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.”
NURSES FILE APPLICATION TO EXPAND SCOPE OF PRACTICE: This September, the Arizona Nurses Association (AzNA) and their component associations filed for a major scope of practice change to the Nurse Practice Act that would impact in varying degrees four categories of advanced practice nurses: Nurse Practitioners (NP), Certified Nurse Midwives (CNM), Certified Nurse Specialists (CNS), and Certified Registered Nurse Anesthetists (CRNA). The full application is available here and is more than 75 pages long.
Two requested changes for NP and CNM are focused on the statutory word “collaboration” that they feel is causing them problems with payers and health systems because they contend it is vague. Their initial request, which ArMA would oppose, was to remove the collaboration provision from statute. We have communicated to the nurses we are willing to work on better descriptive language to help maintain the current concept of collaboration and clarify what is required.
A major change being sought is for Certified Nurse Specialists (CNS). For this category AzNA is requesting what is best described as a parallel independent scope of practice to what is permitted for Nurse Practitioners -- under Arizona law today, this can include complete clinical independence and complete prescriptive authority. In-depth review of the application has shown us there is a substantive disparity between the education and clinical experience of CNS and NPs, with CNS education and experience being markedly less in some cases than that of NPs. In meetings with nursing group representatives, ArMA has expressed with specificity our significant concerns as they relate to patient safety and quality of care.
The final proposal relates to CRNAs and would be a substantial expansion of their current scope of practice, which was put into statute in 2011 after intense negotiations between the Arizona Nursing Board, Arizona Society of Anesthesiology, ArMA, and the Arizona Association of Nurse Anesthetists. The key element of this newly-proposed change to their scope of practice is to remove the current statutory language that requires CRNAs to provide their services under the direction and in the presence of a physician or surgeon; it would also give CRNAs complete prescriptive authority and the ability to receive patient referrals directly from any licensed health provider. The CRNAs have also made very clear their desire to allow trained CRNAs to provide chronic pain management services independently. ArMA, the Arizona Osteopathic Medical Association (AOMA), and the Arizona Society of Anesthesiologists (AzSA) have serious concerns about patient safety being adversely affected if this were permitted and have expressed strong opposition to the entire CRNA proposal. The CRNAs' scope expansion application does not present documented reasons that necessitate these changes, with the only tangible observation being that the current Arizona statute has resulted in the DEA requiring CRNAs to relinquish their DEA numbers, which they state presents problems for their normal operating procedures outside of licensed facilities.
We are openly discussing and conveying our strong concerns to AzNA and their component associations who are asking for these changes. The first official step of this process will be a formal hearing at the Arizona Legislature on December 7, 2015, where the Committee of Reference (COR), who hear all proposed scope changes, will consider the request and take testimony as to the need and justification, qualifications of the applicants, and public safety.
HHS FAILS TO ADDRESS STAGE THREE MEANINGFUL USE SHORCOMINGS: More than 110 medical societies from across the country has joined the AMA in asking Congress to address shortcomings in the Stage 3 Meaningful Use final rule. Among the chief concerns are the limited focus on advancing interoperability and the apparent unwillingness of the Department of Health & Human Services and Centers for Medicare & Medicaid to respond to stakeholder feedback in a meaningful way. In the view of the coalition, urgent congressional action to ‘refocus’ the Meaningful Use program is necessary in order to prevent physicians from abandoning the program completely due to the near impossibility of compliance with meaningless and ill-informed bureaucratic requirements. The coalition contends that Stage 2 has “largely been a failure, with only 12 percent of physicians successfully participating and little improvement in data exchange across care settings.” Relying so heavily on the failed construct of Stage 2 will only guarantee continued failure in Stage 3.
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.
NURSES AND PHARMACISTS SEEK EXPANSION OF CARE UNDER SUNRISE PROCESS: The Sunrise process is unique to Arizona and was lobbied for by Arizona’s physician organizations many years ago in order to minimize the lack of scientific presentations that were occurring at the legislature over medical scope of practice expansion requests as well as requests for new licensure.
Non-physician groups were finding legislative sponsors to introduce licensure and scope expansion bills, and hearings were taking place where little or no scientific justification was presented as to the rationale or qualifications of the group seeking these changes. The Sunrise Process established a requirement that any group seeking certification or an expansion in its scope needed to notify the legislature of their request prior to the session convening, and a bi-cameral group, Sunrise Committee of Reference (COR), was established to hear testimony as to the need and justification for the expansion or certification/licensure, and qualifications of the group seeking the changes. The COR then issues a report indicating support or lack thereof for the application. The findings report and recommendation of the COR is critical to whether or not the group goes forward with its legislative request and the ultimate legislative outcome.
The Arizona Medical Association (ArMA) monitors the Sunrise process closely. The Sunrise applications this year originate from nurses, for certain categories of nurses seeking additional scope and independence from physician supervision, and pharmacists, who are seeking to administer vaccinations to children. ArMA has concerns about the scope of practice expansions being sought in these applications and we are actively meeting with stakeholders to advocate for patient safety, the doctor-patient relationship, while still protecting the integrated health care approach with doctors and nurses. We will provide more detailed information in the next few weeks. The hearing on these applications is scheduled for December 7, 2015, 9:00 a.m. at the Arizona Senate. The applications for nurses may be viewed here and for pharmacists here. If you would like more information, or to review the applications, email or call Pele Peacock Fischer, vice president of policy and political affairs at email@example.com or (602) 347-6910.
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.
ACA “GRACE PERIOD” PROBLEM FOR PROVIDERS AS OPEN ENROLLMENT BEGINS NOV. 1:
Recent reports on June 2015 federal data indicate that more than 22% of ACA enrollees had dropped their insurance coverage. Federal regulations allow enrollees a three-month grace period during which coverage is active even if premium payments are not made. Insurers must cover care provided during the first month of the grace period, while providers are responsible for the remaining two months. Providers have raised concerns that large numbers of enrollees could receive care during the grace period without ever paying their premiums, leaving providers at risk of absorbing the cost of care. Encourage your patients to remain current on their premium payments in order to retain their insurance coverage. Have your office staff check patient insurance status and information. Additionally, while participating in an exchange may be voluntary, physicians may not be certain what plans they are participating in, and should review their contracts or directly contact insurance companies to determine what marketplace plans include them as part of the network. Open enrollment for 2016 begins on Sunday, November 1, at healthcare.gov. HHS is encouraging all enrollees with current plans to “shop and save” by comparing current plans with new plans and premiums. With narrow networks increasing, patients may have to change not just their insurer but also their doctor if they want to find a cheaper plan. Open enrollment ends January 31, 2016.
COURT APPEAL CHALLENGES MEDICAID EXPANSION: Following the ruling last month of a Maricopa County Superior Court judge that the simple majority vote that expanded AHCCCS in 2013 was constitutional, the Goldwater Institute filed an appeal of the decision to the Arizona Court of Appeals this week. The case will ultimately be decided by the Arizona Supreme Court. Arizona’s physician societies fully endorsed and actively supported Governor Brewer's work to expand the AHCCCS program, and we will continue to closely monitor the progress of the lawsuit.
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. Review the court document here. Media coverage is available here.
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.
THERANOS’ TESTING QUESTIONED: Earlier this year, Arizona passed a self-referral laboratory testing bill, SB2645, which enabled individuals to obtain their own blood testing. The laboratory startup Theranos was instrumental in supporting passage of the legislation and has concurrently partnered with Walgreens in the Arizona market to offer direct-to-consumer blood testing. The Arizona marketplace is a unique testing ground for what Theranos envisions as a national model. An article this week in the Wall Street Journal raised concerns about the methods of blood drawing and accuracy of lab test processing offered by Theranos. While ArMA values patient autonomy and engagement in managing one's own health, concern about the possibility of missing important diagnoses and critical test findings led to ArMA’s position of active non-support on SB2645.
PRESCRIBING REPORT CARD: Arizona law requires all medical practitioners, including MDs and DOs, who are licensed under Title 32 and who possess a DEA registration to also possess a current Controlled Substances Prescription Monitoring Program (CSPMP) registration issued by the State Board of Pharmacy. The PDMP Report Card offers all prescribers the opportunity to review your prescribing patterns in relation to the average data of other prescribers in your specialty type. The State Board of Pharmacy operates the CSPMP and as part of their work to meet new legislative requirements, they will be distributing the Prescriber Report Card to all registered prescribers later this year. They need your help in verifying email addresses for all registrants. Please register or log-in to verify that your email address is on file with CSPMP at https://www.azrxregistration.com/Login.aspx.
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.
2012 ABORTION MEDICATION LAW OVERTURNED: In 2012, the Arizona Legislature passed a law requiring abortion providers to strictly adhere to Food & Drug Administration (FDA) requirements for medication that induces abortions. The FDA restricts the use of the medication to women seven or fewer weeks into their pregnancy and requires three visits to a physician. Prior to the law passage, clinicians had been using an evidence-based regimen allowing the medication to be used up to nine weeks of a pregnancy and with two visits to a physician. This week, a Maricopa County Superior Court judge declared the law unconstitutional, finding that it makes Arizona law contingent on FDA rules.
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.
AMA RELEASES PHYSICIAN PAY STUDY: The American Medical Association (AMA) has released a report on their 2014 Physician Practice Survey detailing how physicians outside of solo practice are paid. The survey, completed by 3500 physicians around the country, identifies six trends:
- Slightly more than one-half of physicians (51 percent) reported being paid by multiple methods.
- Salary and productivity-based payment were the most common payment methods.
- On average, one-half of physicians' total compensation was earned from salary.
- Being employed didn't necessarily mean a salary.
- Outside of group practice, salary was more often a key factor than inside group practice.
- Physician payment methods vary widely across specialties.
The study found that while the structure of physician payments has changed little since 2012, the use of productivity-based pay and bonuses both increased by about three percent.
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.
ACS CHALLENGES SURGEON RATINGS: With the rollout this week of a ProPublica database calculating complication rates for 17,000 surgeons around the country, the American College of Surgeons [ACS] has released a statement cautioning against the perceived usefulness of the data. The following is excerpted from the ACS statement. "[ACS] strongly believes that patients and their families deserve to have meaningful information available to assist them in selecting the right surgeon. This week, two public interest groups launched websites promising to assist with surgeon evaluation. Unfortunately, the usefulness of the information they shared is questionable for a number of reasons. The two groups used differing methodologies, including how many years of Medicare data they reviewed, procedures studied, and rating scales used. A patient who visited both websites could potentially find the same surgeon rated very differently or only find a surgeon on one of the two websites. Use of clinically validated data would have more fully taken into account the severity of the patient's condition when assessing surgeon performance...Without factoring in surgeons' success rate with the more challenging patients, the potential for wrongly directing patients away from these surgeons certainly increases. And as troubling, some insurers might restrict access to these surgeons in the future. The importance of relying on clinical data to accurately measure surgeon performance is well documented in scientific literature, and clinical registries are considered the standard for collecting this information...Collection and dissemination of accurate clinical data, however, is a shared responsibility because it is a labor- and cost-intensive process. Private payors, government, professional societies, and public interest groups-all of whom are invested in transparency-must share this responsibility. Two other issues bear consideration. First, surgery is a team experience. The surgeon works closely with the anesthesiologist and surgical nurses during an operation. While using clinical data can get us closer to measuring surgical performance, the reality is that in the operating room, many factors and many individuals contribute to the surgical outcome. Rating a surgeon's skill in performing a particular operation, without factoring in these other considerations, leads to an incomplete analysis. Second, we must ask ourselves how much data is helpful to a patient's decision. The American College of Surgeons fully supports sharing the right data with the right person at the right time." Read the complete ACS statement here. The ProPublica database and commentary are available here.
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.
PCMS / FAVORITE STAFFING SERVICE: If you need staffing, contact Favorite our affiliate medical staffing service. Favorite provides a full range of services including direct hire, contract, temp- to-perm, permanent placement and “just –in-time” per diem. Special rates are given to member physicians. Call Amy Erbe at 319-5766. She is anxious to assist.
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 with questions. There is one more walk scheduled for 2013. It's on December 14. In 2014 walks will be held on January 11, February 8, March 8, April 12, September 13, October 11, November 8 and December 13. They begin at 8 a.m.