CALL TO ACTION - CONTACT MEMBERS OF THE SENATE HEALTH AND HUMAN SERVICES COMMITTEE!
SB 1473 is scheduled to be heard in front of the Senate Health Committee on February 10th at 2pm. We need our physicians, residents, and medical students voice their strong objections with SB 1473 and the dangerous impacts on patient safety it will have.
Contact Your Legislators!
Take action to protect your patients and integrity of your training! SB 1473 will dramatically and dangerously expand scope of practice for advanced practice nurses. The Arizona Medical Association (ArMA), the Arizona Osteopathic Medical Association (AOMA), PCMS and every other major Arizona medical and specialty society strongly oppose SB 1473 because of the potential danger to Arizona patients.
Get in touch with members of the Senate Health and Human Services Committee and let them know that SB 1473 is dangerous for Arizona and dangerous to our patients. You can submit your letter by clicking here, which also provides a great resource for finding your district!
You may contact Senate Health and Human Services committee members directly by calling, emailing, or tweeting!
* Senator Nancy Barto (LD 15, North Phoenix) (chair): (602) 926-5766, firstname.lastname@example.org, @nancybarto
* Carlyle Begay (LD 7, Window Rock): (602) 926-5862, email@example.com, @carlylebegay
* David Bradley (LD 10, Tucson): (602) 926-5262; firstname.lastname@example.org, @Bradley4AZ
* Katie Hobbs (LD 24, Central Phoenix): (602) 926-5325, email@example.com, @katiehobbs
* Debbie Lesko (LD 21, Peoria): (602) 926-5413, firstname.lastname@example.org, @DebbieLesko
* Lynne Pancrazi (LD 4, Yuma): (602) 926-3004, email@example.com
* Kimberly Yee (LD 20, Phoenix): (602) 926-3024, firstname.lastname@example.org, @KimberlyYeeAZ
Here are the latest talking points.
ABOUT SB1473: Senator Barto has introduced SB 1473. It will dramatically and dangerously grant independent scope of practice and extensive prescriptive authority to advanced practice nurses. It essentially allows advanced practice nurses to act as physicians without the requisite education and training patients expect and count on for the highest quality care. The Arizona Medical Association (ArMA), the Arizona Osteopathic Medical Association (AOMA), and every major Arizona medical and specialty societies strongly oppose this legislation because of the potential danger to Arizona patients.
You must take action immediately to protect your patients and the integrity of your training. Contact your senator and representatives now. Here’s what we suggest:
- Review the talking points https://azmed.org/wp-content/uploads/2016/02/Arizona-Medical-Association-Talking-Points-2216.pdf before contacting your Senator and Representatives. If you don’t know who your representatives are you can identify them through your district. http://azredistricting.org/districtlocator/
- When contacting them, make sure to address them appropriately, refer to them as Honorable, Senator or Representative. To contact your legislators, you can use the instructions at azleg.gov.
- Thank them for their service.
- Tell them you are a constituent in their district.
- Explain who you are and what you do.
- Outline your concerns about SB 1473 - its impact on patients and the quality and safety of the care they receive.
- Personalization is always helpful.
Take action immediately!
If you need assistance or have questions, please contact Bill Fearneyhough at email@example.com or call 795-7985.
LEGISLATIVE WEEK TWO: Governor Ducey unveiled a proposed state budget for fiscal year 2016-17. The Governor is asking the AZ Legislature for a supplemental funding of $105 M in FY16. For FY17, he wants $284 M in spending above current levels. Of that amount, $168 M would go to new initiatives, 81% of which is for one-time spending. One new spending item of interest to those in health care is the restoration of preventive dental under AHCCCS, for adults with developmental disabilities. And speaking of AHCCCS, there are no provider rate cuts in this year’s budget plan (last year there was a 5% rate cut enacted, then drug rebate money was reallocated and the cut was not imposed). If approved, the Governor's proposal would grow the budget to $9.5 B in FY17, which his staff notes is less than a two-percent increase from current levels. The Governor's budget office estimates that under this proposal, the State would be structurally balanced with a surplus of $173 M by FY17.
The Governor’s Office announced two key legislative goals related to health care, and they are ones we have been anticipating and look forward to working on. One priority was mentioned in Governor Ducey’s address at the start of the legislative session last week: mandating physicians to check the state’s prescription drug monitoring program (PDMP). Since then, ArMA has been working with AOMA to develop policy to ensure that any mandate is not imposed “bluntly” but is situational, circumstantial, and preserves clinical judgment. Furthermore, we have been in dialogue with the Director of the PDMP to assess what is needed to make the program as efficient, user-friendly, and reliable as possible. We have been in regular dialogue with the lead health policy adviser to the Governor, Christina Corieri, about what the legislation should look like, the need for reasonable accommodations for special prescribing situations, and sufficient support and resources for the AZ State Board of Pharmacy to administer it competently. Other licensed professional associations will work in tandem with ArMA as this legislation takes shape.
The second legislative priority for the Ducey Administration is the streamlining of state licensing boards for the health professions, including larger ones like the Arizona Medical Board (AMB) and the Arizona State Board of Nursing (ASBN). The Governor has enlisted House Health Chair, Representative Heather Carter to introduce this legislation and lead a stakeholders’ process with the boards and professional associations involved. We see this as an excellent choice given Rep. Carter’s demonstrated commitment to all licensed health professionals and her reasonableness, and her balanced approach between preserving public safety and avoiding overregulation. The licensing board streamlining legislation is just now being created, and while it is not consolidation of boards (assurances have been given that existing boards will remain intact), there could be significant operational changes. For example, the plan (to be carried out over a four year process with the AMB and ABN being left to the final year) entails physically relocating all the boards and housing them at the Arizona Department of Health Services (ADHS). Operational efficiencies with board staff will be achieved in this manner, and there will be an emphasis on streamlining and standardizing board administrative functions. The final key component – providing a level of final oversight over all the boards by the ADHS Director (currently, Cara Crist, MD) – is yet to be fleshed out and could face opposition. The rationale behind this component is the need for Arizona to take “state action” to address potential legal challenges. The Ducey team has voiced concerns about a key federal court case out of North Carolina brought by the Federal Trade Commission against the state dental board for engaging in anti-competitive practices (under the guise of stopping unlicensed activity). The question is what is the appropriate level and scope of this sort of final administrative oversight for our licensing boards. We’ll work cooperatively with Rep. Carter and the Ducey team to address this issue and help craft a workable piece of legislation.
LICENSURE COMPACT BILL: Representative Heather Carter, House Health Chair, has decided to take the lead in advancing an important licensure compact bill for physicians, HB 2502, to create an expedited process for doctors to gain licenses in any state that is a party to the compact. ArMA’s Legislative Committee discussed and the ArMA Executive Committee approved supporting this bill as a way to improve licensure portability and enhance patient access to care. At this time, 12 states have enacted a physician licensure compact law and many other states have introduced legislation. The compact would not take away the home state’s jurisdiction and oversight over its licensed physicians. For more on what the compact means, please visit this link: www.licenseportability.org/.
ZIKA VIRUS OUTBREAK IN THE AMERICAS: Due to the rapid expansion of Zika virus to Central America, South America, the Caribbean, and Mexico, there are new recommendations for clinicians and travelers to Zika-affected countries. Local mosquito-borne transmission of the virus has not been documented in the continental United States, but infections have been identified in travelers returning from affected areas. A link has also been identified between Zika virus infection in pregnant women and microcephaly and fetal losses. CDC recommends that pregnant women should consider postponing travel to areas where Zika virus transmission is ongoing. All travelers should take steps to avoid mosquito bites to prevent Zika virus infection and other mosquito-borne diseases.
Recommendations for healthcare providers:
- Consider Zika virus in patients with a travel history to affected countries (http://www.cdc.gov/zika/geo/index.html and http://wwwnc.cdc.gov/travel/notices/)
- Symptoms of Zika virus infection are usually mild, and include maculopapular rash, arthralgia, conjunctivitis and fever
- Notify the Pima County Health Department immediately about suspected Zika cases. Commercial testing for ZIka virus is not currently available, but can be coordinated through your local health department. Cross-reactions can occur with dengue, West Nile virus, and other flaviviruses. No specific antiviral therapy is available; aspirin and other NSAIDs should be avoided until dengue virus has been ruled out.
- Ask pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission and who have symptoms compatible with Zika, or ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with the local health department.
For more detailed information about Zika virus, visit http://www.cdc.gov/zika/.
KIDSCARE REINSTATEMENT: The Arizona Medical Association (ArMA) has joined a coalition of health care and children advocates to support reinstatement of KidsCare, the state’s Children’s Health Insurance Program (CHIP). Arizona continues to hold the dubious distinction as the only state in the nation without a functioning CHIP program. For the fifth year in a row, Arizona had the third highest child uninsured rate in the nation. In 2010, Arizona’s leaders “temporarily” froze our CHIP plan, known as KidsCare, just before the ACA was signed into law. Nearly six years later, that “temporary” freeze is still in place but the state budget can no longer be used as a justification for keeping children out of KidsCare. The state would receive 100% federal financing to reinstate KidsCare at no cost to the state budget. Accepting full federal funding to lift the freeze on KidsCare would help Arizona dramatically reduce the number of uninsured kids in Arizona and help create a brighter future for our state and our children. Health coverage during childhood helps children achieve academically and grow up to become healthier, more productive adults. Learn more about how KidsCare would benefit Arizona children here, and view local media coverage here.
MEANINGFUL USE ENDS: According to comments made by CMS Acting Administrator Andy Slavitt earlier this week, it appears there will be no Stage 3 of Meaningful Use as we know it after 2016. His exact words were, “Now that we effectively have technology into virtually every place care is provided, we are now in the process of ending Meaningful Use and moving to a new regime culminating with the Medicare Access & CHIP Reauthorization Act (MACRA) implementation. The Meaningful Use program as it has existed will now be effectively over and replaced with something better. Since late last year we have been working side by side with physician organizations across many communities — including with great advocacy from the AMA — and have listened to the needs and concerns of many. We will be putting out the details on this next stage over the next few months.
HEALTH ALERT - ARIZONA SEES INCREASE IN DENGUE FEVER AND CHIKUNGUNYA:
Dengue fever is a mosquito-borne disease in the Flavivirus genus of the Flaviviridae family. It is primarily transmitted by Aedes aegypti and Aedes albopictus mosquitoes, which can also transmit chikungunya virus and yellow fever virus. These mosquitoes are found throughout the tropics and subtropics, and their abundance has aided in the geographic expansion of the virus. Dengue is expanding rapidly, and has had a 30-fold increase in incidence during 2000–2010. This includes increased disease incidence in endemic countries as well as encroachment into new countries and regions.
Currently, there have been no locally-acquired cases of dengue identified in Arizona. However, cases are brought into Arizona every year by travelers who pick up the virus while abroad. Arizona is at risk for local transmission of dengue virus because of the presence of the Ae. aegypti vector mosquito, which is widespread throughout Arizona. This would most likely occur if an individual was infected while traveling outside of Arizona, but then returned to Arizona and was bitten by an Ae. aegypti mosquito. . If this mosquito then took a blood meal from a new host, it could transmit the virus to this next host. This person would be considered a locally-acquired case.
For practitioner information click here.
Chikungunya fever is a mosquito-borne disease caused by a virus in the Alphavirus genus, and Togaviridae family. Chikungunya virus is primarily transmitted by Aedes aegypti and Aedes albopictus mosquitoes, which can also transmit dengue and the yellow fever virus. Since 2004 chikungunya has caused large outbreaks in Africa, Asia, Indian Ocean islands, and Italy. Attack rates in these outbreaks ranged from 38-63% and reached over 500,000 cases in multiple outbreaks.
In December 2013 the first cases of locally-acquired chikungunya in the western hemisphere were reported among residents of St. Martin in the Caribbean. The virus quickly began to spread across the Caribbean region, and locally-acquired cases have been reported from North, Central, and South America. As of this writing, there have been 11 locally-acquired cases of chikungunya fever in Florida, as well as a chikungunya positive mosquito found in the Houston area.
For more information click here.
COMMITTEE OF RECORD REPORT (COR) – NURSES SEEK SCOPE OF PRACTICE EXPANSION: The Legislative Committee of Reference (COR) met to consider a major scope of practice expansion (aka a sunrise application) for advance practice nurses (nurse practitioners, clinical nurse specialists, certified nurse midwives, certified registered nurse anesthetists) proposed by the Arizona Nurses Association (AzNA) and affiliate nursing associations. By law, the COR had two possible options: 1. Vote the application down; or 2. Recommend it go forward through the normal legislative process for consideration as a change to existing law. After nearly five hours of debate the COR voted 5 to 4 to recommend the application go forward.
The following legislators’ voted against the Nursing Associations' sunrise application and in support of physicians and patient safety:
Representative Heather Carter
Representative Jay Lawrence
Senator Kelli Ward, DO
Senator Kimberly Yee
The five legislators who agreed to move the nurses' sunrise application forward were:
Senator Nancy Barto
Senator David Bradley
Senator Lynne Pancrazi
Representative Regina Cobb, DDS
Representative Randy Friese, MD
In addition to ArMA, this sunrise application was strongly opposed by our close partners the Arizona Osteopathic Medical Association (AOMA) and every major medical and specialty society in Arizona, as well as the Arizona Dental Association (AzDA). The Arizona Society of Anesthesiologists (AzSA) and their national affiliate the American Society of Anesthesiology (ASA) were essential in providing clinical and practice information and access to medical experts well versed in CRNA education and competencies. The American Medical Association (AMA) provided important information about physician availability and comparison of physician training to various nursing disciplines.
The sunrise application has different requests for the advance practice nurses involved; most troubling is the one over-arching concept common to all, the request to separate APRNs from physicians as part of the medical team.
By design, ArMA’s testimony was focused 100% on patient safety. It was led by ArMA's veteran lobbyist Steve Barclay and reinforced with sound medical science through our four expert witnesses, Dr. Raymond Woosley (rigors of medical education and pharmacology), Dr. William Thompson (pain medicine as a specialty and the danger of opioid prescribing), Dr. Ross Goldberg (the surgeon as head of operating team), and Dr. Jane Fitch (comparison of anesthesiologist and CRNA competency). This is without a doubt the strongest team of advocates ArMA has ever fielded at a legislative hearing.
Ironically, while the vote was to keep this application alive in this preliminary round (this was only the "qualifying round" for the nursing associations to advance to the legislative session), eight of the nine committee members stated on the record that they agreed with many of the serious medical concerns we raised, and said that they wanted to see our concerns addressed. Strategically, we know that the concerns raised by the COR on the merits of the application will be extremely important and impactful as we argue our position during the regular legislative session. It is unfortunate that a majority of the COR members allowed an overreaching and unsafe sunrise application to move forward despite their acknowledged concerns, perhaps in the mistaken belief that a compromise will be struck. We will continue our dialogue with the APRNs and their nursing associations as our valued colleagues; however, we cannot and will not compromise where patient care is concerned. ArMA will continue to be diligent and fully engaged with our allies to make sure all concerns for patient safety are fully understood and addressed.
Advance practice nurses have generally enjoyed a positive environment at the Legislature. And in years past their associations have generally been very good about working with ArMA and other physician groups in a cooperative, up-front, "let's work together" way. However, the aggressive scope of practice expansion application the nursing associations have put forth, without the prior input of any member of our physician coalition that we are aware of, is a clear departure from that cooperative working relationship. Moreover, the vigorous social media and press campaign they launched in conjunction with their lobbying effort this week – holding a press conference, flooding the COR members with emails, letters, calls, texts and tweets, and trying to pit physicians against physicians – opens a new chapter of what to expect in the future as trade groups seek to use the Legislature to expand practice competency privileges.
While far from a lasting defeat for us (again, this was just the qualifying round), the outcome of the COR hearing this week again demonstrates the need for all Arizona physicians to be fully engaged and vocal with the Legislature. We must have direct physician member involvement all across our state to make it clear physicians will not compromise quality of care, despite a practice environment that is already making it difficult on a daily basis to prioritize patient needs above administrative and business burdens.
AMA PHYSICIAN ALERT: Practices that may have thought they were safe from Medicare payment penalties next year could be in for an unpleasant surprise if they don't take action now. Problems with how the Centers for Medicare & Medicaid Services (CMS) has been collecting and analyzing data related to the Physician Quality Reporting System (PQRS) and the value-based payment modifier are leading to inappropriate penalties of 2-4 percent of Medicare payments for thousands of physicians. How to avoid the penalty: File an informal review request with CMS before midnight Eastern time December 16. CMS has said it will verify incentive eligibility and payment adjustment determinations for practices that file such a request. Additional information about the process and contact information for questions is available in CMS' informal review fact sheet. Note: CMS has said the informal review system will be down Dec. 3-7 and unable to accept requests during that time. View the complete notice from the AMA Wire here www.ama-assn.org/ama/ama-wire/post/file-dec-16-avoid-medicare-pay-cut-of-2-4-percent.
ADHS CONSIDERS OFFERING PHYSICIANS MOBILE APP: The Arizona Department of Health Services / Office of Infectious Disease is exploring the option of creating a mobile application (a “phone app”) for physicians that includes easily accessible contact numbers for health departments and public health physicians as well as noninvasive updates on current outbreaks and testing guidance for diseases of public health importance. The Department is gathering impressions from Arizona physicians as to how often they might use such an application, and what they would find most valuable. There is a 9-question anonymous survey online, please complete it at your earliest convenience: https://www.surveymonkey.com/r/ADHS-IDapp. The relationship between physicians and public health in Arizona is a crucial one, and having public health literally “in the pocket” of clinicians enhances that connection.
KEEP AMB CONTACT INFO CURRENT: The Arizona Medical Board (Board) sent the following reminder as an email to Arizona physicians last week about keeping contact information current. The email was “sent as a reminder of your statutory obligation to maintain your contact information with the Arizona Medical Board. 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 that 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.
32-1435. Change of address; costs; penalties:
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.”
2016 SEES MEDICARE FEE SCHEDULE CUTS: The Medicare Access and CHIP Reauthorization Act (MACRA), passed earlier this year to repeal the broken sustainable growth rate (SGR), called for an annual raise of 0.5% for physician pay from 2016 to 2019. At the time of the passage, it was considered an improvement over the threatened cuts of 21% under the SGR formula. In the final 2016 Medicare fee schedule released last week, a 0.3% cut was implemented instead. Medscape reports that this cut occurred because the Affordable Care Act and several other laws that set Medicare reimbursement policy trumped the Medicare Access and CHIP Reauthorization Act (MACRA). When the draft form was released this past summer, organized medicine realized that a pay cut was coming and medical groups urged CMS to alter its methodology for essentially re-pricing codes and calculating the savings so it could hit the 1% target and avoid canceling the MACRA raise. But, when it released the final fee schedule last week, CMS had kept the cuts in place, citing “current law” requirements under the federal alphabet soup of MACRA, ACA, PAMA (Protecting Access to Medicare Act), and ABLE (Achieve a Better Life Experience). Meanwhile, medical associations are voicing their displeasure at the canceled MACRA raise.
MEDICARE IMPACTED BY U.S. HOUSE BUDGET DEAL: The U.S. House of Representatives voted this week 266-167 to pass a budget legislation that would raise the nation’s debt limit and set spending targets for the next two fiscal years of the federal budget. The bill would extend the debt ceiling to March 2017 and raises by $80 billion the discretionary spending caps imposed by sequestration since 2011. It limits to 17 percent the increase for some Medicare Part B premiums and deductibles, which otherwise may have spiked by more than 50 percent. Under the legislation, hospitals could see some Medicare payments reduced. The deal lowers payments for care delivered at newly opened or acquired hospital-owned outpatient centers by requiring facilities to bill under the fee schedule for physicians’ offices or outpatient sites, rather than the higher levels for care delivered in hospitals. Trends in health care delivery have been heavily impacted by hospitals buying physician practices and employing physicians directly, but there is some speculation that this legislation may have a dampening effect on the practice.
AMB ANNOUNCES NEW PHYSICIAN LICENSING RULES: The Arizona Medical Board announced that effective October 16, 2015, the Board implemented new rules related to physician licensing found in the Arizona Administrative Code, Article 2 (Licensing). The new rules were adopted to streamline the process and to allow for more expeditious licensing while permitting the Board to fulfill its mission to protect the public through the judicious licensing and regulation of physicians.
The rules were revised after the Board’s significant review of its processes and with helpful input from interested stakeholders. The new rules have been introduced along with a new application that reflects the rule changes and provides clear and concise instructions to assist applicants in filling out the application.
The new rules modernize the process by loosening the requirements for certified documents and allowing for the electronic submission of documents directly from a primary source. In addition, applicants will be permitted to submit a notarized statement of identification and a copy of a birth certificate or passport in lieu of providing certified documents. Applicants will no longer be required to submit ABMS certification, AMA reports or a FSMB report; Board staff will obtain these credentialing documents on behalf of the applicant.
The new rules also allow an applicant to petition the Board for a waiver if after exercising due diligence the applicant is unable to provide the required documentation. A complete version of the revised rules can be found on the Board’s homepage, www.azmd.gov.
Now that the new initial application is in place, the AMB will roll out its online initial application which will allow an applicant the ability to file and check the status of the application electronically.
PHYSICIAN ORGANIZATIONS URGE IMPROVEMENTS TO NAIC MODEL ACT: Along with other state medical associations and national groups, the Arizona Medical Association (ArMA) has joined the American Medical Association (AMA) in submitting to the National Association of Insurance Commissioners (NAIC) a letter regarding its work to revise its 1996 network adequacy model act to be used by state legislatures in upcoming legislative sessions. The latest draft of the model act has been approved by the NAIC’s network adequacy subgroup and is now moving to the parent committees for consideration. It makes a number of important changes, but additional requirements are needed to ensure meaningful access to care.
ArMA signed onto this letter to encourage adoption of the most meaningful network adequacy requirements possible. The letter outlines priorities for further improvement to the bill, including:
- require prior approval of networks before health plans are sold,
- require states to institute measureable quantitative standards for network adequacy, and
- include stronger protections for tiered networks.
These priorities are shared priorities among many stakeholders and the letter was crafted to demonstrate the broad and strong support for these additional changes to the model act before it reaches state legislatures. The final draft of the letter is available here.
FEDERAL JUDGE BLOCKS SB1318: Last week, a federal district court judge issued a preliminary injunction to officially block Arizona law SB1318. A trial originally scheduled for next week on the law was canceled. This law would require physicians to tell their patients both on the phone and in person that it “may be possible” to reverse the effects of a medical abortion. In June, a lawsuit was filed against the legislation by Planned Parenthood and three Arizona physicians. The lawsuit alleges the law violates physicians’ First Amendment rights as it forces them to communicate "a state-mandated message that is not medically or scientifically supported." The lawsuit further alleges the law violates patients' 14th Amendment rights because they are getting "false, misleading and/or irrelevant information."
The Arizona Medical Association (ArMA) has determined SB1318 requires physicians to present non-peer reviewed, questionable medical information that could be both misleading and dangerous for patients. In accordance with that position, ArMA has joined as amicus the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) in support of legal action to stop implementation of the requirements set forth in SB1318. According to court records, one reason the state has asked to postpone the trial is because the research director of the abortion pill reversal program was found to lack the “publication and research background and experience” to be qualified as an expert witness.
TOBIN APPOINTED STATE INSURANCE DIRECTOR: Governor Doug Ducey has appointed former Arizona Speaker of the House Andy Tobin as director of the Arizona Department of Insurance. Mr. Tobin has served as director of the Arizona Department of Weights and Measures since January. He has owned and operated a local Farmers Insurance and his own employee benefit company. From 2006 to 2015, Mr. Tobin represented rural Arizona in the state House, serving as Majority Whip, Majority Leader and eventually Speaker of the House from 2011 until 2015. Prior to serving in the Legislature, he was CEO of a local aerospace company.
FRAUD STILL IMPRACTS ELECTRONICALLY FILED PHYSICIAN TAX RETURNS: The Thursday, October 15, 2015 deadline for those filing tax extensions has passed, but some physicians have found themselves impacted by the same fraudulent federal income tax scheme when returns are filed electronically. If you find you are a victim of this scam, please notify Bill Fearneyhough, PCMS executive director, and include your full name, home address and phone number. The agencies involved have asked us to provide them with known victims, so please let us know in your email that you authorize release of your contact information, including email address. Bill may be reached at firstname.lastname@example.org or 795-7985.
GME FUNDING TO INCREASE BY $81 MILLION UNDER PROPOSED RULE CHANGE: The existing Arizona statute that covers AHCCCS GME funding, ARS Section 36-2903.01 (specifically, subsection 9), requires AHCCCS to prescribe a formula for funding of both direct costs and indirect costs of GME programs. This is patterned after the way CMS does GME funding at the federal level. Recent changes proposed by the Ducey Administration and AHCCCS would call for a simple, yet very significant change to the indirect costs part of the funding formula. AHCCCS describes their intention for updating the rule on GME funding for indirect costs "to modify the method of allocating funds for indirect GME costs to permit payments that will cover a greater portion of the costs incurred by the GME programs." In the current formula, the payments are limited to the lesser of two alternative calculations (described in the proposed rule). AHCCCS is proposing to modify it so that the payments are limited to the greater of the two alternatives. The rulemaking publication explains that this proposed rulemaking intends to calculate the maximum payment for the indirect costs of GME programs. It states that this rulemaking will benefit hospitals operating GME programs because the proposed rule amendment, which will not require additional State funding, will expand payments in support of GME. Payments to Arizona GME program hospitals are expected to increase or enhance payments by approximately $81 million annually - without use of additional State funds. The publication also notes that there is a public comment period on this proposed rule change and there will be some public meetings around the state in October.
AHCCCS EXPANSION IN ARIZONA CONSTITUTIONAL: Maricopa County Superior Court Judge Douglas Gerlach ruled that the simple majority vote that expanded AHCCCS in 2013 was constitutional. Last December, the Arizona Supreme Court ruled to allow a lawsuit challenging Governor Jan Brewer's AHCCCS (Arizona's Medicaid program) expansion plan to move forward. The high court agreed that 36 Republican lawmakers can sue Governor Brewer over the legality of a hospital assessment that funds the expansion plan, which was passed by a bare majority in the legislature. The Goldwater Institute, suing on behalf of lawmakers, argues that the assessment meets the criteria of tax and therefore requires a two-thirds majority in the legislature; state attorneys counter that the assessment is not a tax because it is collected from hospitals rather than the broad population. Without the assessment, Arizona would not have the matching funds needed to pay its share of the expansion that is now covering about 255,000 low-income Arizonans. In his ruling, Judge Gerlach stated that since hospitals directly benefit from the assessment, it is actually a fee rather than a tax. As the judge himself pointed out during the court hearing last month, his ruling means very little at this point as appeals will be filed regardless of his decision. The case will ultimately be decided by the Arizona Supreme Court. The Arizona Medical Association (ArMA), PCMS and Maricopa County Medical Society fully endorsed and actively supported Governor Brewer's work to expand the AHCCCS program.
ARIZONA HOME OF NARROW NETWORKS: A new study released from the University of Pennsylvania's Leonard Davis Institute of Health Economics finds the prevalence of narrow physician networks in the Health Insurance Marketplaces varies widely by state. The study considers networks narrow if 25% or fewer physicians in a rating area participate. According to the study, 73% of qualified health plans offered on the Marketplace in Arizona in 2014 were comprised of narrow networks making Arizona the fifth highest state in terms of narrow network prevalence.
ARIZONA LAW AND PHYSICIAN ASSISTANT SUPERVISION: Do you have or are you thinking of bringing physician assistants into your practice? Arizona law sets forth requirements for physician assistant (PA) licensing, scope of practice and physician supervision of PAs. As a reminder, the pertinent laws include ARS 32-2531 and 32-2533, and include the following points:
- The physician assistant may provide any medical service that is delegated by the supervising physician if the service is within the physician assistant's skills, is within the physician's scope of practice and is supervised by the physician.
- The physician assistant may perform health care tasks in any setting authorized by the supervising physician, including physician offices, clinics, hospitals, ambulatory surgical centers, patient homes, nursing homes and other health care institutions.
- Supervision must be continuous but does not require the personal presence of the physician at the place where health care tasks are performed if the physician assistant is in contact with the supervising physician by telecommunication. If the physician assistant practices in a location where a supervising physician is not routinely present, the physician assistant must meet in person or by telecommunication with a supervising physician at least once each week to ensure ongoing direction and oversight of the physician assistant's work. The board by order may require the personal presence of a supervising physician when designated health care tasks are performed.
- A supervising physician shall not supervise more than four physician assistants who work at the same time.
- A supervising physician shall develop a system for recordation and review of all instances in which the physician assistant prescribes schedule II or schedule III controlled substances.
We encourage you to review the complete law, available online at http://www.azleg.gov/ars/32/02531.htm and http://www.azleg.gov/ars/32/02533.htm.
NORIDIAN PROVIDES GUIDANCE ON PATIENT OXYGEN: The Comprehensive Error Rate Testing (CERT) contractor has identified multiple errors in the claims received for oxygen equipment and supplies. Your medical record documentation determines whether your patient can receive the oxygen equipment and supplies you have prescribed and the amount of the patient's out of pocket expenses. Your medical record documentation must show that other alternative treatments (e.g., medical and physical therapy directed at secretions, bronchospasm and infection) have been tried or considered and deemed clinically ineffective. The documentation must show the patient was seen within 30 days prior to the start of oxygen therapy. The medical record must show the medical condition necessitating the home use of oxygen therapy. The medical record and/or prescription would indicate the oxygen flow rate (e.g., 2 liters per minute), and the estimation of the frequency (10 minutes per hour), duration of use (12 hours per day) and duration of need (6 months.) You must specify the type of oxygen delivery system to be used (i.e. portable/stationary concentrator, compressed gas portable/stationary, liquid portable/stationary.) Medicare can make payment for home oxygen supplies and equipment when the patient's medical record shows the patient has significant hypoxemia and meets medical documentation, test results, and health conditions as specified in the CMS Internet-Only Manual (IOM) Publication 100-03, Section 240.2. You must complete and sign Form CMS-484 (Certificate of Medical Necessity (CMN): Oxygen.). However, the CMN itself is not considered part of the medical record. All information included in the CMN must be supported by the contemporaneous medical record. You can find instructions on completing this form in the CMS IOM Publication 100-08, Chapter 5.
TAX SCAM CONTINUES TO TARGET PHYSICIANS: The IRS tax scam that emerged during the 2014 tax season continues to plague physicians and other health care providers during 2015. Last year, more than 120 Arizona physicians were victims of the IRS tax scam. We have already had a number of Arizona physicians fall victim to the scam this year. According to reports, fraudulent federal income tax returns using physician names, addresses and Social Security numbers are being filed electronically. IRS officials believe this scam is an attempt to fraudulently collect tax refunds through a sophisticated electronic redirection of refunds to fraudulent bank accounts that can then be accessed by the perpetrators. Victims are unaware of the identity theft until they attempt to file their taxes electronically, at which time they discover that a return has already been filed under their Social Security number. The IRS is sending 5071C letters to suspected fraud victims with instructions to contact the IRS identity theft website or call the IRS at (800) 830-5084. At this time, physicians are encouraged to go to www.experian.com/fraud and place themselves on a 90-day credit fraud alert. This could potentially slow or halt further attempted identity theft activities. This is only suggested out of an abundance of caution - we have no reason to believe that every physician is at risk. We understand that Experian will feed this information and fraud alerts to the other two major credit reporting agencies. If you remain concerned, it is suggested that you go back onto www.experian.com/fraud after 89 days to initiate subsequent 90-day credit fraud alerts. If you are NOT affected, our IRS agent contact does not recommend filing paper returns. In fact, it is considered best to file electronically as early as possible so as to prevent the bad guys from getting there first.
If you are a victim of this scam, please notify Bill Fearneyhough at email@example.com. Please provide your full name, home address and phone number. The information will be shared with ArMA so please let us know in your email that you authorize release of your contact information, including email address.
IRS - If you are a victim of this scam, you'll note the IRS 5071C letter provides instructions about contacting the IRS through its identity theft website guide or by phone at (800) 830-5084 to let officials know you did not file the return referenced in their letter. If you are a victim, you will not be able to electronically file your return this year since a return with your Social Security number has already been filed. You'll need to file a paper return and attach an IRS 14039 Identity Theft Affidavit to describe what happened. Attach copies of any notices you received from the IRS, like the 5071C letter. Be sure to let your tax preparer know if this happens to you. Verify with the IRS and your tax preparer where to mail your paper tax return, based on the type of return you are filing and your geographic area. Work with your tax preparer to file paper returns with Form 14039 (identity theft affidavit) and Form 8948 (e-file opt-out). You will also need an affidavit and a government issued ID (driver's license or passport). The process of an individual filing the paper return with the Form 14039 notifies IRS that the paper return is the correct filing. IRS then removes the fraudulent filing from the taxpayers account, posts the correct tax return and if due a refund, issues the refund. The major way it impacts someone due a refund is that the process takes longer.
Federal Trade Commission (FTC) - File a complaint with the FTC here. This not only helps the FTC identify patterns of abuse, but the printed version becomes your Identity Theft Affidavit. Along with a police report, that affidavit becomes your Identity Theft Report, which you will need. The FTC recommends other immediate steps and provides helpful information at www.consumer.ftc.gov/topics/repairing-identity-theft.
Police report - Consider filing a report with the local police where you reside. Bring all documentation available, including any state and federal complaints you filed. This will likely be necessary if there is financial account fraud as a result of the identity theft. However, if the only fraud is tax fraud, the police report will be necessary only if requested by the IRS.
Social Security - Call the Social Security Administration's fraud hotline at (800) 269-0271 to report fraudulent use of your Social Security number. In case your number is being used for fraudulent employment, you can also request your Personal Earnings and Benefit Estimates Statement at www.ssa.gov/ or call (800) 772-1213. Check it for accuracy.
Credit Bureaus - Contact a fraud unit at one of three credit bureaus: Equifax, TransUnion and Experian
Office of the Arizona Attorney General - Physicians affected can find additional guidance through the office of the Attorney General. Their website lists resources and steps for identity theft victims to take at https://www.azag.gov/identity-theft.
If you have not received a notification from the IRS but believe your personal information may have been used fraudulently or are concerned about whether you may have been victimized, call the IRS Identity Protection Specialized Unit at (800) 908-4490. Find more information from the IRS, including forms, at the IRS website.
ArMA and PCMS will keep you informed of further developments and information.
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 2015 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 firstname.lastname@example.org. 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 email@example.com for more information or if you have questions.