WINTER 2021
A P U B L I C AT I O N O F T H E M A R I C O PA C O U N T Y M E D I C A L S O C I E T Y
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Doctors share their views on the major health issues in Arizona and what motivates them to improve
From the Brink to Redemption Personal experience guides Dr. Monica Faria’s efforts to improve physician wellness
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“
Village Medical focuses on quality of care and puts the patient first. Through the use of technology, I can spend more quality time with my patients and focus on their needs, to ensure better outcomes and overall experiences. -Michael Herrera, DO
”
At Village Medical, we know the more you can connect with patients, the better care they receive. That’s why we empower providers with a patient-centered, tech-enabled model backed by a clinically integrated care team, to help you deliver better outcomes at a lower cost. If you’re looking for a change, we’re hiring primary care physicians and APPs right now in: • Mesa • Gilbert • Phoenix
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Join the team that’s transforming primary care. To learn more, contact Vice President of Business Development Sam Martinez at smartinez@villagemd.com
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CONTENTS VOLUME 3 • ISSUE 1
Editor-In-Chief John McElligott, MPH, CPH
Managing Editor Edward Araujo
Creative Design Randi Karabin, Karabincreative.com
IN EVERY ISSUE 4 | From the MCMS Board President 6 | From the Editor-in-Chief 8 | Briefs 26 | Legal Corner 28 | How To 30 | Physician Spotlight
Cover & Physician Profile Photography Advertising ads@arizonaphysician.com
Maricopa County Medical Society Board Members
John Prater, DO
Past President Lee Ann Kelley, MD
Ricardo Correa, MD, ESD, FACP
What Arizona Docs are Saying
Secretary Karyne Vinales, MD
Brenda LaTowsky, MD
Resident & Fellow Director Anchit Mehrotra, MD
Digital & Social Media arizonaphysician.com
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Treasurer & President-Elect
Gerald Golner, MD, FAAP
Learn what the Arizona Department of Health Services priorities will be for 2021–2015.
Arizona Health Care Cost Containment System (AHCCCS) strategies to improve the integration of behavioral health and primary care.
President
Shane Daley, MD
New AZ Health Improvement Plan
Improving Behavioral Health & Primary Care Integration
Ben Scolaro, scolarodesign.com
Directors
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16 C O V E R S T O R Y
From the Brink to Redemption: Dr. Monica Faria shares how her journey helps her provide mental health care for fellow physicians
Physicians across Arizona give their take on major health issues facing the state.
ArizonaPhysician @AZPhysician @AZ_Physician
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FROM THE MCMS BOARD PRESIDENT
W E H AV E M E T T H E E N E M Y, AND IT IS US. —POGO
P
rior to moving to Arizona, I resided in Florida for four decades and was fortunate to live near Sanibel Island. Driving to the island — just as I approached the causeway — there were several homes that had been built on pilings about 100 feet inland from the shoreline. Through the years, I noticed the shoreline creeping closer and closer to the homes. Eventually, water from the Gulf of Mexico eroded the pilings to the point that the houses eventually collapsed, and one by one those homesteads were lost. For whatever reason, I never saw any meaningful preventative measures taken to prevent that from occurring. Medicine has likewise faced an insidious erosion of its traditional foundation over the past several decades. Concern for quality of care has now taken a back seat to profit. Our role as the principal driving force in the health care equation is being challenged by non-physician “doctors” and “providers” of various disciplines, aided and abetted by insurance companies and hospital executives. Unfortunately, even our heavily lobbied legislative representatives are culpable. The various nonphysician “provider” organizations have leveraged these changes by a large and active membership, which has given them monetary advantage over many physician-led organizations. Therefore, ladies and gentlemen, we physicians are a large part of the problem. We are our own adversaries. There has been no profit in our projecting blame for these changes onto these other organizations when our own membership numbers are so low. Our apathy and passivity have rendered us complicit in surrendering our position as the driving force in health care, a position which is now more important than ever. Others of us are so busy that we, like the homeowners near the causeway, do not notice what is happening around us. That is why we must rely on grassroots medical societies to keep us abreast of these changes and to challenge those which may adversely affect our practices. Let me remind you that one day we are all going to be patients. When that inevitable day comes, what do you hope our health care model will look like?
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As incoming president of the Maricopa County Medical Society (MCMS), I intend to work toward the following goals in 2021: First and foremost, I will begin an aggressive campaign to increase membership in the organization by underscoring what we can do with strength in numbers, and by pointing out the advantages of membership. I will collaborate more closely with ArMA and AOMA and other physician-led organizations in the state to address and challenge issues that adversely affect patient care and physician practices. I will promote complimentary CME programs co-sponsored by MCMS and our partners that will address common clinical issues confronting physicians. By mid-year I hope these programs will be live half-day seminars that will foster face-to-face physician interaction and personal exchange. In the meantime, a virtual spring CME program on general medicine is on the drawing board. I will continue the MCMS community outreach programs for physicians, patients and public health entities to maintain the primary role of MCMS in supporting the physicians who provide patient care in the community. Thank you for the opportunity to serve as your president of Maricopa County Medical Society. With your help, the Board of Directors and I will continue to work tirelessly this coming year to accomplish these goals and grow our society. Respectfully,
John Prater, DO Dr. Prater moved from Ft. Myers, FL to Phoenix in 2017 and shortly thereafter became a Director on the Board of Maricopa County Medical Society. He was active at the state and local levels of organized medicine in Florida for decades where he served in several physician leadership positions, including President of the Southwest Florida Psychiatric Society and President of District Eleven of the Southwest Florida Osteopathic Medical Society. He is a board-certified psychiatrist currently practicing at the Phoenix VA Medical Center.
Creighton’s Creighton’s four-year four-year medical medical school school is is coming coming to to Phoenix. Phoenix.
New New health health sciences sciences campus campus to to open open in in fall fall 2021. 2021. Creighton is expanding in the Southwest with a Creighton is expanding in the Southwest with a 183,000-square-foot, state-of-the-art interprofessional 183,000-square-foot, state-of-the-art interprofessional campus. The expansion will make Creighton the largest campus. The expansion will educator make Creighton the largest Catholic health professions in the nation, and Catholic health professions educator in the nation, we’re proud to bring a full range of health sciences and we’re proud a full range of health sciences programs to to thebring region. programs to the region. This expansion was brought to life through the This expansion was brought life through the Alliance, Creighton University Arizonato Health Education Creighton University Arizona Health Education Alliance, a partnership between Creighton University, Dignity a partnership between Creighton University, Dignity Health St. Joseph’s Hospital and Medical Center, Health St. Joseph’s Hospital and Medical Center,
Learn more at creighton.edu/phoenix Learn more at creighton.edu/phoenix The Creighton Alliance includes: The Creighton Alliance includes:
Valleywise Health, and District Medical Group. The Valleywise Health, will andprovide District access MedicaltoGroup. The Creighton Alliance high-quality Creighton Alliance will provide accessstudents to high-quality teaching environments for Creighton and teaching for Creighton and residents,environments and it’s a natural extensionstudents of our mission. residents, and it’s a natural extension of our mission. As a Jesuit, Catholic university, Creighton has been As a Jesuit,changemakers Catholic university, Creighton has been educating for more than 140 years. educating changemakers for more than 140 years. We’re proud to continue that tradition in Phoenix We’re that tradition in Phoenix as we proud partnertotocontinue help passionate students become as we partner toprofessionals. help passionate students become compassionate compassionate professionals.
FROM THE EDITOR-IN-CHIEF
N E W DE S IG N, G R E AT E R F O C U S ON YOU I am pleased to announce Arizona Physician has a new design for 2021 and will include a greater focus on you and other physicians. The cover story will remain a physician, but the structure of the magazine sections will become consistent. More importantly, the content will highlight the work and impact of more doctors throughout the pages of each issue. It is important for physicians to hear from their peers and learn about perspectives on medicine across specialties, patient populations, employment settings, and geographic locations.
W H AT ’ S I NS I DE ? Our theme for this issue is Major Health Issues of Arizona. We thank Sheila Sjolander, Assistant Director of the Arizona Department of Health Services for sharing the new Arizona Health Improvement Plan, an updated effort to develop “a set of health priorities with plans to implement actions to address those priorities.” Included in the five priorities for 2021-2025 is mental well-being, including social connectedness, substance use, and suicide prevention. One person who lived through substance use and now treats colleagues to improve their mental well-being is Monica Faria, MD, FASAM. We are honored Dr. Faria shared her journey with us. It is powerful and worth your time reading. Another of the health priorities, and major health issues in Arizona, is fostering health in all policies. Along those lines, we convinced William Riley, George Jacobson, and George Runger to explain the Targeted Investments Program. It is a five-year, $285 million program of the Arizona Health Care Cost Containment System for incentivizing providers to develop systems for integrating physical and behavioral health. In our section What Arizona Docs are Saying, we ask several physicians what they see as major health issues in the state. We also dive into what
motivates them, the role physicians should play in promoting health equity, and get some advice for medical students. Thank you to Drs. Miriam Anand, Adrienne Forstner-Barthell, Pamela T. Frazier, Brenda LaTowsky, Ann Cheri Foxx Leach, Paul Lynch, and Edward Patterson for sharing their views. Those are just some examples of what you’ll find inside this issue of Arizona Physician.
S H A R E YOU R T WO C E N T S We strongly encourage more physicians to share their views on any topic related to clinical care, training, medical education, or something else related to the practice of medicine. You have a few options for sharing your perspective as a doctor. In addition to quarterly issues of the Arizona Physician print magazine, we will publish content in the digital version of the magazine. We welcome your articles for consideration. Finally, we publish two episodes of Arizona Physician Podcast each month. We are recruiting more physicians as guests. The short episodes, usually 15 minutes, cover a wide range of topics.
T H E T E A M BE H I N D A R I Z ON A P H Y S IC I A N I applaud everyone working behind the scenes to create each issue of Arizona Physician and to disseminate content you care about. Chief among them are physicians serving on the Board of Directors for the Maricopa County Medical Society. Edward Araujo is our Managing Editor and Randi Karabin is our new Creative Designer. Ben Scolaro provides photography.
We are looking for article contributors, podcast guests, and virtual event presenters. Contact us at information@arizonaphysician.com for these and many more opportunities. 6
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Enjoy the magazine.
By John E. McElligott, MPH, CPH
W H Y BECOME A
Maricopa County Medical Society member?
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Patient Referrals Helping patients reach you
Professional Referrals From legal, financial, etc.
We create an environment that serves physicians’ best interests
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BRIEFS
NEWS AND NOTES FROM THE FIELD
Coping with Stress
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hysicians and caregivers face stressful situations daily, but the COVID-19 pandemic has shone a light on their emotional wellbeing needs. Retired physician William Morgan, MD, MA, is Founder of the Arizona Asthma and Allergy Institute. After retiring from medicine, he flunked retirement and went back to school for a graduate degree in counseling psychology. He is particularly interested in physician resilience. Dr. Morgan says the simplest method to seek support is to follow guidelines found online at mentalhealthfirstaid.org.
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MAKE A TOOL KIT WHAT NEEDS TO BE DONE | Simple things like
groceries and activities of daily living WHAT MAKES YOU HAPPY | Plan
your hikes or take-out from your favorite restaurant JOURNALING | It helps to
ventilate both tough and good times COMMUNICATE | Call a family
member, friend, colleague or mentor every day. Reach out to someone you haven’t talked to in a while — chances are they need to hear from you too.
PROVIDE SELF-CARE
SLEEP | Get 7-8 hours, set a
routine to wind down, limiting screen time EXERCISE DAILY | Even a short
20-minute walk helps
RELAX AS NEEDED | Try deep
breathing and a pleasant memory LIGHT THERAPY | If you are prone
to Seasonal Affective Disorder MEDIA CONSUMPTION | Know
when it is time to walk away HEALTHY ACTIVITIES | Do things you enjoy but avoid alcohol and drugs SEEK COUNSELING | Often hard
for physicians to do, but nobody can go this alone
5 HEALTHCARE TRENDS FOR 2021 2021 may feel like a breath of fresh air, yet many issues linger and solutions for efficient and quality healthcare are out there. Here are some healthcare trends for 2021.
VALUE-BASED CARE | Value-based care is
a form of reimbursement that has emerged as an alternative and potential replacement for fee-for-service reimbursement which pays providers retrospectively for services delivered based on bill charges or annual fee schedules. Value-based care aims to advance the triple aim of providing better care for individuals, improving population health management strategies, and reducing healthcare costs.
TELEHEALTH CONTINUED | Telehealth has
allowed patients to receive the same level of care at home as they would form a visit to the doctor’s office. The number of virtual visits has gone up during the pandemic and Forrest predicts they will hit one billion by the end of 2020. Telehealth reduces the risk of the spread of the virus and allows physicians more patient consultations.
SMART HOSPITALS | A hospital’s ability
to optimize, redesign or build new clinical processes, management systems and potentially even infrastructure, enabling its underlying digitized networking infrastructure of interconnected assets, to provide a valuable service or insight which was not possible or available earlier, to achieve better patient care, experience, and operational efficiency. A critical component for smart hospitals will be the ability to provide a valuable service of insight, which was simply not possible or available earlier.
MODERNIZED PPE STANDARDS | To mini-
mize exposure to infectious diseases, more hospitals will rethink personal protective equipment (PPE) and modernize standards to include hands-free communication technology. In addition to protecting people, hands-free communication can save valuable time and resources.
MENTAL HEALTH | Mental health will
become an even bigger issue as the breadth of individuals experiencing depression during the pandemic is fully realized. There will be efforts to address issues such as loneliness, depression, and social isolation. The pandemic has pushed the importance of progress in mental health and communitybuilding to the forefront.
7 FREE RECIPE APPS ON IOS & ANDROID TASTY | Through their great videos on social media, Tasty provides great step-by-step instructions and keeps your phone’s screen awake while it does so. You will get the earliest access to the latest Tasty videos plus filters allow you to search vegan, vegetarian, and gluten-free recipes. BBC GOOD FOOD | Yes, you heard right, not just news! BBC Good Food brings you over 10,000 recipes from both users and tested recipes. Its easy to create and save your favorite recipes for later use. SUPERFOOD | Great app that offers very tasty and healthy recipes using ingredients in line with where you live. The app allows for saving of grocery lists plus each recipe allows you to see the nutritional information to ensure a healthy diet. Great for using on a tablet. NYT COOKING | With over 19,000 saved recipes, beautiful photography, and easy to follow instructions, NYT Cooking is a must use app. BIG OVEN | This app has over 350,000 recipes! You will be able to add snapshots of your recipes and even make a grocery list in the app. Big Oven has a social media component that allows you to share and check out what family and friends are making. YUMMLY | Through a great search engine, Yummly allows you to tailor searches to fit your needs and eating. EPICURIOUS | One of the first and most recognizable cooking apps, Epicurious proves over 35,000 members rated and tested recipes through a beautiful interface. The app allows you to manage shopping lists and recipes across multiple device platforms.
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How to Take Great Photos RESEARCH THE AREA Research area you are going to shoot Look in the “Images” tab on Google and study photos from other photographers. Note what you like and do not like. Consider what composition elements work at this location. Then, plan what you want to achieve on the shoot. LIGHTING IS 90% OF THE BATTLE! I ask myself what time of day I will
be shooting. There are only two options — sunrise and sunset. The first hour and last hour of daylight are called “The Golden Hour.” The light is low and soft, and your subject will really pop! THINK ABOUT COMPOSITION Here are the basic rules of composition. First, simplify your images — declutter your foregrounds and backgrounds. Second, use the rule
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(continued from opposite page) of thirds by putting your subject on intersecting lines of thirds. Third, use leading lines. If you spend some time thinking about your composition, then your photos will start to look professional. GET AWAY FROM PATH This is my favorite moment — I’m on site and ready to shoot. My number one piece of advice is to get away from the path. I see lots of photos from amateurs where you can see a beautiful mountain but there is also a hiking trail or even (God forbid) some people or signs in the foreground! Find a spot where you create a simple but compelling scene. CHANGE YOUR PERSPECTIVE Think about capturing the scene differently than others have before. That means changing your perspective. Sometimes I get low in front of a cholla cactus. Other times I get high and shoot down or employ advanced techniques like focus stacking or perspective blending. My final piece of advice is to think of your photo as four parts — foreground, midground, subject, and sky. Think about each of these elements and you will start to take amazing photos!
Paul Lynch, MD, CEO of Arizona Pain Inc, lynchmd@gmail.com. Paul trained at the New York Institute of Photography.
Be a Podcast Guest
E
very physician has contributed to advancing health care for their patients and pushing the medical community forward. If you have something to say about your work or have tips to share with fellow doctors, then please consider being a guest on the Arizona Physician Podcast. With two short episodes a month, the show highlights a wide range of topics in healthcare and medicine impacting the physicians in Arizona. Have an idea for a topic or guest? Contact us at information@arizonaphysician.com.
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GettingWELL HOW THE ARIZONA HEALTH IMPROVEMENT PLAN WILL ACHIEVE THIS
LEARN MORE Please visit azhealth.gov/azhip if you would like to learn more about the AzHIP or contact the AzHIP team (AzHIP@azdhs.gov) to find out how you can participate. 12 n
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ith a vast array of health issues impacting Arizona, it becomes critical to set priorities to focus action on where it is needed the most. The Arizona Department of Health Services (ADHS) has taken on this task and articulated a set of health priorities with plans to implement actions to address those priorities. The Arizona Health Improvement Plan (AzHIP) AzHIP was first established in 2016 to provide a five-year roadmap with 17 health priorities covering issues like chronic disease, mental health, injury prevention, maternal & child health, access to care, and the built environment. The process brought together a network of partners to align resources and efforts so that the plan reflects collective action taken by multiple partner organizations to achieve the goals and actions set forth. ADHS and its partners are preparing to measure their impacts and transition activities as the five-year life span of the plan closed at the end of 2020.
Get Involved Currently, the development of the next five-year plan for 2021-2025 is underway. The new AzHIP will focus on a smaller number of priorities which underlie multiple health issues and disparities. Priorities were informed by data in the Arizona State Health Assessment and established with community input and guidance from the AzHIP Steering Committee. The 2021-2025 priorities are: Health Equity Health in All Policies/Social Determinants of Health (with an initial focus on housing) Mental Well-being (including a focus on social connectedness, substance use, and suicide prevention) Pandemic Recovery Rural Health & Urban Underserved (including a focus on access to care) While health equity stands as a distinct priority of new AzHIP, it is core to achieving progress in all of the priority areas and is intended to be integrated throughout the plan. The AzHIP Health Equity Core Team offers the following definition of health equity, adapted from the Centers for Disease Control and Prevention: “Health equity is defined as every person having a fair and just opportunity to “attain their full health potential,” and is achieved when individuals who are impacted by injustices are co-creating solutions and policies. When systems are responsive to communities, health equity is achieved and health injustices are eliminated. Health injustices include differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; access to treatment; and/or disadvantages due to race or other socially determined circumstances.” The development, and impact, of the AzHIP is the result of the hard work of public health professionals, advocates and community stakeholders at the state, county and community levels. The AzHIP is a plan for the entire state and reflects the commitment to improving public health by multiple partners. ■
ADHS encourages Arizona physicians to engage in opportunities to address these health priorities in the communities and systems in which you work and live. Suggestions for consideration include: Join the Arizona Maternal Health Taskforce and lend your clinical expertise in addressing health disparities in maternal health outcomes and learn more about our Governor’s Goal Council Action Plan. Contact us at maternalhealth@azdhs.gov
Learn more about how to get involved with the Arizona Area Health Education Center (AHEC) and the five statewide Arizona AHEC regional centers that support local efforts to develop health professions workforce education programs in rural and urban medically underserved areas.
Ensure your patients that may be at risk of an opioid overdose have a prescription for naloxone and family members or friends know how to use it.
Consider how the social needs of your patients impact their health. Refer patients to 211 (211arizona.org/ or dial 2-1-1) for information about assistance for financial needs like utilities and rent, for crisis counseling, and for other resources.
Create opportunities for all public facing/frontline staff to receive evidence-based suicide prevention training.
Become knowledgeable of insurance coverage options for non-opioid therapies for pain management services.
Learn how to identify signs and symptoms of loneliness related to social isolation.
By Sheila Sjolander, Assistant Director, Arizona Department of Health Services, Division of Public Health – Prevention Services A R I ZO N A P H Y S I C I A N . C O M
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Improving
Behavioral Health and Primary Care Integration T
his article describes the Targeted Investments (TI) Program, the Arizona Health Care Cost Containment System’s (AHCCCS) strategy for incentivizing providers to develop systems for integrating physical and behavioral health. The TI Program is a five-year project that provides financial incentives totaling $285 million to eligible AHCCCS providers with the aim to reduce fragmentation between acute care, primary care, and behavioral health care; increase efficiencies in service delivery for members with behavioral health needs; and improve health outcomes for AHCCCS members. The TI Program includes approximately 150 health care organizations and consists of six areas of concentration (Adult Primary Care Providers, Adult Behavioral Health Providers, Pediatric Primary Care Providers, Pediatric Behavioral Health Providers, Criminal Justice focused clinics, and Hospitals). For each of these areas of concentration, AHCCCS has established milestone targets that support improved care coordination and clinical outcomes through use of standardized performance measures. Historically, care coordination between primary care providers and behavioral health providers for persons with behavioral health disorders has been extremely challenging. This is due to many factors including separate payer sources, distinct clinical structures, and unaligned provider communities.
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The consequence is that important patient care guidelines are poorly met. Nationally, 73% of children three to six years of age with Medicaid coverage received a well-child visit with a primary care provider in the last 12 months; metabolic monitoring for children on antipsychotic medication is 35%; diabetic screening for adults with severe mental illness on antipsychotic medications is 80%; and the ambulatory follow-up for hospitalized adults discharged for severe mental illness within 30 days is 58%. Similar to national performance, adults and children in Arizona covered under the AHCCCS program have gaps in care when compared to clinical standards.
QUALIT Y IMPROVEMENT METHODS THAT IMPROVE OUTCOMES The TI Program is currently in its fifth year. Since 2019, AHCCCS has partnered with a team from Arizona State University (ASU) led by Dr. William Riley and Dr. George Runger, from the College of Health Solutions, to develop a Quality Improvement Collaborative (QIC) for assisting the TI participating providers to meet their performance measure target. Quality Improvement (QI) methods have been widely used in the health care delivery system over the last 20 years to successfully improve outcomes and increase
William Riley, PhD, Professor in the College of Health Solutions at Arizona State University, Director of the Safety Net Advancement Center | William.J.Riley@asu.edu
value. A QIC is a common approach in health systems to improve performance and involves interdisciplinary teams sharing best practices, peer learning, and routine performance updates. Successful QICs take an active collaborative mindset, strive for improvement rather than perfection, and do not consider themselves in competition with other participating organizations. Typically, a QIC focuses on a process or outcome measure that is achieved based on the standardized delivery of evidenced based care. A QIC is facilitated by experts knowledgeable about the clinical content as well as QI methods and techniques. The TI Program QIC consists of interdisciplinary participants from all organizations participating in the TI Program. A minimum of two designated champions from each organization, a clinical representative and an administrative representative, participate in the TI Program QIC. Participants in this QIC are eligible to receive up to 28 Continuing Medical
Education/Continuing Education Units. TI participants in the QIC use QI techniques to improve performance and gain competency with a variety of QI methods such as root cause analysis, process engineering, cause and effect diagrams, and statistical process control to better understand process problems and make progressive metric improvements. Additionally, by engaging with their peers, providers are able to identify and mitigate barriers to achieving milestone targets. TIP providers participating in the QIC are provided with timely and actionable performance metric information calculated by ASU. Each provider has access to a webbased dashboard that displays their performance on TI program measures, allowing providers to review their performance measures in a consistent, organized manner and review historical trends. ■
George Jacobson, MPH, Project Administrator of the Targeted Investments Program at AHCCCS | george.jacobson@azahcccs.gov
George Runger, PhD, Professor in the College of Health Solutions at Arizona State University, Director of the Center for Health Information Research | George.Runger@asu.edu
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Monica Faria, MD, FASAM
From the Brink to Redemption C ON N E C T I NG T H E P I E C E S Born in Los Angeles, Monica Faria’s Guatemalan family spoke no English. The multicultural childhood laid the foundation for her career in psychiatry, making the young Dr. Faria sensitive to what others were saying and feeling. Despite being drawn to sciences, animals, and nature in high school, she did not have the selfconfidence to see medicine as a path forward. That changed in college. While attending Northern Arizona University (NAU), an advisor helped her to connect the pieces, pointing out that medical school was within reach. Dr. Faria was studying the burgeoning field of neuroscience, which merged her favorite studies of psychology and biology. When she started hearing about Freud’s theories
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for emotion predicated upon molecules and neurotransmitters, she was hooked. Dr. Faria recalls in influence of books such as Molecules of Emotion by Candice Pert, which presented the body and the mind as a fluid system.
R E S I DE NC Y T O T H E BR I N K After surviving the University of Arizona College of Medicine, Dr. Faria accepted a general surgery residency because the specialty symbolized strength and courage and was a way for Dr. Faria to deliver immediate results to her patients. But the second year of residency pushed her to the brink. Overburdened by long hours and constant paging, working thousands
of miles away from home, and being among few Latinas doctors brought little to no satisfaction. After two years of anguish, Dr. Faria left what she and others viewed was a malignant residency program on the East Coast. She had never felt that level of desperation before and began to see a psychiatrist for support. Looking back, Dr. Faria sees a young woman who was extremely depressed, at times suicidal, and who was not given the resources or time to get things figured out. After checking herself into a hospital for treatment, her doctor said physicians had to ‘live with depression.’ So, Dr. Faria followed the treatment team’s recommendations for medications and an extensive outpatient program with group therapy. Over the next few weeks it helped her recover and see a way forward.
R E DE M P T ION At her family’s urging, Dr. Faria returned to Arizona. Without a license to practice, she worked at a law office and got a crash course in organization, legal writing, and health care law. A year later, when she applied for a medical license, Dr. Faria was no longer seeing a psychiatrist or using medication. One question asked if she had suffered from a medical condition that could impair her ability to practice. Feeling like she was in a stable situation, Dr. Faria didn’t feel it necessary to reveal that she had checked into a hospital for treatment. After an eightmonth wait, the Arizona Medical Board requested her entire medical history, stating they were not convinced her condition had been resolved and were not ready to grant her licensure. Later they denied her application, citing unprofessional conduct for omitting the details of her mental health treatment. The Board gave her the opportunity to reapply if she would follow certain requirements, including undergoing a comprehensive mental health and substance abuse evaluation. Under a significant amount of anxiety, Dr. Faria’s new psychiatrist put her back on medication and advised she undergo said evaluation at Talbott Recovery in Georgia, founded by renowned cardiologist Dr. G. Douglas Talbott who had been in recovery himself and was a formative figure in the AMA’s Impaired Physicians Program. At Talbott, Dr. Faria met with multi-disciplinary teams who provided a 360-degree assessment. They confirmed her history of depression and other co-morbid conditions were stabilized. Also, they concluded she had only intermittingly abused substances in the past but that she did not have a substance disorder. Unfortunately, the Arizona Medical Board rejected Talbott’s evaluation findings and requested she attend a place of their choosing. Staff at The Meadows of Wickenburg provided a similar assessment. They also identified a history of depression, eating
“A journey into the unknown territory of the mind is fraught with confusion and anxiety. I cannot afford delaying embarking on a quintessential mission to discover a reason to endure the heartache and tragedy that inevitably comes with living an all too human existence.” —Kilroy J. Oldster, Dead Toad Scrolls
disorder, and substance abuse yet they found no current impairment. That assessment, and in conjunction with the approval from two consultants to the Arizona Medical Board, allowed her to finally get licensed to practice medicine in Arizona. Through the difficult journey, Dr. Faria found several allies, including the two consultants who would later become mentors during her fellowship and even business partners later in her career. Newly licensed in Arizona, Dr. Faria worked in an urgent care setting. Enjoying one-on-one interactions with patients confirmed psychiatry would be a better fit for a specialty. Nearly three years after she first applied for licensure she had learned what she needed to do to stay healthy and found herself in the right place in life to shift specialties.
T H E W HOL E S Y S T E M Since becoming a psychiatrist, Dr. Faria has wanted to overcome the stigma associated with mental illness. Seeking care is often seen as a weakness, not on par with maintaining physical health. Dr. Faria says we can change that perspective, “Through education, support, and by having payer systems that understand the need for more time with patients.” Besides, mental health, physical health, and spiritual health are interrelated. Dr. Faria is pleased to see more research showing links between the nervous system and immune system. Although emotions are physiological changes that directly impact how we behave and view the world, Western medicine remains focused on treating disease, not preventing it. Dr. Faria sees this evolving. She says, “Psychiatrists are collaborating with their medical peers to treat patients in an integrative way through medical home models and improved electronic medical records to allow interdisciplinary communication.” For her patients, Dr. Faria consults with fellow physicians to provide a more holistic diagnosis and treatment plan.
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On the Personal Side with Dr. Faria Q: If could describe yourself in one word, what would that be? A: Warm Q: Do you have family? Pets? A: Yes, my brothers and mother live in town. Me personally, I’m single. Gio, a twelve-year-old Maltese poodle is my four legged child. My patients sometime call to see him, but I don’t get offended.
Q: Do you have a hidden talent most people wouldn’t know about you? A: I’m a black belt in Taekwondo. Q: What career would you be doing if you weren’t a physician? A: I’d probably work with animals or work with flowers.
What book are you reading right now? Or recently? A: John Gottman, The Science of Trust. It’s about how people turn to each other for emotional connection.
Q: What’s your favorite movie? A: Contact with Jodie Foster Q: What’s your favorite food? A: Greek or Middle Eastern Food or Pizza Q: What’s your favorite local restaurant? A: Persian Room Q: What’s your favorite sports team? A: I don’t watch sports. Q: What’s your favorite activity outside of medicine? A: I love hanging out by the beach.
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C A R I NG F OR C OL L E AG U E S Most of her patients are adult health professionals who are symptomatic from an addiction or mental illness. Often, with chemical addictions to alcohol or opioids or behavioral addictions like gambling, pornography, or hoarding, some patients have co-occurring conditions. Dr. Faria identifies what patients need, helps them to get through the initial period of peeling away what has been pathological, and then guides them to find a healthier outlook. The process can take years, because a big challenge is motivating patients to see a new path forward. Addiction treatment may also involve educating family or involving them in the recovery process whenever issues at home led to the addictions. Dr. Faria views medical societies as playing a pivotal role in physician wellness. She says, “It’s about connection, mentorship, and the idea that you can do more in numbers through synergistic collaboration than alone.” As President of the Arizona Chapter of the Society of Addiction Medicine, she saw how professional and personal bonds provide physicians with a stronger coping network to lean on whenever they face what may seem to be insurmountable stress. Everyone, including physicians, need mental health hygiene, including outside support. Dr. Faria says, “We need to have people seek outside help to understand where they’re at, decide if they want to change, and then link them with someone who can help over the long term.” She continues, “This is more than reacting only when patients are in extreme distress before helping them. We are still somewhat away from that happening.”
A DVO C AT I NG F OR BE T T E R P H Y S IC I A N M E N TA L C A R E Most doctors are slow to admit they have an issue because they are afraid of the impact it will have on their career. Unfortunately, that can be true. Physicians don’t have the same privacy protections as their patients, which can lead to investigations, potential loss of liability coverage, and loss of employment. Although every state medical board has a different physician health program with different structures and/or requirements, Dr. Faria sees improvements happening locally and elsewhere. Questions on licensure applications focus more on present conditions and less on the past. This leads to fewer inquiries into a physician’s medical history. Also, more consultants and treatment centers have been added to the resources the Arizona physician health program relies upon. This allows for improved access to evaluations and/or treatment, which can speed up the process of license reinstatement for many. Still, Dr. Faria would like to advocate for a safe-haven for physicians to seek help without repercussions on their medical license. She also advocates for consistencies across the various state physician health programs. For example, Dr. Faria argues there should be a national standard on the type of specialist who treats the complex needs of physicians.
SUBSCRIBE TO THE ARIZONA PHYSICIAN PODCAST Monica Faria, MD will be a guest in April 2021 discussing her residency experience and physician wellness.
FAST FACTS ON PSYCHIATRY Psychiatry is the study of treatment of mental illness, emotional disturbances, and abnormal behavior.
Psychiatry’s inception as a medical specialty dates to the middle of the nineteenth century by German physician Johann Christian Reil, who coined the term, and German psychiatrist Emil Krapelin, who published a comprehensive system of psychological disorders that centered on a pattern of symptoms (i.e., syndrome) suggestive of an underlying physiological cause.
Another topic to tackle is the Arizona requirement for physicians to report a peer who is impaired or suspected of being impaired. “Even though that rule is in place for the greater good, it has stopped physicians from speaking to one another,” says Dr. Faria. “It has stopped physicians from being one another’s best medical and behavioral resources for the fear that engagement may get them reported.” The Arizona Medical Board and the Arizona Board of Osteopathic Examiners are aware of these challenges. Now more than ever, they are receptive to ideas on how to help improve the system. Cases before the boards are being reviewed by more physician consultants, which leads to faster resolution. The boards are also allowing for assessments of monitoring to be done sooner and chances for review are being given more consideration.
SOURCE: nobaproject.com
Today 1 in 5 adults, nearly 47 million Americans are being treated for mental health conditions.
SOURCE: Psychiatry.org
Prevalence rates of depression and anxiety among medical student have een recorded as between 25% and 56%, which is greater than the estimated prevalence in both agemathced cohorts and the general population.
SOURCE: psychiatryonline.org
A DV IC E F OR P H Y S IC I A NS Dr. Monica Faria believes the most important thing for her fellow physicians to know is that “you’re not alone and it’s never too late to get better.” Addictions and some mental health disorders can distort our view of what’s possible, because of changes in the brain. When someone is dealing with advanced addiction or other mental health condition, the part of our brain designed for complex decision making and creative solutions does not work property. It’s important to break the cycle by seeking help. ■
By Edward Araujo, Maricopa County Medical Society (MCMS), Communications Coordinator, earaujo@mcmsonline.com
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What
Arizona
DOCS are Saying
Providing the best care to my patients inspires me to improve. I spend time outside of clinic reading medical literature, speaking with peers about challenging cases or new technologies, and researching new and alternative treatments for patients. —Brenda LaTowsky, MD
What motivates you to improve as a physician?
My philosophy is to treat every patient as if they were my own mom or dad. While my care is driven by medical knowledge, it is important to remember you are treating a person. I became interested in pain management when I was in medical school, as I experienced my mother-in-law suffering from end-stage pancreatic cancer. I became completely enmeshed in her care and saw how vitally important it was to provide pain relief and comfort. I often still think of that as I meet with patients and their family members. I can see myself in their shoes and know how desperately they want help for their loved one. —Paul Lynch, MD To improve my knowledge because of the trust that my patients have in me. We are mandated by the state to obtain a certain amount of continuing medical education. But, more importantly it is the patients that motivate me to stay current on medical issues and treatments. —Edward Patterson, MD
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Learn more about the participating physicians Miriam Anand, MD, FACP, FAAAAI, FACAAI PRACTICE | Allergy Associates & Asthma, Ltd. PHONE | (480) 838-4296 WEBSITE | allergyassoc.net LOCATIONS | Tempe, Mesa, and Chandler
What do you see are the major health issues in Arizona? Access to affordable care. Even patients with insurances often have deductibles that are prohibitive. Another challenge is on the PCP side, as their care model is structured against giving patients needed time and attention and focused on seeing mass numbers to pay overhead. —Adrienne Forstner-Barthell, MD The pandemic has increased depression, anxiety, substance abuse and loneliness. It has been a year of people feeling more troubled, depressed, and anxious due to fear, uncertainty and confinement. The inability to travel and see loved ones has been a major loss for many. The elderly and people who live alone are especially affected. At the same time, it has been more difficult to see mental health practitioners in person. The availability of virtual treatment has been very beneficial to maintaining health and wellness. —Pamela Frazier, MD COVID-19, healthcare disparities, and the erosion of the independent practice of medicine by physicians are major health issues facing Arizona. —Ann Cheri Foxx Leach, MD Another pandemic has continued to grow by exponential numbers. Initial data have shown that more drug overdoses occurred in 2020 than ever before, and Arizona has been hit particularly hard. The COVID-19 pandemic has highlighted where our healthcare system falls short in providing adequate treatment for those suffering from substance abuse disorders. As a pain management physician, I experience the struggle of finding appropriate resources to assist these patients, including inpatient services and behavioral health options. —Paul Lynch, MD
Adrienne Forstner-Barthell, MD, FACS, FASCRS PRACTICE | Arizona Advanced Surgery PHONE | (602) 993-2622 WEBSITE | arizonaadvancedsurgery.com LOCATIONS | Avondale, Chandler, Gilbert, Glendale, Mesa, Peoria, Phoenix, Scottsdale, and Sun City West Pamela T. Frazier, MD PRACTICE | Pamela T. Frazier, MD PHONE | (480) 425-7927 LOCATIONS | Scottsdale
Brenda LaTowsky, MD PRACTICE | Clear Dermatology & Aesthetic Center PHONE | (480) 398-1550 WEBSITE | cleardermatology.net LOCATIONS | Scottsdale
Ann Cheri Foxx Leach, MD PRACTICE | Nocio Interventional Pain Management PHONE | (480) 818-4314 WEBSITE | nociopain.com LOCATIONS | Scottsdale
Paul Lynch, MD PRACTICE | Arizona Pain Specialists PHONE | (480) 500-6038 WEBSITE | arizonapain.com LOCATIONS | Chandler, Gilbert, Glendale, and Scottsdale
Edward Patterson, MD PRACTICE | Panda Pediatrics and Adolescent Care PHONE | (602) 257-9229 WEBSITE | pandapediatricscare.com LOCATIONS | Phoenix
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What role should physicians play in promoting health equity? It is important for physicians to have some level of involvement in the policy process. This includes at their place of practice/employment by participating on committees or in a leadership role and supporting those who advocate for us in public policy through membership in organized medicine. —Miriam Anand, MD I would love to see more physicians in leadership roles. If a physician is not wanting to pursue a leadership role, then there are other ways to promote health equity. For instance, during the shutdown in Arizona my practice set aside several telemedicine slots for uninsured patients. —Brenda LaTowsky, MD Physicians should first enlighten themselves regarding health equity issues then aspire to become leaders in conversations about health equity. —Ann Cheri Foxx Leach, MD
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We have a duty to treat every patient with dignity and respect and advocate for patients who may not be able to advocate for themselves. With respect to patients suffering from addiction, I think it is imperative the physician treat these patients without prejudice or judgment. Physicians must also be a voice in their communities and healthcare systems, to ensure that underserved patients are made a priority and provided equal access to care. We cannot shy away from difficult conversations regarding the state of our healthcare system or be afraid to stand up against healthcare bureaucracy. I acknowledge this takes time, commitment, and work, but as healthcare professionals, this is what we are called to do. —Paul Lynch, MD
Arizona is growing rapidly. How will more residents impact your specialty? While this is less of an issue in the urban areas, there are parts of our state where there are no allergists available and patients must drive long distances to get this care. However, there have been several positive changes over the years that will help. For decades, there were no allergy/immunology training programs in Arizona and we now have two. We also have a few new medical schools in Maricopa County, but increased Graduate Medical Education (GME) funding will be important to increase available residency slots to keep more of the graduates practicing in Arizona. —Miriam Anand, MD It will make it harder for patients to get an appointment with a psychiatrist. A growing population will also require psychiatrists to work with psychologists and social workers to provide patients with the combination of psychotherapy and medication management that is necessary to attain and promote mental health wellness as well as growth. For many psychiatrists there will be increased pressure to see more patients, narrowing many practitioners to medication management. —Pamela Frazier, MD More residents mean more patients and more dermatologists in the area. I see this as a positive. I love to collaborate with others in the community and I think more dermatologists will lead to potentially more dermatology residents and the opportunity for sub specialization. —Brenda LaTowsky, MD There will be more demand for services in the face of decreasing reimbursements from third-party payors. This creates the challenge for physicians to meet demands with limited resources. Meanwhile, patients are complaining about rising insurance costs and, in some cases, less comprehensive insurance policies or higher deductibles. This does not seem fair to patients or physicians. —Ann Cheri Foxx Leach, MD
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Arizona now has six medical schools. What advice would you offer to aspiring physicians? Educate yourself about business, do not over commit financially when you get out of school. Most importantly always stay teachable and prepare to work harder and longer hours the first few years out of school to build your practice. Search out mentors and ask for advice and follow it- successful doctors got that way for a reason and most of us are happy to advise and help show others a good path. —Adrienne Forstner-Barthell, MD We are fortunate to offer multiple medical school choices to students who want a career in medicine. Ours continues to be a dynamic, rewarding field. It offers opportunities for treating patients, doing research, and teaching. There are many challenges and rewards, offering different roles to physicians over the course of their careers. —Pamela Frazier, MD Pursue what you love. If there is a specialty, fellowship or even technique or procedure that you want to pursue, do it. I feel so fortunate to
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love what I do. The days are so much easier if you have passion for your work, and this passion will get you through the hard times. Also, find a practice setting where you enjoy your coworkers. A positive and healthy workplace is so important and contributes to your mental health immensely. —Brenda LaTowsky, MD Seek out a wide variety of experiences in various medical fields. There are many ways to help people that are fulfilling and a service to the community. —Ann Cheri Foxx Leach, MD I would advise aspiring physicians to be aware of physician saturation not only of physicians but of nurse practitioners. And that they should be committed to the medical care of patients as the reward and not as much financial. The field has many rewards in patient relationships and the trust they have for us as physicians. —Edward Patterson, MD
We need to support our physicians in practice. Physicians are at increased risk of experiencing burnout. Consequently, burnout must be recognized, confronted, and treated early to prevent mental illness and suicide which are at high rates for physicians. Better information about burnout and prevention must be included in medical school curriculum. Professional organizations for physicians, for example,
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There needs to be reform of both the process to add new physicians to existing group practice insurance contracts (docs can end up shut out up to a year) and of the authorization of care for surgical services. —Adrienne Forstner-Barthell, MD
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One of the issues that we face is that physicians often do not have a seat at the table when decisions are made that impact our ability to provide the best care that we can to our patients. History has shown us the impacts of this in relation to federal and state laws passed without physician input. Many have resulted in more “hoops to jump through” to care for our patients. Policies need to be developed that allow us to spend more time caring for our patients and less time documenting in the EHR, doing time consuming prior authorizations, etc. The recent E&M coding changes implemented by Medicare, while not perfect, are a step in the right direction. Changes that allow patients to have access to medical care and medications at reasonable costs are also needed. —Miriam Anand, MD
I would love to see more control being put back in the hands of the physicians. On a political level, this would mean physicians had more say in policymaking. On an insurance-level, this would mean physicians would be involved in medical decision making for the patients. On a hospital-level, this would mean that physicians would be involved to decrease waste and increase quality of care. On an individual practice level, this would mean physicians would be adequately compensated so that they can spend more time with their patients. These are difficult things to achieve. However, if these changes are made, the quality of health care would go up dramatically. —Brenda LaTowsky, MD ■
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What policies or systemic changes are needed for physicians to provide better care?
MCMS, have an important role to play in providing guidance, education, and social involvement to physicians in training and practice. —Pamela Frazier, MD
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LEGAL CORNER
2021 Asset Protection
FOR ARIZONA PHYSICIANS
P
hysicians should examine their estate and asset protection planning in 2021, due to increased risks including COVID-19, the economy, various current social, legal, and political variables. Unfortunately, not all strategies marketed to doctors are equally legitimate or effective. Here are some common mistakes to avoid.
FAILING TO ACT | Doing nothing or failing to act under blue skies, while you do not have any existing claim, is the single biggest and most common asset protection and estate planning mistake doctors make. KNOW AND MANAGE ALL YOUR RISKS, NOT JUST MALPRACTICE | Doctors are naturally concerned about professional liability, and you should be, but acting as if that your only significant risk can be financially fatal. You have risks as a business owner,
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employer, parent, real estate owner, board member and many others that must be managed; think holistically.
FAILURE TO LEAD AND MANAGE | Many exposures are based on a failure of leadership, management or compliance. The best way to avoid a lawsuit or any other exposure is still managing bad behavior that creates risk by yourself, family members staff and partners so you don’t have a problem to begin with. FAILING TO ADEQUATELY INSURE PERSONAL RISKS | I routinely speak to physicians that are un-insured or under-insured for both loss and liability related to their homes, cars, real estate investments and other nonpractice risks. Many of them contact me after an exposure, when options to protect
their assets are limited, less predictable and in some cases, even illegal. A personal umbrella policy of at least $1MM is the bare minimum, ideally higher.
NOT ADEQUATELY INSURING ALL BUSINESS RISKS | Medical practices require specific, high limit commercial liability insurance that goes far beyond their medical malpractice and general liability coverage. This coverage protects you against employment liability, data breaches, managerial malpractice and a variety of other business risks your med-mal policy does not cover. RELYING ON INSURANCE ALONE | Insurance is a vital line of defense but will always be limited in the scope of what it covers and excludes and the dollar limit to which it can be covered. Assume there will be a gap in coverage and have a back-up plan that limits your exposure. LEAVING INCOME STREAMS EXPOSED | Actively earned income streams are difficult to fully protect but passive income from real estate investments, interests in other businesses and personally held investments can much more predictable and tied to the eventual control of your estate plan. These income streams should be paid directedly to an entity that is legally distinct from your unrelated personal and professional liability, like a limited partnership, trust or other appropriate family holding company, instead of to you personally. MIXING ASSETS AND LIABILITIES | Some physicians continue to hold too many assets personally or mix assets that can affect each other in a single holding entity like an LLC (too many eggs in one basket). Common examples include not separating a medical building from the medical practice inside it, over-funding LLCs with too many pieces of property and mixing safe, passive assets like investment accounts with dangerous ones, like rental properties.
HOLDING ASSETS PERSONALLY | Assets held personally are available for all your personal and professional liability and may not be linked to the control of your estate plan. Long term assets should be held in the right legal entity that makes them legally distinct from your personal and professional liability. DIY STRATEGIES AND AMATEUR PLANNERS | Giving assets to relatives like a spouse or sibling, using “sham” liens recorded without a real exchange of value, and using LLCs as a magic bullet are common examples of strategies that will fail. It can be even worse however, when strategies include frivolous arguments, tax evasion, fraud and perjury. Not only will those strategies probably fail, but they also create additional legal jeopardy. FAILING TO USE THE RIGHT TOOLS | A revocable living trust, as one common example, is great estate planning tool but will not provide creditor protection during your life. An LLC is a great business tool but typically won’t protect the home you live in or your personal vehicles because it lacks legitimate business purpose. Asset protection planning is most effective when implemented as preventative medicine and should be implemented with the help of experienced experts that can diagnose your specific exposures and prescribe tools and risk management measures specific to your facts. ■
By Ike Devji, JD, Legal & Wealth Advisor, Pro Asset Protection, ike@azwealthlaw.com
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HOW TO
Advocating for Health Policies
‘T
is the season for advocacy. Organized medicine organizations like Maricopa County Medical Society work with partner associations, lobbyists, and elected representatives to ensure physicians are heard and priority items to improve medicine and public health are enacted and funded appropriately. For physicians living in Maricopa County, the two most likely groups to influence are the county Board of Supervisors and the Arizona State Legislature.
B OA R D OF S U P E R V I S OR S Each of the five elected supervisors represents one of the county’s five districts. The supervisors set the agenda for county priorities, oversee publicly funded programs, and approve department budgets. In response to the rise of COVID-19 cases in 2020, the Board of Supervisors required everyone in Maricopa County to wear face coverings in public settings. One department the Board oversees is the Maricopa County Department of Public Health, which protects county residents from food-borne illnesses, disasters, toxic exposures, and injury. They also address prevention of chronic diseases. During the COVID-19 pandemic, the county health department played a large role in tracking cases, communicating with doctors about ways to reduce the spread of SARS-CoV-2, and administering vaccines. Physicians may attend meetings of the Board of Supervisors, submit comments for the public record, and seek meetings with their respective supervisors to discuss health priorities.
BILL TRACKING: Search online by bill number to track
the latest information for anything proposed in either the House or Senate chambers. REQUEST TO SPEAK (RTS): This system allows the
public to register an opinion on any bill and request to speak in a committee. You must register for an account in person at one of the RTS kiosks at the Capitol. Then, you can participate remotely. Staff at Maricopa County Medical Society can help you through the process. Call us at 602-252-2015. | Check out azleg.gov for more information.
Arizona Senate
16
14
Arizona House
31
29
A R I Z ON A S TAT E L E G I S L AT U R E Arizona’s part-time legislators must pass a budget and consider a wide range of bills, some of which touch healthcare.
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16 Republicans, 14 Democrats
31 Republicans, 29 Democrats
E X P E R T S W E IG H I N
A R I Z ON A C A P I T OL T I M E S Published each Friday, the non-partisan newspaper covers state politics and government affairs. The journalists at Arizona Capitol Times produce frequent updates and push out information through their printed newspaper, website, The Breakdown podcast, email alerts, and events. | Find the paper online at azcapitoltimes.com.
S O C I A L M E DI A Knowing your audience and how they consume information are keys to effective social media campaigns. Count elected officials and government agencies among those who tweet, like, share, and post information and photos for the world to see. Having a social media presence can be an effective way to engage with others and influence healthcare policies. Consider using short videos, live streaming, eyecatching photos, and influential hashtags. Learn from the best by browsing winners of the Webby Awards in the social category at winners.webbyawards.com/ winners/social.
We asked a couple of health lobbyists for their views on healthcare priorities, power players, and the impacts of the pandemic and economy on the 2021 legislative session. Steve Barclay, lawyer-lobbyist with Barclay Legal, PLC, and Will Humble, MPH, Executive Director of the Arizona Public Health Association, weighed in. Both gentlemen believe the Arizona State Legislature will debate reimbursement rates for telehealth. Will Humble predicts legislators may also try to make permanent cost-effective measures that led to better health outcomes like “incentivizing influence vaccines among Medicaid members or the ADES Developmental Disabilities program.” Steve Barclay foresees debate on COVID-related liability protections for healthcare workers. He also predicts they will discuss a uniform prior authorization form, step therapy reform, and preserving the public health emergency powers of the governor and state agencies. The ongoing pandemic will impact the legislators’ ability to function. Will Humble says, “The biggest challenge may be getting to the majority votes of 16 and 31, especially early in the session before the vaccine is widely distributed.” Steve Barclay believes it depends on whether all members follow safety requirements like wearing masks and social distancing. He says, “one Republican legislator sidelined with COVID-19 and the session could come to an abrupt halt.” Arizona’s economy is faring better than most. People and businesses continue to relocate here, providing county and state officials with options for stimulating growth in healthcare. Steve Barclay says, “CARES Act monies, PPP loans and other federal and state relief helped, as did online sales tax revenue. Questions remain about AHCCCS enrollment levels, unemployment vs. job growth, the fiscal impact of Proposition 208, local government needs, and the like. But overall, I see more opportunities ahead for Arizona.” Will Humble is also looking at effects the national shift in power will have in Arizona. He says, “With new decision-makers inside CMS and HHS, we expect to see great changes in the types of Medicaid waivers and state plan amendments that CMS will be receptive to. For example, Arizona’s Medicaid work requirement waiver is likely toast for the next four years.” ■
By John McElligott, MPH, Executive Director, Maricopa County Medical Society (MCMS), john@mcmsonline.com
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PHYSICIAN SPOTLIGHT
May H. Mohty, MD, FAAP, FAAUCM shares her thoughts with Arizona Physician Magazine. Q: What do you see are the major
health issues in Arizona? A: Conditions like obesity and diseases like cardiovascular disease, diabetes, and hypertension affect many Arizonans. The current pandemic did shine a light on these health issues since many of the patients seriously affected by COVID-19 had one or more of these co-morbidities. Primary care physicians have the vital role of promoting a healthy lifestyle, encouraging weight loss, and exercise, as well as better control of diabetes and hypertension which if controlled can lead to fewer renal, cardiac, and neurological complications. Q: How will pediatrics adjust to
medicine after COVID? A: Pediatric practices must budget for PPE and cleaning supplies, as well as reliable office-based rapid viral tests and equipment. Each practice has to offer telemedicine and know how to code for virtual encounters. They may need to account for a remote administrative work force. Plus, pediatricians should have a good network of behavioral health specialists to whom they can refer patients. Having a reliable locum tenens company will help in the event of a physician illness. Finally, pediatric practices should consider adopting an employee assistance program that can offer assistance for a variety of personal and workplace issues (e.g., mental health, financial, and legal support services).
Q: What motivates you to educate
medical students? A: When we teach either as academic or clinical physicians, we are teaching a very select student body who will be entrusted with taking care of the most valuable assets we have, our health and the health of those we care about. I have constant desire to pass down my knowledge and expertise to the next generation of physicians. Plus, the act of teaching is highly rewarding. Nothing brings more satisfaction than witnessing a student acquire new skills. ■
Q: What value do you see in organized medicine
DR. MAY H. MOHTY
and get from being a member of medical societies and associations?
Clinical Associate Professor, University of Arizona College of Medicine-Phoenix
A: In organized medicine, member physicians work with all political parties to improve care and reduce disparities for patients and
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disparities in the healthcare workforce. Physicians are most effective when they speak in a unified voice. With debates on healthcare policies and healthcare delivery and given the diverse opinions of physicians, it is more effective to be part of an organized voice for medicine. Medical societies and associations make it possible.
A R I ZO N A P H Y S I C I A N M A G A Z I N E
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Arizona Physician Magazine 326 E Coronado Rd, Suite 101 Phoenix, AZ 85004 (602) 417-2303 information@arizonaphysician.com
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