overdoses. They also build on the National Pain Strategy, the federal government’s first coordinated plan to reduce the burden of chronic pain in the U.S.

Actions include:

Buprenorphine Final Rule

Expanding access to MAT is one of the three foundational priorities of the HHS Opioid Initiative, and buprenorphine is one of the drugs frequently used for MAT.  The rule finalized today by the Substance Abuse and Mental Health Services Administration (SAMHSA) allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.  Practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.

HCAHPS Proposal

Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS survey pain management questions are tied to Medicare payments to hospitals.  But those payments currently have a very limited connection to the pain management questions on the HCAHPS survey.  In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation. This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.

IHS PDMP Policy

While many Indian Health Service (IHS) clinicians already utilize PDMP databases, IHS will now require its opioid prescribers and pharmacists to check their state PDMP database prior to prescribing or dispensing any opioid for more than seven days.  The new policy is effective immediately for more than 1,200 IHS clinicians working in IHS federally operated facilities who are authorized to prescribe opioids.  Checking a PDMP database before prescribing an opioid helps to improve appropriate pain management care, identify patients who may have an opioid misuse problem, and prevent diversion of drugs. This policy builds on IHS efforts to reduce the health consequences associated with opioid use disorder. As a part of this work, IHS announced that it would train hundreds of Bureau of Indian Affairs law enforcement officers on how to use naloxone, and provide them with the life-saving, opioid overdose-reversing drug.

New Research Priorities

Research  on opioids conducted and funded by HHS helps the department better track and understand the epidemic,  support the development of new pain and addiction treatments, identify evidence-based clinical practices to advance pain management, reduce opioid misuse and overdose, and improve opioid use disorder treatment – all areas of research that are critical to our national response to the opioid epidemic. HHS will launch more than a dozen new scientific studies on opioid misuse and pain treatment to help fill knowledge gaps and further improve our ability to fight this epidemic. As part of this announcement, the department released a report and inventory on the opioid misuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area. The report will also help these stakeholders and external funders of research avoid unnecessarily duplicating research that is currently underway. For more information, download the HHS infographic on the department’s research priorities.  

Prescriber Training RFI

HHS is actively working to stem the overprescribing of opioids in a number of ways, including by providing prescribers with access to the tools and education they need to make informed decisions.  In particular, HHS has developed a number of activities that support opioid prescriber education.  This request for information seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities.

For more information on other actions HHS has taken to address the opioid epidemic, download the department’s new Opioid Epidemic fact sheet.

NEW CDC FLU RECOMMENDATIONS: The Centers for Disease Control and Prevention has stated that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine, should not be used during the 2016-2017 flu season. CDC continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone six (6) months and older. More information can be found here.

PCHD RELEASES UPDATED ZIKA VIRUS GUIDANCE:  The Pima County Health Department has released the following guidance to answer questions about identifying and testing for Zika. This information is intended to inform the way providers in Pima County consider Zika virus infection as a  diagnosis for their patients and outlines the Arizona Department of Health Services guidance for testing.

  • Testing for Zika virus infection should be considered among for individuals who
  • Have travel to a Zika virus-endemic areas (http://www.cdc.gov/travel/notices); OR
  • Have had sex (including vaginal, anal, and oral) with someone suspected to have Zika virus infection; AND
  • Have at least two of the following four symptoms/signs that constitute the clinical case definition: fever (low-grade, 37.8-38.5 degrees C),
  1. Rash (maculopapular),
  2. arthalgias (small joints of hands and feet), and/or
  3. conjunctivitis (nonpurulent, bilateral); OR
  • Are pregnant (including asymptomatic)

Decisions to test based on travel history are made on an individual basis at the discretion of the local health department with input from the healthcare provider. Although some countries (such as Mexico) have ongoing Zika virus transmission, the risk level for disease transmission is not the same in all areas (for example, Zika virus has not been detected in the northern states of Mexico). Please see the attached testing algorithms for detailed testing information and Arizona Department of Health Service’s full Interim Zika Testing Guidance document on their website.

All suspected cases should be reported to the local health department. We are available 24-hours a day by calling (520) 724-7797. Local health department staff will help coordinate testing if warranted.

This is a rapidly evolving situation and the Pima County Health Department is eager to work closely with PCMS to ensure the health and safety of this community. You are encourage to PCHD’s website, for additional information that includes guidance for healthcare providers, informational handouts, and other resources to share with the public.

MEASELS:  The Arizona Department of Health Services has confirmed eleven cases of Measles in Maricopa and Pinal Counties.  No confirmed cases have been report by Pima County.

Seven of the cases are inmates at the Eloy Detention Center and four are workers there.  Health officials are working to control its spread; prior immunizations against the highly contagious disease are having beneficial results.

You’ll find more provider news and information here.

VA PROPOSES SCOPE OF PRACTICE EXPANSION FOR NURSES:  The U.S. Department of Veterans Affairs released its proposed rule regarding Advanced Practice Registered Nurses.  It grants independent practice to all APRNs in the VA health system, including nurse anesthetists.

While nurse practitioners (NPs) and certified nurse midwives (CNM) can practice independently in Arizona, certified registered nurse anesthetists (CRNA) and clinical nurse specialists (CNS) cannot. With the adoption of this new rule expanding the scope-of-practice for CRNA and CNS, VA will put in jeopardy the quality care our veterans receive from a physician-led treatment team. It’s important that we let VA know our veterans don’t deserve second-tier treatment.

VA will accept public comment about the proposed rule for the next 60 day, which began May 25.  After that, they’ll issue their final rule. 

Make your objection to the new rule heard by going to www.safevacare.org

PDMP:  The Prescription Drug Monitoring program is now law.  The mandate to use the system is effective October 1, 2017, and 60 days after the Arizona Health-e Connection has integrated the PDMP data into the state health information exchange.

It’s important that you are fully informed about the law’s requirements and exemptions available.  You can find more information here.

SCAMMERS CONTINUE TO FILE FALSE PHYSICIAN RETURNS:  Physicians continue to be targeted under a tax return scam that began in 2014. ArMA reports more than 50 physicians have notified them that they have been victimized by the cyber scam.  Some have been victimized more than once.

Under the scam, criminals us fraudulent federal income tax returns using physician names, addresses and Social Security numbers to file electronically for refunds.  

If you are a victim, please contact PCMS Executive Director Bill Fearneyhough, billf5199@gmail.com.  He will forward your full name, home address and phone number to ArMA’s Chic Older.  Older is working directly with Arizona IRS to monitor the situation.

KEEP AMB CONTACT INFO CURRENT:  The Arizona Medical Board (AMB) is urging physicians to keep their contact information current. In an email, physicians were reminded of their statutory obligation to maintain their contact information with the Arizona Medical Board.

In part the email read: As your licensing agency, there are times when we need to contact you and/or send you reminders regarding the status of your license. For example, the Board does send an email reminder regarding your renewal deadline. It is imperative we have up-to-date information which will allow us to communicate directly with you. In order to facilitate communication between you and the Board, please take a moment to click on this link Online Change of Address (https://azdo.glsuite.us/glsuiteweb/clients/azbom/Private/changeaddress/login.aspx) to access your profile and update your contact information. Please see the statute below that requires you to report a change of address and allows for a penalty if this information is not maintained with the Board. 

Statute 32-1435:

    A. Each active licensee shall promptly and in writing inform the board of the licensee's current residence address, office address and telephone number and of each change in residence address, office address or telephone number that may later occur.

    B. The board may assess the costs incurred by the board in locating a licensee and in addition a penalty of not to exceed one hundred dollars against a licensee who fails to comply with subsection a within thirty days from the date of change. Notwithstanding any law to the contrary, monies collected pursuant to this subsection shall be deposited in the Arizona medical board fund.” ‚Äč

NOMINATE A COLLEAGUE FOR “PHYSICIAN OF THE YEAR”:  A highlight of every PCMS/Alliance Stars on the Avenue event is the presentation of several recognition awards including “Physician of the Year.”  If you would like to single out a colleague for the prestigious 2016 POY Award please forward a brief letter or email outlining why they should be 2015’s Physician of the Year and mail it to 5199 E. Farness Drive, Tucson, AZ 85712 or email to Executive Director Bill Fearneyhough at billf5199@gmail.com. For more information call Bill at 795-7985.

WALK-WITH-A-DOC:  The Society is teaming with the Arizona Chapter of the American College of Physicians (ACP) to host and provide physician leaders for the monthly Walk-With-A-Doc outings.  Walkers sign in at the ramada east of Swan Bridge on the south bank.PCMS physicians are encouraged to urge patients to participate in the program. Each walk begins with a brief discussion on a health topic and includes a one- or two-mile walk on level ground. Please contact Dennis Carey at 795-7985 or dcarey5199@gmail.com for more information or if you have questions.