Round-up Magazine, November 2016

ROUND-UP PROVIDING NEWS AND INFORMATION FOR THE MEDICAL COMMUNITY SINCE 1955 • November 2016 | Volume 62 | Number 11

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Round-up Staff Editor-in-Chief Adam M. Brodsky, MD, MM abrodsky@mcmsonline.com Editor Jay Conyers, PhD jconyers@mcmsonline.com Content Editor Dominique Perkins

Connect with your Society mcmsonline.com facebook.com/MedicalSociety twitter.com/MedicalSociety instagram.com/Medical_Society Letters and electronic correspondence will become the property of Round-up, which assumes permission to publish and edit as necessary. Please refer to our usage statement for more information.

Advertising To obtain information on advertising in Round-up, or to become a Preferred Partner, contact: Barb Spitzock 602-528-7704 bspitzock@mcmsonline.com

Cover photo and member profile photos by: Denny Collins Photography www.dennycollins.com 602-448-2437

Also featured in our profile photos this month: Helene Wechsler, MD

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Round-up November 2016

MCMS 2016 Board of Directors Officers

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MCMS offers: A FREE physician referral service benefit of membership – we help A drive new patients to your office To learn more contact: Dixie Harris 602-251-2363 dharris@mcmsonline.com Visit us online at: www.mcmsonline.com

November 2016 | Volume 62 | Number 11 Round-up (USPS 020-150) is published 12 times per year by the Maricopa County Medical Society, 326 E. Coronado Rd., Phoenix, AZ 85004.

Round-up is a publication of the Maricopa County Medical Society (MCMS). Submissions, including advertisements, are welcome for review and approval by our editorial staff at roundup@mcmsonline.com.

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No part of this magazine may be reproduced or transmitted in any form or by any means without written permission by the publisher. All rights are reserved.

ROUND-UP

PUBLISHED MONTHLY BY THE MARICOPA COUNTY MEDICAL SOCIETY

November 2016 | Volume 62 | Number 11

4 Arizona Physician 6 Letters to the Editor 8 What’s Inside 12 President’s Page Membership

14 Dangers, Developments, and

Disclosures Related to Kickbacks, Referral Fees, and False Claims

By Lon R. Leavitt

17 The Out of Network Model:

An Uncertain Environment

By Robert J. Milligan & Neel Kothari

23 Whole Healing:

an interview with life-long healer

Gladys McGarey, MD

By Dominique Perkins

29

Can MCMS Help You Grow Your Practice?

By Dixie Harris

31

Doctors In The Desert

MCMS’ Annual Event

36 42 43

New Members In Memoriam Marketplace

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Out with ROUND-UP, in with ARIZONA PHYSICIAN!

I

n the coming months, you will be receiving your last few issues of Round-up. After more than sixty years of providing our member physicians with the monthly publication, the Society has decided to pursue an excited new endeavor.

This coming January, you will begin receiving a new publication that we have aptly named Arizona Physician.

This will be a combined effort with the Arizona Medical Association (ArMA) and Pima County Medical Society (PCMS) and will replace the magazines that each of us currently distributes to our members. This means that Round-up, Arizona Medicine, and Sombrero will cease to be printed and circulated by the end of this year.

So why the change? For one, our three organizations have been in discussions to identify ways that we can work more closely together. We each strive to protect the practice of medicine here in Arizona, and much of what we publish in our magazines has considerable overlap. Issues that pertain to our readers – MACRA, ICD-10, AHCCCS expansion, scope of practice concerns, etc. – apply to ArMA and PCMS readers as well as ours. Additionally, our three organizations contract with many of the same advertisers, a number of whom prefer a single ad buy in a magazine with more widespread distribution. By combining efforts, we are able to reduce the costs of production and can now afford to distribute this new publication to all Arizona physicians, as our issues impact every physician. We are creating a new alliance to move forward on behalf of physicians and their patients and this is the first important step.

Arizona Physician will be a monthly magazine that provides all physicians in our state with a collective voice.

It will strive to capture the views and concerns of the nearly 18,000 physicians (MD and DO) practicing in Arizona.

It will inform Arizona physicians about issues that stand to impact the way they practice medicine, and it will be a valuable resource to connect with other physicians.

Our primary objective with Arizona Physician will be to provide you with the highest quality magazine each month. We are confident this effort will enhance the practice of medicine here in our state and will encourage collegiality amongst our physicians. We also believe it will serve as a resource for busy practitioners who may not know where to look for legislative updates, opportunities to network, and CME offerings, among other things.

Arizona Physician will also be available each month electronically. For those of you who don’t currently receive the electronic copy of Round-up but prefer to 4

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read publications online, please simply email us at information@arizonaphysician.com and we will make sure you are added to the distribution list for the electronic version.

With the healthcare landscape evolving ever so rapidly, so must the organized medicine. Each of our three organizations is committed to protecting what you do best — caring for your patients – and being a valuable resource to you. This magazine is a big step in the direction of more collaboration amongst our three organizations, and we are confident it will be something you look forward to reading each month.

Has this been done elsewhere? To the best of our knowledge, it has not. We cannot find an example of other state and local organized medicine groups banding together to provide more value to their members as well as every licensed physician in the state. This is admittedly a huge undertaking, and our three organizations are up for the task!

We welcome any comments you have about this exciting endeavor, and encourage you to let us know if you have interest in providing content or ideas for new articles.

Your Community.

Our Community.

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Letters To The Editor Women should demand right to early screenings

Dr. Grant-Whyte has been diplomatic in his thoughts on breast cancer. The problem is that women are being misled by papers that are making their way into the medical literature through poor peer review that are scientifically flawed, leading to faulty conclusions and the dissemination of misinformation. The death rate from breast cancer had been unchanged dating back to 1940, until mammography screening began in the mid-1980s. Soon after, in 1990, for the first time in 50 years, the death rate began to fall, so that now, there are 35% fewer women dying each year from breast cancer. Not only have the most scientifically rigorous studies (randomized controlled trials) proved that earlier detection saves lives, but numerous more recent observational studies have shown that women who participate in screening are much less likely to die than those who do not, despite all women having access to the same therapies. In two of the largest Harvard Medical School hospitals more than 70% of the women who died from breast cancer were among the 20% of women who were not participating in screening. It is likely that a large percentage of the 40,000 women who still die in the U.S. each year from these cancers were not being screened.

There are some who are advising delaying the start of screening until the age of 50. Fortunately, this approach has not been universally accepted. Experts are working very hard to maintain annual access for women starting at the age of 40. What women have not been told is that everyone agrees (the US Preventive Services Task Force and the American Cancer Society) that the most lives are saved by annual screening starting at the age of 40. Those who advise waiting until the age of 50 and then being screened every two years know full well that tens of thousands of lives will be lost that could have been saved by annual screening starting at the age of 40. They are willing to let women die to reduce the number of women recalled for a few extra pictures or an ultrasound!

Many of the arguments against screening are based on faulty science. Claims that invasive breast cancer would disappear on their own if left undetected are fantasy. No one has ever seen an invasive breast cancer detected by mammography that has disappeared on its own, yet those trying to reduce access to screening are claiming there are tens of thousands of these each 6

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year. Tens of thousands each year but no one has ever seen it happen?!

Women should demand that the misinformation stop and that the medical journals return to rigorous science, and stop the scientific nonsense. No one has suggested that mammography screening will save every woman with breast cancer. Screening does not find every breast cancer and does not find every cancer at a time when it can be cured, but it is a major step. We are all hoping for a universal cure or a safe way to prevent breast cancer, but none is on the horizon. Therapy has improved, but treatment saves lives when breast cancers are treated early. Early detection is saving thousands of lives today and women should continue to have access to annual screening starting at the age of 40.

Women should be aware that the U.S. Congress has put a moratorium on following the US Preventive Services Guidelines until the end of 2017. If this is not renewed, then women in their forties will lose access to screening, and women ages 50 and over will only have access every two years which will give cancers an extra year to grow and spread. — Daniel B. Kopans, M.D. Professor of Radiology, Harvard Medical School Senior Radiologist, Breast Imaging Division

Priority relationships

I read with interest your article in the June issue of Round-up regarding the deterioration in doctor-patient relationships over recent years. You asked how the art of medicine could be resurrected. Being a gratefully retired physician who does not have to contend with the ridiculous administrative pressures brought to bear on physicians currently in practice, I would suggest it’s a matter of priorities.

If the requirement for paperwork has become so onerous as to interfere with patient relationships, perhaps doctors need to regain control of this aspect of medicine.

Physicians in general do not fully realize the extent of their power to control matters. As a simple example, in about 1980 I was president of the medical staff at Desert Samaritan Hospital (DSH). We needed a CT scanner, and I learned the Samaritan Health Service (SHS) was planning to install one at Good Sam. I became incensed, went downtown, met with SHS administration, and threatened to lead the East Valley physicians on a strike if no CT was provided to DSH. It was, and the matter ended there.

Letters To The Editor Doctors are the only ones who can provide the higher levels of care needed by patients. This is a powerful tool, but the will and organization to affect change has been sadly lacking, and to a large extent physicians have lost control of their own profession.

If physicians as a group wish to resurrect the art of medicine, a goal which us old dinosaurs would consider admirable, they could simply start practicing in the “old-fashioned” way and leave the details, such as maintaining the EHR or worrying about billing, to other office personnel. I know, I know, it’s all tied up with governmental (Federal or State) regulations; but meeting these requirements shouldn’t have to be the goal of a practice.

Too little teaching is provided students these days in the art. Admittedly the required volume of medical learning has increased with the expansion of technology, but the dedicated professors who actually train students and residents could begin emphasizing the art (as many of my professors did in the 1950s and early 1960s). Medicine is filled with a myriad of wonderful stories and vignettes that are being lost in the maze of technological advancement, and these could be the basis for an entire course in the history of medicine (for example, in the 7th edition, 1st printing, of Nelson’s Textbook of Pediatrics, the index contains the entry “for the birds” listing pages of the entire book. Nelson’s teenage daughter was asked to do the indexing. She missed many date nights, and, as revenge, slipped that one past the proof readers.) Giving students some direct associative connection with the history and traditions of medicine might be of value. Recalling how physicians during the depression of the 1930s went door to door at the homes of their patients to see if anyone was sick because so many patients lacked funds to come to the office could emphasize that the practice of medicine is, or at least should be, unrelated to monetary considerations.

I apologize for rattling on so long, but I’ve been distressed by the loss of empathic concern for patients and agree fully that some measures should be instituted to improve the situation.

With best wishes, Albert E. Breland, Jr, MD 3481 Overpark Rd. San Diego, CA 92130

Masterpiece cover photograph

Denny Collins has produced a Masterpiece with the portrait of Dr. David Beyda that appears on the September issue of Round-up.

It gives me great pleasure to look upon it and I know it will be treasured by generations of Beydas.

— Paul B. Jarrett, MD

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What’s Inside M

embership, as the saying goes, has its privileges. The catchy slogan used by American Express® in the 1980s helped make the credit card giant a household name. They created an image of exclusivity, and touted ‘member benefits’ you couldn’t get from Visa®, Mastercard®, or others.

Jay Conyers, PhD EXECUTIVE DIRECTOR

jconyers@mcmsonline.com 602.251.2361

Many other national brands have since adopted this mantra. To this day, Sam’s Club® and Costco® still open their doors only for their card-carrying members, while those not in the club can’t take advantage of 96-count packages of hotdogs, gallon jugs of mayonnaise, and those enormous packages of toilet paper that require a U-Haul® truck to get back home, and a storage shed to keep on hand for when the cardboard roll has no more squares to spare. I don’t know about you, but I like the idea of being able to buy a keg-sized container of pretzels (but then the container is so large, I have nowhere to put it in the kitchen!).

Want that gallon of milk for $1.99 at Fry’s®? Well, make sure you have your membership card on your keychain, otherwise you’ll pay $3.49. Like to order online, but don’t want to pay for shipping?

You can do that, too, but you first have to cough up the money for Amazon Prime® membership.

The key with membership is that members must feel they’re getting value by paying annual dues and fees. It’s usually a personal decision that isn’t necessarily one size fits all. Value comes in all shapes and sizes, and the same is true for professional organizations.

For me, I was a member of the American Chemical Society (ACS) for nearly 20 years, first joining as a freshman chemistry major in 1991, and remaining active throughout my PhD training and nine years in academics. By 2010, I was no longer doing chemistry and, thus, no longer saw value in the networking, the dis-

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counts on courses and conferences, and the reduced rates on books and journals that the ACS provided to its 147,000+ members. It was like breaking up with a longtime partner, but remaining on good terms. We just no longer needed one another.

But what about medicine and physician organizations? For one, there’s a huge difference between what my professional chemists’ organization provided for my colleagues and me, and what organized medicine does for its physicians.

I never worried about lawmakers telling me what chemical reactions I could carry out, or that I had to hire and work alongside people with inferior training. I never concerned myself with bureaucrats determining at what price products I designed were to be sold.

But medicine is drastically different, with many other players impacting the profession — lawmakers, lobbyists, patients, insurance companies, federal and state agencies, regulatory boards, and the list goes on.

As a chemist, I never had to worry about being replaced by a biologist or a physicist.

But as a physician, it’s a constant concern that midlevel providers are trying to do the same thing that physicians train so long and hard to do. And, in many cases, lawmakers help them get there, the result of which is often physicians being marginalized.

Like those for other licensed and regulated professionals, such as lawyers and accountants, physicians’ organizations work to protect the trade for which it represents — the practice of medicine.

Groups like MCMS, ArMA, and the AMA focus on protecting your profession and providing resources to help you hone your craft.

Despite this ever-growing need to protect the practice of medicine, one would expect membership to remain

What’s Inside strong. But unfortunately, nearly every local, state, and national physician organization has seen membership numbers decline since the 1950s, a time in which AMA participation peaked. Today, roughly 25% of our nation’s more than 900,000 actively licensed physicians engaged in full-time practice belong to the AMA. Despite taking a big hit in membership after the endorsement of the Affordable Care Act back in 2009, numbers have slowly inched back up to a level comparable to pre-ACA impact.

One common trend in membership organizations is the decline in participation from younger individuals.

A recent marketing survey of dozens of professional membership organizations across the nation revealed a huge generational divide. Boomers and professionals over the age of 40 tend to be more receptive to

participating in membership, yet younger ones migrate towards communities, such as social media platforms, hip and newly developed parts of town, and outdoor activity groups. So, while more established physicians are connecting through their membership organizations, such as MCMS or ArMA, the younger ones are reaching out to one another for news and information using Facebook, LinkedIn, and Twitter. As the saying goes, the times they are a-changing.

So why get involved with local physician organizations? For many physicians, they see little value in joining multiple membership organizations, but each has core value propositions that contribute to strengthening the practice of medicine. But many recognize how value varies from one to the other, and choose a few, or just one, to join.

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What’s Inside Healthcare is largely delivered locally, and the networking and communities that groups like county medical societies promote help physicians stay connected.

Specialty societies provide excellent practice-specific education and training resources. And state medical societies provide value due to their activities with state government, where health policies are set and licensure is regulated. Each is unique, and each has value.

It’s up to you to decide which is best for you. Hopefully you find value in any and all organizations you pay membership dues to each year.

If you’re not a member, join us. If you’re a member and you’re concerned abut the value you’re receiving, please reach out to me personally. Feel free to either call or email me. I’m always receptive to ideas about what we can do better.

So, what about this issue of Round-up? This month we profile Gladys McGarey, MD, a true pioneer in her own right. Still going strong at age 95, Dr. McGarey has widely been credited with bringing acupuncture and holistic medicine to Arizona. We hope you enjoy reading about one of our longest running members, one who’s spent nearly 70 years in the profession (and remains active today!). We also have

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some great articles on membership, a write-up from our recent annual event, and an update on federal Zika policy. Also in this issue are two thought-provoking legal articles, with one looking at how the Justice Department is pursuing violations of the Anti-Kickback Statute, the Stark Law, and the False Claims Act, and the other focusing on out-of-network billing and waivers of patient financial responsibilities. We hope you enjoy this issue!

Next month marks the end of an era, as December will bring you the final issue of Round-up. After 61 years in print, the magazine will emerge in January as a new resource for the roughly 18,000 physicians practicing throughout the state of Arizona. Coordinated in collaboration with the Arizona Medical Association and the Pima County Medical Society, this new publication, Arizona Physician, will arrive in your mailboxes sometime in early-to-mid January.

We welcome any thoughts on how you’ve viewed Round-up over the years. If you have any stories or comments on how you’ve seen Round-up evolve over the years, please send me an email at jconyers@ mcmsonline.com and hopefully we can include it in the last issue.

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President’s Page T Adam Brodsky, MD, MM

MCMS PRESIDENT 2016 abrodsky@mcmsonline.com 602.307.0070

his month’s Round Up is about membership in organized medicine. Clearly if you are reading this column, you are at least somewhat engaged in your county medical society.

However, the majority of doctors today are not engaged at all in local organized medicine. I think it is worth reminding ourselves of our mission and of the power we have in organized medicine. First of all, it is worth re-reading the mission statement of our Maricopa County Medical Society: The Mission of the Maricopa County Medical Society is to promote excellence in the quality of care and the health of the community, and to represent and serve its members by acting as a strong, collective physician voice.

In fulfilling this Mission, the Society will initiate, respond to, and implement efforts through which professionalism in medicine is enhanced; the ethics of medicine are fostered and preserved; the patient’s rights and choice are supported; and quality practice of medicine is preserved.

Through these actions, members will have their current and future needs met in a manner that they cannot effectively undertake or achieve individually.

Dr. Brodsky specializes in Interventional Cardiology He joined MCMS in 2005.

Contact Information: Heart & Vascular Center of Arizona 1331 N. 7th Street Suite 375 Phoenix, AZ 85006 http://heartcenteraz.com

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A few points are worthy of note. First of all and most obviously, we are here to support excellence, quality, professionalism, ethics,

Round-up November 2016

and choice. However, it is worth realizing that there are many other organizations which fancy themselves as also promoting many of these same qualities - for example, government, insurance companies, drug companies, hospital systems, etc. How many of those organizations would have similar lists appear in their mission statements? It is therefore incumbent upon us to realize that perhaps the most important aspect of our mission statement is the “strong, collective physician voice.” If not for the constant presence of our strong physician voice, these other goals will be defined by the myriad of other non-physician actors in the health care field.

We can and should have a lot to say about the regulatory framework in which we practice. We can and should have a lot to say about the competitive framework in which we practice. And we can and should have a lot to say about the many public health issues which affect us communally.

All of these issues are real and affect us every day of our medical practice. Sometimes we physicians are content to simply let others make these decisions for us. But I wonder if we forget just how un-medically educated most of the “other” decision-makers are.

While there is only one local county medical society, there are many oth-

President’s Page er medical societies with which we may interact. These range from our local county and state medical societies (the Maricopa County Medical Society and the Arizona Medical Association), to national organizations such as the American Medical Association, to our own specialty societies, such as, in my case, the American College of Cardiology. Many of the national specialty societies have their own local chapters as well. Traditionally, the specialty societies have focused more of their energy on the dissemination of medical science and research, including medical guidelines and practice pathways, and the results of new medical trials which will influence the actual medicine we practice on a daily basis. Many of them do have political action committees which tend to specialty-specific national legislative issues. I encourage everyone to be involved with their specialty society, but I feel that their mission is different than the mission of our local county and state medical societies, and therefore

being involved in one does not obviate the need to be involved in the other.

The reality is that many physicians simply do not have the time or inclination to be involved in organized medicine in any capacity. Therefore it is my feeling that we should leverage the strength of those who have become involved by working together. This means, for example, the local county and state medical societies working together to collaborate on local issues of interest. It simply does not make sense for us to duplicate our efforts given the small cadre of interested and involved physicians. There may even be opportunities for collaboration between specialty medical societies and local and state medical societies. We are clearly stronger when we speak with one unified voice rather than a separate voice for each specialty and subspecialty.

HEALING HANDS. BIG HEARTS.

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Dangers, Developments, and Disclosures Related to Kickbacks, Referral Fees, and False Claims

BY LON R. LEAVITT

M

edicare and other federal health care programs, like all consumers of health care goods and services, necessarily expect and depend on health care professionals to make independent decisions grounded in clinical criteria, sound science, and the patient’s best interests. Kickbacks, referral fees, and other financial incentives have long been prohibited because of their potential to corrupt the judgment of medical professionals by basing it on money instead of medicine. See United States v. Starks, 157 F.3d 833, 838 (11th Cir. 1998) (“the giving or taking of kickbacks for medical referrals is hardly the sort of activity a person might expect to be legal”); United States v. Neufeld, 908 F. Supp. 491, 496 (S.D. Ohio 1995) (“Taking bribes for referrals . . . is an inherently wrongful activity and one of which a physician should particularly be aware.”).

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Persons who offer, pay, or accept bribes in doing business with federal health care programs forfeit their right to bill those programs and, in some circumstances, commit crimes. This article provides an overview of key statutes the government commonly uses to combat this misconduct, highlights areas of recent and current enforcement interest, and suggests options for providers who may be aware of potential problems—either their own or others’.

The Anti-Kickback Statute The Anti-Kickback Statute (AKS) is a criminal statute that prohibits “knowingly and willfully solicit[ing] or receiv[ing] any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind… in return for referring an indi-

vidual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made” by Medicare or other federal health care programs. 42 U.S.C. § 1320a-7b(b)(1)(A).

•

Billing for procedures contrary to regulations or published guidance.

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Billing a non-covered service as covered.

Although receiving remuneration triggers liability, “the AKS [also] prohibits willfully offering remuneration to induce the referral of program-related business, so proof of payment is not required.” United States v. Center for Diagnostic Imaging, Inc., 787 F. Supp. 2d 1213, 1221 (W.D. Wash. 2011). AKS violations are felonies that can also result in administrative sanctions, including civil penalties and exclusion from federal health care programs. See 42 U.S.C. § 1320a-7.

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Misrepresenting the diagnosis to justify the services or goods provided.

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Double-billing.

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Billing for services performed by an employee who was unqualified, was improperly supervised, or was excluded from participation in federal healthcare programs.

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“Upcoding” (i.e., using billing codes that reflect a more severe illness than actually existed or a more expensive treatment than was provided).

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“Unbundling” (i.e., billing separately for services already included in a global fee).

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Offering, paying, or receiving kickbacks.

The Stark Law The Stark Law (Stark) prohibits referrals for specifically designated health services, prohibits billing for those services, and prohibits federal health care programs from paying for such services when the referring physician or a member of his or her immediate family has a financial relationship with the entity providing the service and that relationship does not fall into one of several specified statutory or regulatory exceptions. See 42 U.S.C. § 1395nn(a), (g); United States ex rel. Ebeid v.

Lungwitz, 616 F.3d 993, 1000 (9th Cir. 2010). Like AKS violations, Stark violations subject both the referring physician and the entity that bills for the referred service to administrative penalties.

FCA cases in Arizona have included: •

A $35 million settlement with a hospital system alleged to have billed federal health care programs for inpatient rehabilitation facility services rendered to patients who were not appropriate for such services.

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A $5.85 million settlement with a hospital system alleged to have misreported data about the hours worked by its employees.

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A $2.2 million settlement with a hospice (whose founder and former president was excluded from federal healthcare programs for five years) alleged to have billed Medicare for ineligible patients.

•

A $525,000 settlement with a physician who allegedly billed Medicare for treatment he provided to hospice patients while representing that he was not employed or paid under agreement by the patients’ hospice providers, even though the hospices were paying the physician as a medical director and as a home care team physician.

•

A $430,000 settlement with a physician and his practice alleged to have billed Medicare for tests that did not meet applicable Medicare coverage requirements.

The False Claims Act Benjamin Franklin reportedly said, “There is no kind of dishonesty into which otherwise good people more easily and frequently fall than that of defrauding the government.” The False Claims Act (FCA) is the government’s primary tool to combat such dishonesty. The FCA, 31 U.S.C. §§ 3729-3733, permits the government to file its own civil action (or whistleblowers – relators – to file a civil action known as a qui tam action) and recover damages for materially false or fraudulent claims to the government. Persons who submit materially false claims or statements with knowledge (defined as reckless disregard, deliberate ignorance, or actual knowledge) are liable for three times the amount the government paid because of the false information, plus a civil penalty of $5,500 - $11,000 per false claim.

31 U.S.C. § 3729(a), (b)(1), (b)(4).

Enforcement trends and areas of interest Enacted in the throes of the Civil War, the FCA was intended to address rampant fraud in selling supplies to the Union Army, including selling boxes of sawdust instead of guns, lame and sickly mules, and moth-eaten blankets. Today, the FCA is used to curb a variety of misconduct by healthcare providers, including: •

Billing for services that were not rendered, were not medically necessary, or were of such low quality that they are virtually worthless.

The offer or payment of “remuneration” to physicians for referring beneficiaries of federal healthcare programs can affect referral decisions. When it does, the government will take interest and action, often in the form of AKS, Stark, and FCA investigations and claims.

One recent and noteworthy example is the $237 million judgment against Tuomey Healthcare System, which eventually settled for $72.4 million, for illegally billing Medicare for services referred by physicians with whom the hospital had improper financial relationships. mcmsonline.com/round-up

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The Arizona healthcare market includes some ancillary service providers (such as labs and imaging centers, for example) that appear to be engaging in aggressive marketing techniques. This development seems particularly predominant in service lines in which there may be excess capacity. Providers of all types should be cautious about giving or accepting gifts, payments, and other items of value and should avoid making treatment decisions based on factors other than the propriety, quality, and medical necessity of the service and the condition, convenience, and prognosis of the patient. See United States v. Goldman, 607 F. App’x 171, 174 (3d Cir. 2015) (“Doctors are supposed to make decisions based on medical necessity, not their own fiscal interests. . .”).

Reporting and correcting potential violations If you believe a provider billed a federal healthcare program in a way that may violate a statute described above, you may contact the United States Attorney’s Office, the Federal Bureau of Investigation, or the Department of Health and Human Services’ Office of Inspector General (HHS-OIG). You may also file a qui tam case under the FCA’s whistleblower provisions. Regardless of how you report the conduct, government officials will review it carefully and will take appropriate action.

If you believe your conduct may constitute a potential, or even inadvertent, violation, consider disclosing and correcting the situation. Knowingly retaining government overpayments violates the FCA (see 31 U.S.C. § 3729(a)(1)(G), (b)(3)) and will likely subject you to greater liability if the overpayments are discovered.

Several disclosure options, which you should discuss with an attorney, are available, including the self-disclosure protocol administered by HHS-OIG, or contacting the United States Attorney’s Office. Whatever option you elect for making a voluntary disclosure, doing so timely and thoroughly will reduce your potential liability and will result in a more favorable resolution. See 31 U.S.C. § 3729(a)(2) (reducing liability to double, instead of treble, damages when the disclosing party comes forward timely, cooperates with the investigation, and is not already a defendant in a case or a target of an investigation).

LON R. LEAVITT Mr. Leavitt is an Assistant United States Attorney for the District of Arizona. Mr. Leavitt represents the government in civil fraud and abuse matters, including False Claims Act investigations, cases, and qui tam/whistleblower actions, involving Medicare and other federal programs. Mr. Leavitt also serves as the Affirmative Civil Enforcement Coordinator and the Civil Health Care Fraud Coordinator.

Any opinions expressed in this article are those of the author and do not necessarily reflect the government’s views. Nothing in this article constitutes legal advice, creates or diminishes any rights, or places any limitations on the government’s otherwise lawful prerogatives.

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The Out of Network Model: An Uncertain Environment

BY ROBERT J. MILLIGAN & NEEL KOTHARI

O

ver the last ten or fifteen years, changes in health care regulation and reimbursement have spawned a series of innovations, ideas, and outright schemes that have been promoted as ways to provide physicians with opportunities to offset decreasing reimbursement, and, in some cases, avoid the regulatory burden that is crushing many practices that have adhered to a conventional practice model. Examples of these new arrangements include concierge medicine; pod labs; clinically integrated networks; accountable care organizations and similar networks; risk contracting and gainsharing; and physician-owned dis-

tributorships.

Most of these arrangements are rolled out with great fanfare, often by individuals and organizations looking to make a quick buck on the front end. Some of them are likely to be enduring business models and opportunities for physicians. Others have proven to be short-term fads, which fade when, e.g., enforcement activities push them into extinction. One of the trends that is currently getting a lot of attention, from promoters, physicians, insurers, the state Medical Boards, and government agencies, is the out of network (OON) practice mcmsonline.com/round-up

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model. This article discusses some common OON models and some of the legal and other risks facing OON providers. Given the seemingly limitless variety of OON models and the payors’ responses to these models, uncertainty is the only certainty about the OON model.

Multitude of OON models There are many variations on the OON theme. For example, some busy and highly regarded physicians have opted out of federal health care programs (FHCP, e.g., Medicare, Arizona Health Care Cost Containment System (AHCCCS), Tricare, etc.) and all commercial plans. These physicians do business on a cash pay basis, and their patients agree up front to forego any health care benefits they might have in order to have these physicians provide their care. Another model involves surgeons who provide trauma and emergency department coverage as a regular part of their practice opt for the OON model; these surgeons typically (and not surprisingly) are unwilling to respond to calls at all hours of the day and night, and to provide care to patients who may or may not have a payor source, in exchange for reimbursement levels that are identical to what they would get if they limited their practice to elective cases scheduled during normal business hours. Another relatively common scenario involves ASCs and other facilities that are OON, but are owned by physicians who participate in FHCP and commercial programs, and who bring their in-network patients to the OON facility.

OON and Patient Responsibility For physicians involved in the first type of OON model referenced above (cash pay and no third party payor involvement), the patient knowingly and willingly accepts the fact that he or she will have to pay the entire bill out of pocket. For most other OON models, both the patient and the payor typically have some obligation to pay for the care. Under most commercial insurance plans that include OON coverage, the patient has an obligation to pay higher co-pays, deductibles, etc. (collectively, “Patient Responsibility”) for OON care.

OON providers employ an almost infinite variety of approaches in dealing with Patient Responsibility.

Some insist on payment of the Patient Responsibility before the service is provided. At the other end of the liability gradient, some OON providers promise patients that they will have no obligation to pay out of their own pocket for the OON services, or that the patient will not have to pay more than he or she would be obligated to pay for in-network services; in fact, it seems that some of these providers market their services to patients on that basis. Between these two extremes, providers vary in the intensity of their efforts to collect the Patient Responsibility.

Providers who are aware that they have an obligation to make some effort to collect the Patient Responsibility often ask for precise guidance as to how much effort is required, e.g., “what if I submit two bills, and 18

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then write off the unpaid balance;” “what if the amount owed exceeds the cost of collecting it;” “what if I have reason to believe the patient is indigent or judgment proof”? There are no good answers to these questions.

It is becoming increasingly clear, however, that those OON providers who uniformly make no effort to collect any material portion of the Patient Responsibility (an approach that will be called the “Routine Waiver” approach in this article) face a variety of potential challenges, some of which are discussed below.

Federal healthcare programs Opting out of Medicare A provider has three options to bill for services rendered to Medicare beneficiaries: bill Medicare and the beneficiaries as a participating or non-participating provider, or bill the beneficiaries, only, after opting out of Medicare. If a provider remains in Medicare as a participating or non-participating provider, he or she would be subject to the federal prohibitions on Routine Waivers described in the next section. If a provider opts out of Medicare, however, he or she would not be subject to those prohibitions as to Medicare beneficiaries, as the provider would not submit a claim to, or receive payment from, Medicare. A provider who opted out of Medicare, but participated in Medicaid/AHCCCS, would be subject to these prohibitions regarding his or her Medicaid/AHCCCS patients, however.

Waiving or discounting Patient Responsibility for FHCP patients.

The good news relating to Routine Waivers for FHCP patients is that the rule is simple: don’t do it. For this patient population, Routine Waivers may violate the federal Anti-Kickback Act, 42 U.S.C. 1320a-7b(b), which among other things prohibits providers from offering remuneration to patients, in order to incentivize the patients to seek care from the provider offering the incentives. In addition, Routine Waivers can result in the submission of false or fraudulent claims, in violation of the federal False Claims Act (FCA). The theory behind this interpretation of the FCA was articulated by the DHHS Office of Inspector General in a 1994 Special Fraud Alert relating to Routine Waivers of Medicare Part B copayments and deductibles, as follows: •

A provider, practitioner or supplier who routinely waives Medicare

•

copayments or deductibles is misstating its actual charge. For example,

•

if a supplier claims that its charge for a piece of equipment is $100,

•

but routinely waives the copayment, the actual charge is $80. Medicare

•

should be paying 80 percent of $80 (or $64), rather than 80 percent of

•

$100 (or $80). As a result of the supplier’s misrepresentation, the

•

Medicare program is paying $16 more than it should for this item.

Depending on the specific facts and circumstances, and the creativity and aggressiveness of the enforcement attorneys, Routine Waivers for FHCP patients can result in prosecutions for mail fraud, Medicaid fraud and conspiracy (e.g., US v Nichols, 6th Circuit, 1992)); civil actions under the federal False Claims Act (e.g., US v Eastern Oklahoma Orthopedic Center, (N.D. OK, 2009)); and civil actions under the federal Anti-Kickback Act (e.g., US ex rel. Doe v Institute of Cardiovascular Excellence, PLLC (M.D. FL, 2015).

On October 21, 2016, the U.S. Attorney’s Office for the Southern District of New York announced a $5.31 million settlement with a hematology/oncology practice that, among other things, “routinely waived copayments without lawful basis….” According to one report, the settlement resulted from a qui tam whistle-blower lawsuit filed by an employee of the practice. It should not surprise anyone that an employee who was aware of (a) the employer’s FHCP Routine Waiver policy, and (b) the fact that the policy is illegal, would view the situation as an opportunity to make a profit.

Commercial payors Given the fact that there is an infinite variety of OON models, and an infinite variety of payor programs, it is not surprising that there is an infinite number (maybe infinite squared) of potential outcomes in litigation between OON providers and payors. While it is impossible to quantify the risks associated with different types of OON models, a review of outcomes in litigation between various types of OON models and various payors is at least somewhat instructive.

One of the common themes in many of these cases is a payor argument premised on the fact that an indemnity insurer agrees to pay a specified portion, e.g., 80%, of the patient’s obligation to pay for a medical service. If the patient has no obligation to pay anything, the argument goes, 80% of nothing is nothing, so the insurer has no payment obligation. Taking this argument one step further, payors argue that when providers submit claims for payment to an insurer, the providers are making an affirmative statement that the patient has an obligation to pay the claim. If the provider has no intention of seeking payment from the patient, the payors claim, the provider’s submission of a claim to the payor is fraudulent.

The OON Practice and Routine Waivers.

An early case, T.J. Kennedy v Connecticut General Life Insurance Co. (7th Cir., 1991) tells the story of Dr. Kennedy’s effort to recover from Cigna for OON ser-

vices provided to one of Cigna members. As an indication of Dr. Kennedy’s honesty or naiveté, he had entered into a written agreement with the patient, specifying that he would not look to the patient for any payment. Cigna became aware of the arrangement with the patient and declined to pay a claim that Dr. Kennedy submitted.

Dr. Kennedy sued Cigna and the case ended up being heard by the United States Court of Appeals for the Seventh Circuit. Cigna’s insurance policy included a common type of exclusion, which stated that Cigna would not be obligated to pay “charges for which the [member] is not legally required to pay.” Since Dr. Kennedy and the patient had an agreement relieving the patient of any payment obligation, Cigna argued that it was not obligated to pay the claim. The Court summarized the parties’ positions as follows: Here we encounter delicious circularity. The agreement relieves Myers [the patient] of any obligation to pay. That triggers Sec. 12(5) of the policy, which relieves CIGNA of any obligation to pay.

That in turn triggers the clause of the Kennedy-Myers contract reinstating Myers’ obligation to pay. Once this occurs, Sec. 12(5) of the policy is no longer applicable. Thus CIGNA must pay. Kennedy stops here. Let us press on: once CIGNA becomes liable, the Kennedy-Myers contract again relieves the patient of any legal obligation. Which in turn reactivates Sec. 12(5). And so it goes.

The Seventh Circuit Court of Appeals has a reputation for considering economic principles in resolving cases. Although the Court’s opinion discussed in some detail the vagaries the Employee Retirement Income Security Act (ERISA), it seemingly punted on those issues and looked to the marketplace and the contract between Cigna and the member, where is found a basis for a resolution in favor of Cigna: Some welfare benefit plans have lower (or no) co-payments, perhaps because they doubt that the incentive effects of co-payments justify saddling with higher costs those employees unlucky enough to encounter medical difficulties. Co-payments mean more risk borne by participants. Whether full indemnity is preferable to a co-payment system is a question for the marketplace. The answer in this health plan is co-payments, and its terms will be enforced.

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OON facilities Another common OON situation involves OON ASCs, hospitals and other facilities. In some cases the owners of the facilities also are OON; in other cases, the owners are in-network. Perhaps in part because of these and other differences, there have been dramatically different outcomes in these cases.

ed Cigna’s claims against Humble and found in favor of Humble on most of its claims against Cigna. The Court awarded Humble $11,392,273 on Humble’s claim that Cigna had underpaid Humble, and ordered Cigna to pay Humble an additional $2,299,000, plus attorneys’ fees, on Humble’s claim that Cigna had violated its fiduciary duties under ERISA.

In a case dear to the hearts of payors, Aetna won a $37.4 million dollar jury verdict against a California OON ASC management company in 2016. (Sanborn, B, Aetna awarded $37.4 million in lawsuit against Bay Area Surgical Management, April 22, 2016, www. healthcarefinancenews.com). According to this article, a whistleblower had approached Aetna about the returns earned by ASC investors; Aetna also had noticed a pattern of referrals to the OON ASCs by Aetna-affiliated physicians who had ownership in the OON company.

Of course, Cigna may well appeal this decision. If it does, the appeal will be heard in the Fifth Circuit Court of Appeals, which recently issued an opinion adverse to Cigna in another somewhat similar case, North Cypress Medical Center…. v Cigna Healthcare…,” (5th Cir. 2015). In that case, North Cypress sued Cigna to recover payments on claims submitted by North Cypress for OON services provided to Cigna members. According to the Fifth Circuit opinion, the facts were similar to those in the cases discussed above:

According to another article, this OON company, “recruited patients by offering waivers of co-pays and other fees and through selling shares in the facilities to referring physicians who received handsome returns on their investments….” (Eslinger, B, Aetna Wins $37.4M Jury Verdict Over Medical Billing Fraud, April 14, 2016, Law360). Not surprisingly, the attorney for the OON company promises to appeal the verdict. Also not surprisingly, according to this article, Aetna’s complaint included a text message between one of the individual defendants and a “conspiring physician,” in support of its claims. It seems that text messages invariably provide an embarrassment of riches to government and private attorneys who bring criminal and civil cases against physicians.

A seemingly similar case from Texas yielded a result that was so at odds with the Aetna case that it seems to have come from an alternative universe. In Connecticut General … v Humble Surgical Hospital, a case decided by the United States District Court for the Southern District of Texas in 2016, Cigna filed suit against Humble, seeking recovery of payments Cigna made to Humble. The District Court characterized Cigna’s theory as follows: According to Cigna, the overpayments are a result of Humble’s fraudulent billing practices and/or scheme to defraud private payors, such as Cigna, by engaging in prohibited practices, namely routinely waiving members’ financial responsibility under the terms of their plans and paying kickbacks to hospital physician-owners for their unlawful patient referrals.

Based on that summary, it might seem that Cigna’s lawsuit was a carbon copy of the Aetna lawsuit. That being the case, a similar outcome would seem likely. To Cigna’s surprise and chagrin, the District Court reject20

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Cigna counter-claimed, arguing that it paid more than it owed; that North Cypress as an out-of-network provider did not charge patients for coinsurance, but billed as if it had.

The trial court dismissed or granted summary judgment on all of the claims of both parties. On appeal, the Fifth Circuit affirmed the dismissal of Cigna’s claims. However, it reversed the trial court’s dismissal of North Cypress’s key claims against Cigna, remanding the case back to the District Court for further proceedings on those claims.

The North Cypress opinion consists of thirty-four pages of discussion of detailed facts about the Cigna policies, the application of ERISA to the parties, the potential application of the Racketeering Influenced and Corrupt Organizations Act, and various aspects of Texas state law. As a result, it is difficult to draw any bright line guidance from the case. Two facts seem to have played a significant role in the resolution of at least some issues, however.

The first is that North Cypress offered patients a prompt pay discount, under which patients could get a discount on their Patient Responsibility if they paid upfront or within a short period of time; also, North Cypress notified Cigna of the prompt pay program before it submitted claims for services. In disposing of Cigna’s fraud claim, the Court noted that “given that North Cypress informed Cigna about its [prompt pay] discounts prior to any representations about charges, fraud seems particularly inapt.”

Another seemingly key fact is that North Cypress obtained from the patients an assignment of the patients’ rights under their insurance contracts. (Some health plans include provisions barring patients from assigning their benefits to third parties, and these anti-assignment provisions are enforceable. Spinedex Physical Therapy… v United Healthcare of Arizona… (9th

Cir. 2014)). In the North Cypress case, however, these assignments were not prohibited, and they allowed North Cypress to pursue breach of fiduciary duty claims against Cigna, under ERISA law.

The above cases are just a sampling of the published opinions dealing with these issues, and the law is not well-settled on these issues. It appears, however, that payors are opening new fronts in their war against OON providers who offer Routine Waivers.

Arizona Department of Insurance In a recent letter from one major commercial payor to an OON provider, the payor expresses what it calls its right to reduce its payments to the provider based on Routine Waivers. The letter also states that the payor is reporting the provider to the Arizona Department of Insurance, for insurance fraud.

Under Arizona law, it is a “fraudulent practice and unlawful” for a person to make a false statement, or to fail to disclose a material fact, in connection with the submission of a claim for payment by an insurer.

A.R.S. §20-463. A violation of §20-463 is a class 6 felony. Presumably, this payor is taking the position that a provider that offers Routine Waivers to a payor’s members, but fails to disclose that fact to the payor when it submits a claim, is committing insurance fraud by failing to disclose a “material fact.”

Conclusion

lined above will be resolved. Clearly, the OON model has the potential to create great profits… for the attorneys who litigate these issues. What is less clear is how providers who engage in the OON model will fare.

Consequently, providers who are involved in, or are considering, an OON model should weigh carefully the potential pros and cons of the model.

BOB MILLIGAN Mr. Milligan is a shareholder in Milligan Lawless, P.C., and specializes in healthcare law. He limits his practice to the representation of individuals and companies in the healthcare and life sciences industry. In addition to his law practice, he has received an LLM degree in Biotechnology and Genomics. He received his J.D. from DePaul University, where he was a Dean’s Scholar, and his B.S. from Northern Illinois University.

NEEL KOTHARI Mr. Kothari is an attorney at Milligan Lawless, P.C., in Phoenix.

He regularly helps physicians and physician groups with a wide variety of matters, including business transactions, corporate governance, employment, and regulatory compliance. Neel received his law degree with honors from the University of Chicago Law School.

It is too soon to tell how battles over the issues out-

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MEMBER PROFILE

BY DOMINIQUE PERKINS

Whole Healing: an interview with life-long healer

Gladys McGarey, MD

T

his month we discuss membership — its forms, benefits, responsibilities, and privileges. Some memberships we join exclusively because of the perks we receive, such as shopping loyalty cards that win us points for doing what we were already going to do — buying clothes, groceries, and everyday household necessities. Other memberships you have to put a little more into, such as joining a gym or fitness program.

But, in any case, no matter how big or how small, the memberships we keep do say something about us as people.

They communicate where we spend our time, how we spend our money, what we find important, how we identify ourselves in our personal and professional lives. Aligning ourselves with a particular organization is an opportunity for us to get involved and stand for something, even on a small level.

Outside of loyalty programs that give us coupons and save us money, we

Article photos by Denny Collins Photography. www.dennycollins.com • (602) 448-2437

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tend to join organizations that mean something to us. We join because we want to be a part of something. We join to band together with like-minded peers and colleagues.

We join because we like the direction things are headed.

And, sometimes, we join to make things happen.

Our profile physician this month has more than enough experience with membership — and with making things happen! Dr. Gladys McGarey is certainly not one to watch from the sidelines. In addition to being actively involved in medicine for over 70 years, she has co-founded medical organizations, non-profit groups, medical practices, academies, and symposiums; authored books; served as a public speaker; and many, many other incredible accomplishments.

Even now, she continues to find ways to serve her community and stay involved in healthcare, and she is celebrating her 96th birthday this year! Physician, founder, writer, speaker, and pioneer, surely she is the perfect physician to embody our issue dedicated to those who affect change through their involvement.

Early adventures on the international stage McGarey had a firm hold on her goal to become a physician at the early age of 2 years old, and in over 70 years of involvement she has never looked back. She had a fine example to lend weight and encouragement to her ambition and desire to serve, not to mention set the stage for the direction she would eventually make the focus of so much of her impressive career — her parents were both physicians.

Not only physicians, both her parents were taught

by Andrew Taylor Still, MD, DO — the Father of Osteopathy and Osteopathic Medicine. McGarey still has both of their diplomas, signed by Dr. Still.

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Her parents took their medical degrees and training to India, serving as medical missionaries for the Presbyterian Church in 1914. McGarey was born in November of 1920, in the foothills of the Himalayan Mountains.

“I grew up, living in tents, in the winter time, watching my parents treat anyone who came to them, no matter who they were or what their problem was,” McGarey said.

Amidst a backdrop of elephants, mountains, lepers, and Indian safaris, her childhood and adolescence was filled with sensational adventures and experiences — too many to relate here. Just two such examples (and greatly opposing ones, at that) include an attempted recruitment for Hitler’s youth army by the Third Reich, and a train ride interrupted by chanting followers led

by Mahatma Ghandi himself.

She attended an international school in the high Himalayas through high school. After graduating, she moved to the United States to attend college at Muskingum University, in New Concord, Ohio, and, in the fall of 1941, she began studying at the Women’s Medical College in Philadelphia. That December, shortly after beginning her medical education, World War II began, and everything changed.

“My entire medical training was in the context of the war,” McGarey said.

It was during this time that she met William McGarey, MD, (Bill) who had received his medical degree from the University of Cincinnati. The two were married, and after she graduated McGarey and Bill began a joint family practice in Bill’s hometown of Wellsville, Ohio. They stayed in Ohio until 1951, when Bill was called back into the air force as a flight surgeon.

While serving, he spent some time in Phoenix and

Tucson, and fell in love with the area. McGarey was also quite taken with the place.

“When he was discharged we moved here to Phoenix, which was much more like India for me and I loved it,” she said.

MEMBER PROFILE

Setting up in Phoenix Once she arrived in Arizona, McGarey got straight to work. She and her husband began by setting up shop behind a pharmacy, and soon built The Olive Tree Medical Group. In 1964, the practice hired Edna Germain, FNP. Germain held the first license as a Family Nurse Practitioner in the state of Arizona.

A great supporter of natural birthing, McGarey tackled the difficulties of women who needed support when giving birth at home.

“I needed some program for their education, and some way to have emergency equipment and/or transportation at hand,” she said.

She founded The Baby Buggy program, which featured a fully-equipped mobile ambulance specifically available for home deliveries.

“I worked with Barbara Brown, an FNP; a nurse midwife; and some wonderful OBGYNs who would respond to my calls,” McGarey said.

a unit, capable of self-regulation and healing, and that rational treatment is dependent on an understanding of the whole-body unit and the interrelationship of structure & function.

In about 1970, she and her husband founded the A. R. E. Clinic in Phoenix, Arizona, a pioneer program in the field of integration of allopathic and holistic medical practicing. In conjunction with the practice, they also began an annual medical symposium, dealing with concepts of energy and alternative medicine, held at the Safari Hotel in Scottsdale.

They also founded The Academy for Parapsychology and Medicine, which held major symposiums up and down the west coast, with as many as 1,000 people in attendance.

Their very first symposium was held at Stanford Medical School, where 280 physicians showed up to hear a presentation regarding acupuncture.

“President Nixon had just come back from China and reported on witnessing an appendectomy done with only acupuncture anesthesia,” she said. McGarey was the first to utilize acupuncture in the US, and trained other physicians in its use as well.

In 1989, she and her daughter Helene Wechsler, MD, established the Scottsdale Holistic Medical Group in Scottsdale, Arizona. The practice would later change names — now The Scottsdale Private Physicians.

McGarey’s efforts served to lay the groundwork for the cultural shift of recent years. Her efforts worldwide continue to receive international acclaim. Today, alternative and holistic medical modalities are much more widely recognized and considered, and DO’s are one of the fastest-growing segments of healthcare professionals in the US, with 92,028 DO’s in 2014 (according to the 2014 Osteopathic Medical Professional Report).

Additionally, approximately 42% of all US Hospitals now offer nonconventional medical services (according to a 2016 Newsmax Health report).

Bringing a holistic approach

Beyond practice

McGarey also spent years lobbying to include husbands in the delivery room, and finally achieved her first success on that front at the County Medical Center.

McGarey is Board-certified in Holistic & Integrated Medicine, and throughout her career has been a pioneer for bringing these principles to the forefront of healthcare. In fact, she is internationally recognized as the Mother of Holistic Medicine.

Her life and practice reflect the belief that even some of life’s most devastating afflictions can be met and overcome with a mixture of natural therapies, traditional medicine, and prayer.

Recognizing that there are many approaches throughout the world not in the standardly recognized lexicon of healthcare studies, McGarey sought to bridge the gap by introducing holistic elements and sharing ideas to increase awareness of a whole-body approach to diagnosis and healthcare, believing that the body is

In addition to her work within her practice group, broadening awareness of holistic medicine integration through symposiums, and public speaking engagements, McGarey also found other ways to fight to close the gap between conventional and holistic medicine. In 1978 she co-founded the American Holistic Medical Association.

“We created the Arizona Homeopathic & Integrative Medical Association (AHIMA) here in AZ so that MD’s and DO’s who had adequate training in aspects of alternative medicine could practice,” McGarey said.

She was heavily involved with the association, serving as president, and chair of the board for many years. She describes the work as continually ongoing. mcmsonline.com/round-up

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“I have always felt that it was important to work within the current structure to bring about change, not against it,” McGarey said of her work and ongoing involvement with organized medicine. “Work with what is already working and do what you can to fix what is not working.”

In addition to cofounding the AHIMA, McGarey has also been involved with MCMS for many years.

“MCMS has not always understood what I was working with, like acupuncture, but it allowed us to put on the first conference on acupuncture in Arizona so that physicians could hear about it,” she said.

Around 1989, she also created what is now known as The Foundation for Living Medicine (formerly called The Gladys Taylor McGarey Medical Foundation. This non-profit organization helps to expand the knowledge and application of holistic principles through scientific research and education, working to shift the current disease model to one that focuses on the individual and the wholeness of life.

“Through the years our foundation has had a program where senior medical students who have shown an interest in holistic medicine can spend a month with physicians who are actively practicing holistic medicine and shadow them,” McGarey said.

The Foundation for Living Medicine is actively working with Mesa Community College at Red Mountain to further the work of Living Medicine, she said.

McGarey semi-retired in 2005, and travelled to Afghanistan along with her brother, Carl Taylor, MD, to educate village women. Their maternal death rate was higher than any other place in the world, and McGarey reports that her work there, and the results, have been very gratifying.

In addition to birthing education throughout the regions of Afghanistan, McGarey also spent time in Northern India, implementing international holistic medical projects there.

A celebrated figure The scope of McGarey’s career sweeps across decades, continents, practices, organizations, and philosophies. In addition to her practice, travels, and non-profit work, she has also written and lectured extensively. She has written four books: “The Physician Within You,” “Born to Live,” “Living Medicine,” and “The World Needs Old Ladies.” She is also the subject of another book, “Born to Heal,” which was written by her daughter, Analea McGarey.

McGarey continues to write numerous articles for health publications, both as a columnist and feature writer. Her prolific public speaking career spans four decades, and she has shared the podium with many notable figures of the medical world, including Andrew Weil, Deepak Chopra, Wayne Dyer, Elisabeth KüblerRoss, and others.

DOMINIQUE PERKINS Dominique joined the Maricopa County Medical Society’s staff in 2014, and is currently serving as the Communications Coordinator. She has a bachelor’s degree in Communications and Journalism, and over 6 years’ experience as a writer, editor, and social media strategist.

She described her mission as, “First, listening carefully to the wisdom and healing traditions of rural village people, then offering education, training and treatment that support and augment their practices.”

Dominique also enjoys helping with Society events. Be sure to look for her the next time you attend!

Dominique can be reached at dperkins@mcmsonline.com.

Ask a Debt Collector….

Q. “So, what’s new in collections ?”

A. Last year the 3 national credit bureaus announced the National Consumer

Assistance Plan, outlining new requirements for credit reporting. A part of the plan concerns Medical Debt. Medical collection accounts less than 180 days from date of service will not be listed and agencies must delete accounts that are paid through insurance. Enhanced requirements were also added for data furnishers to supply a full name (First, Middle, Last & Generation Suffix), address, full social security number and/ or date of birth for account acceptance.

NOW MORE THAN EVER, it’s important to have an effective process in place to supply full and accurate account demographics with timely payment reporting to your collection agency to avoid consequences of incomplete credit reporting.

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Call Today for a FREE Accounts Receivable Analysis

602-252-3469

MEMBER PROFILE

Gladys McGarey, MD | On the Personal Side Describe yourself in one word.

I have been called a Trailblazer.

What is your favorite food, and favorite restaurant in the Valley?

Favorite food – Indian. Restaurant – Jewel of the Crown.

What career would you be doing if you weren’t a physician?

Aside from being a mother and grandmother and great-grandmother, I can’t think of any other career. I knew when I was 2 years old that I would be a doctor.

What’s a hidden talent you have, that most wouldn’t know about?

Family?

I have 6 children, 3 are physicians. Eldest son a retired orthopedic surgeon in Washington State.

Daughter, Helene Wechsler, a family physician here in Scottsdale. And youngest son, David, an ophthalmologist in Flagstaff. Second son a Presbyterian minister in New Mexico, and third son a psychologist in Austin, Texas.

I have 10 grandchildren. One granddaughter is an osteopathic family physician in Pennsylvania, another granddaughter is in medical school in Virginia, another granddaughter is an archivist and yoga master, a grandson in medical school in Ohio, the rest are still in school — and 3 are engineers.

I also have 5 great grandchildren.

I knit and do embroidery.

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Can MCMS help you grow your practice?

BY DIXIE HARRIS

“I hope you can help us. We were referred to you by my husband’s doctor. He gave me your phone number to find a doctor. I need someone with experience! I am trying to save my husband!”

every day. There are patients searching for the ideal doctor for specific medical needs. The Maricopa County Medical Society wants to make sure that patients can find you — especially when they need you the most.

“I hope you can help my son. He was addicted to prescription drugs. He weaned himself off, but now he can’t sleep. He hasn’t slept for five days and he is going crazy. I’m afraid he will harm himself.”

To that end, the Society operates a free telephone and web-based Physician Referral Service to match patients with physicians that are active Society members.

“We are new in town and need to find a family doctor. Can you help us find one that accepts Medicare?”

These are samples of the types of calls we receive

We refer thousands of patients each year. Some call us as a first resource, some as a last hope. From asthma to Zika, and from Apache Junction to Wickenburg, our primary purpose is to help the community by finding the right doctor, and by helping you — our members — by making sure you can be found. mcmsonline.com/round-up

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While most modern referrals are sought online, we take dozens of calls every day through the referral hotline. The information exchanged is basic — they tell us what specialty they are looking for, and we give them a few names and phone numbers of active members as close to their area as possible. The final selection of a physician is up to the patient based on their needs and preferences.

But while the information may seem basic, the service is not. There is no typical caller. Some are shell shocked at the news they just received about an illness, whether it’s their own or that of a family member.

Many are also concerned about finding a doctor who accepts their insurance coverage, especially Medicare.

Things are changing and so is the level of anxiety.

A calm, compassionate voice goes a long way to give hope in addition to a referral. And people want to feel they are calling to make an appointment with a physician who has been recommended — someone they can trust.

We know you are the doctor they are looking for, and we want to make sure they know it. If you haven’t taken a look at your searchable MCMS profile information recently, take a look by visiting: https://www. mymcms.com/providersearch/.

Make sure your specialties are listed, as well as which languages you speak, and that your addresses and contact information are correct. If you find that changes need to be made, please contact us! Call Dixie Harris, membership coordinator at MCMS at 602-2512363, or email dharris@mcmsonline.com.

More specialties needed!

We keep track of the number of referrals given on a monthly, quarterly, year-to-date, and previous year basis in the physician’s profile. We have found a few trends and current needs: •

Each member receives an average of eight referrals per year.

•

There is an above average demand in the following categories: allergy & immunology, dermatology, endocrinology & metabolism, family medicine, psychiatry, gastroenterology, internal medicine, cardiology, pain management, maternal & fetal medicine, neurology, physical medicine & rehabilitation, pulmonary disease, rheumatology, and sleep medicine.

•

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Geographically speaking, we welcome doctors from all of Maricopa County to join! We receive referral requests from all ends of the Valley. We are experiencing increased demand from the East Valley and outer regions where the Valley has grown, whether it be North, South, East or West. We welcome new doctors to fill the increasing demand.

Round-up November 2016

If you are not currently signed up to receive FREE patient referrals, isn’t it time?

Referral Line Fast Facts

Phone number: 602-251-2363 Website: www.mcmsonline.com Email: dharris@mcmsonline.com MCMS Membership value is in the numbers MCMS provided 7674 physician referrals in 2015.

This breaks down to 640 calls per month, 148 calls a week, annually.

Annual specialty referrals: Internal Medicine: 1097 Neurology: 830 Family Medicine: 782 Gastroenterology: 671 Dermatology: 503 Orthopedic Surgery: 470 ObGYN: 350 *Cardiology: 340 Ophthalmology: 330 Psychiatry: 300 *Includes cardiovascular disease and interventional cardiology.

Cost The average dollar amount for a regular office visit to a PCP under the CPT code 99213 is $75 (allowed amount) for the visit (Medicare fee schedule is $72).

Three referrals through the MCMS telephone and web-based service could = $250 (active annual dues membership).

DIXIE HARRIS, MBA Ms. Harris is the Membership Coordinator for the Maricopa County Medical Society. She has an MBA from ASU. She has 5 years’ experience in customer outreach & retention, and 10 years’ experience in data analysis. She is also very active in her community, and is involved in several local organizations. Be sure to look for her at our next Society event!

Maricopa County Medical So 2016 Annual Event

Doctors in the

Maricopa County Medical Society’s 2016 Annual Event

Welcome to the Maricopa County Medical Society’s 2016 Annual Event

e octors in the Desert y,

g,

d s e of

October 14, 2016 6:00 - 9:00 pm El Chorro 5550 East Lincoln Dr. Paradise Valley, AZ

October 14, 2016 6:00 - 9:00 pm El Chorro 5550 East Lincoln Dr. Paradise Valley, AZ

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I

t’s hard to believe another year has come and gone, and we find ourselves once again presenting photos from the Maricopa County Medical Society’s annual dinner!

This year’s event: Doctors in the Desert, was Sponsored by Cancer Treatment Centers of America, and held October 14, at El Chorro restaurant in Paradise Valley. It was a beautiful night, with a great turnout by our members.

Members enjoyed our surprise guest – Tesla Motors, who showcased two of their new car models before dinner. Drinks and appetizers were enjoyed on the El Chorro patio, along with group portraits by Denny Collins Photography. All photos have been posted to the Society’s facebook page, so please stop by and find yours!

We enjoyed a wonderful dinner and program. Outgoing MCMS President Adam Brodsky, MD, shared his thoughts on the necessity of an ethical, individual, and personal doctor-patient-relationship in today’s healthcare market befuddled by regulatory concerns. Incoming MCMS president, John Couvaras, MD, shared his enthusiasm, asserting that we, as a Society, have more political power and influence than we realize, and said he is looking forward to a new year of possibilities. So are we!

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Our keynote speakers, Cynthia Stonnington, MD, and Judith Engelman, MD, gave a wonderful presentation on physician reliance – a topic that has been highly talked-of in the past year as more and more doctors are experiencing burnout as they try to adjust to (and keep up with) an ever-changing healthcare landscape that puts more and more pressure on physicians.

Dr. Stonnington is Chair of Psychiatry & Psychology at Mayo Clinic in Arizona. She attended Mayo Medical School in Rochester, MN, did her residency training in Psychiatry at Stanford University Medical Center, and completed a Clinical Research Fellowship in brain imaging at University College London’s Wellcome Trust Centre for Neuroimaging. An Associate Professor of Psychiatry, her research interests include: applying neuroimaging methods to predict cognitive decline; exploring the neuropsychiatric underpinnings of psychosomatic illness; and identifying and testing interventions that can increase resilience in the face of illness or risk for illness, and to help healthcare providers increase their resiliency in the face of burnout.

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Dr. Engelman is a graduate of Case Western Reserve School of Medicine and is a Board Certified Psychiatrist who has practiced in Phoenix and Scottsdale for 33 years. She was the Medical Director of Neuropsychiatric Pharmaceutical Research for a private company for five years. Dr. Engelman has been on the teaching faculty at St. Joseph’s Hospital, Maricopa Medical Center, where she started a Resident Stress Committee in 1985, and Mayo Clinic, where she was recently involved in conducting a research study aimed at fostering resilience in women physicians, nurse practitioners, and physician assistants with children under the age of 18. At present, she is writing a book about developing resilience to thrive after trauma with Sam Harris, a Holocaust Survivor and President Emeritus of the Illinois Holocaust Museum and Education Center.

The evening ended with lingering conversations over mini churros, chocolate tarts, and of course the famous El Chorro sticky buns! We are so grateful to everyone who attended, and for all the hard work that went into making the evening such a success. We have an exciting social calendar planned for next year, so keep your eyes open for our next event. We hope we’ll see all of you there!

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New Members Active Members

Lawrence J. Liszewski, DO

Family Medicine Medical School: Chicago College of Osteopathic Medicine, Chicago, IL Residency: Mt. Clemens General Hospital Practice Address: Allergy & Environmental Tx Ctr, 8952 E Desert Cove, Suite 114, Scottsdale, AZ 85260 Phone: (480) 634-2985 Website: www.allergyenvironmental.com

Emily A. Mallin, MD

Internal Medicine Medical School: Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel Residency: Banner Good Samaritan Medical Center, Phoenix, AZ Practice Address: Banner Good Samaritan Medical, 1111 E McDowell Road, Phoenix, AZ 85006 Phone: (602) 839-3818 Website: www.bannerhealth.com

Shweta Jain, MD

Internal Medicine Medical School: Dr. D Y Patil Medical College, Mumbai University, New Bombay, India Residency: Mount Vernon Hospital, Mount Vernon, NY Practice Address: Banner Arizona Medical Clinic, 13640 N Plaza del Rio Blvd, Peoria, AZ 85381 Phone: (623) 876-3800

Rex H. Ragsdale, MD

Family Medicine Medical School: St. Louis University School of Medicine, St. Louis, MO Residency: St. Mary’s Medical Center, Evansville, IN Practice Address: Iora Primary Care, 9124 E Main Street Suite 20, Mesa, AZ 85207 Phone: (480) 295-8070 Website: www.ioraprimarycare.com/phoenix

Rita E. Fisler, MD

Dermatology Medical School: Harvard Medical School, Boston, MA Residency: University of Kansas Medical Center, Kansas City, KS Practice Address: English Dermatology Centers, 15215 S 48th Street Suite 120, Phoenix, AZ 85044 Phone: 480-706-6580 Website: www.englishdermatology.com

Adele O’Sullivan, MD

Family Medicine Medical School: University of Arizona College of Medicine, Tucson, AZ Residency: University of Arizona Health Sciences Center, Tucson, AZ Practice Address: Circle the City Medical Respite, 333 W. Indian School Rd, Phoenix, AZ 85013 Phone: (602) 776-9000 Website: www.circlethecity.org

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Maaz Iqbal, MD

Pain Management/Anesthesiology Medical School: University of Arizona, Tucson, AZ Residency: St. Joseph’s Hospital & Medical Center, Phoenix, AZ Practice Address: Integrity Pain & Wellness, 10115 E Bell Rd Suite 107 Box 468, Scottsdale, AZ 85260 Phone: (480) 494-3550

Melissa Ludwig, MD

Emergency Medicine Medical School: University of Texas Medical School at Houston, TX Residency: University of Texas at Houston, Hermann Hospital, Houston, TX Practice Address: Banner Good Samaritan Medical, 1111 E McDowell Road, Phoenix, AZ 85006

Linh C. Nguyen, MD

Family Medicine Medical School: American University of the Caribbean, School of Medicine, Plymouth, Montserrat Residency: Lynchburg Family Medicine Center, Lynchburg, VA Practice Address: MD24 House Call, 14780 W Mountain View Blvd, Suite 110, Surprise, AZ 85374

David Beyda, MD

Pediatric Critical Care Medicine Medical School: Loyola University of Chicago Stritch School of Medicine, Maywood, IL Residency: University Louisville Affiliated Hospitals, Louisville, KY Residency: Johns Hopkins University School of Medicine, Baltimore MD Practice Address: 8945 North 45th Street, Phoenix, AZ 85028 Phone: (602) 933-1784

Julie Wendt, MD

Internal Medicine/Allergy & Immunology Medical School: University of Tennessee, Memphis, TN Residency: Rush University Medical Center, Chicago, IL Practice Address: Phoenix Medical Group, 9171 West Thunderbird Road Suite 101, Peoria, AZ 85381 Phone: (623) 815-7800

Christina Chrisman, MD

Neurology Medical School: Indiana University School of Medicine, Indianopolis, IN Residency: St. Joseph’s Hospital & Medical Center, Phoenix, AZ Practice Address: Center for Neurology and Spine, 3815 E Bell Road Suite 2400, Phoenix, AZ 85032 Phone: (602) 482-2116

Amanda Hill, MD

Gynecology Medical School: Albany Medical College, Albany, NY Residency: Women and Infants Hospital, Brown University, Providence RI Practice Address: Kelly H. Roy MD, PC, 3410 N 4th Ave, Phoenix, AZ 85013 Phone: (602) 358-8588

Robert Waldrop, MD

Fellowship: Suny Upstate Medical University at Syracuse, Syracuse, NY

Orthopaedic Surgery/Orthopedic Surgery of the Spine/Musculoskeletal Oncology Medical School: University of South Alabama College of Medicine, Mobile, AL Residency: Banner University Medical Center, Phoenix, AZ Fellowship: UCSF Department of Orthopedic Surgery, San Francisco, CA Practice Address: Sonoran Spine Center, 1255 W Rio Salado Pkwy, Suite 107, Tempe, AZ 85281 Phone: (480) 962-0071

Richard Brown, MD

Linda Lau, MD

Radiology Medical School: Ohio State University College of Medicine & Public Health Residency: Indiana University School of Medicine, Indianapolis, IN Fellowship: Indiana University School of Medicine, Indianapolis, IN Fellowship: Ohio State University College of Medicine, Columbus OH

Family Medicine Medical School: Albany Medical College, Albany, NY Residency: Beth Israel Medical Center, New York, NY Practice Address: Mountain Vista Medical Center, 1301 S Crismon Rd., Mesa, AZ 85209 Phone: (480) 358-6100 Website: http://mvmedicalcenter.com

Jonathan S. Kaplan, DO

Anesthesiology Medical School: Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL Residency: University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY Practice Address: Grand Canyon Anesthesiology, 5110 N 44th Street #L-200, Phoenix, AZ 85018

CTCA Members

Mohammad Abbasian, MD

Anesthesiology Medical School: Tehran University of Medical Sciences & Health Services Residency: Shands Hospital at the University of Florida, Gainesville, FL Fellowship: Arizona Pain Management, Scottsdale, AZ

Brian Acord, MD

Obstetrics & Gynecology Medical School: University of California, Davis, School of Medicine, Davis CA Residency: Mercy Hospital Medical Center, San Diego, CA

Gbadebo Adebayo, MD

Anesthesiology Medical School: Obafemi Awolowo University, Coll of Hlth Sci, Ile-Ife, Ife, Nigeria Residency: Suny/Downstate Medical Center, Brooklyn, NY Fellowship: Baylor College of Medicine, Houston, TX

Hafez Azadeh, MD

Anesthesiology Medical School: University of Washington School of Medicine, Seattle, WA Residency: University of Washington School of Medicine, Seattle, WA

Paramveer Bhugra, MD

Internal Medicine/Pulmonary Medicine/Critical Care Medicine Medical School: St. George’s University of Grenada Residency: New York Hospital Medical Center of Queens, Flushing NY Fellowship: University of Tennessee Medical Center, Knoxville, TN Fellowship: Brown University - MIRAIM, Providence, RI

Jeanette Boohene, MD

Internal Medicine/Palliative Medicine Medical School: University of Newcastle-Upon-Tyne, Fac of Med, Newcastle Upon Tyne, England Residency: Lankenau Hospital, Philadelphia, PA Fellowship: M.D. Anderson Hospital & Tumor Institute, Houston, TX

Jugroop Brar, MD

Pulmonary Disease/Critical Care Medical School: Christian Med Col-Punjab U Residency: Henry Ford Hospital, Detroit, MI

Plastic Surgery/General Surgery Medical School: Rosalind Franklin University of Medicine and Sciences, Chicago, IL Residency: Mt Sinai Hospital Medical Center, Chicago, IL Fellowship: Northwestern University Medical School, Chicago, IL Fellowship: University of Nebraska Medical Center, Omaha, NE

Barbara Ellen Carr, MD

Anthony Cilla, MD

Anesthesiology Medical School: Wayne State University School of Medicine, Detroit, MI Residency: University of Texas - Southwestern Medical Center, Dallas, TX Fellowship: University of Texas Southwestern Medical Center, Dallas, TX

Roma Cruz, MD

Infectious Disease Medical School: University of Santo Tomas, Manila, Philippines Residency: Danbury Hospital, Danbury, CT

Carla Dormer, MD

Anesthesiology Medical School: University of Arizona College of Medicine, Tucson, AZ Residency: Tucson Hospital Medical Education Program, Tucson, AZ

Nathan Duffin, DO

Hospitalist/Internal Medicine Medical School: Midwestern University - Arizona College of Osteopathic Medicine, Glendale, AZ Residency: Sierra Vista Regional Medical Center, Sierra Vista, AZ

John Eelkema, MD

Radiology Medical School: University of Minnesota Medical School, Minneapolis, MN Residency: LA State University Medical Center, New Orleans, LA Fellowship: LA State University Medical Center, New Orleans, LA

John Farley, MD

Gynecologic Oncology Medical School: Uniformed Services Univ. of the Health Sciences, Bethesda, MD Residency: Walter Reed Army Medical Service, Washington DC Fellowship: Walter Reed Army Medical Center, Washington, DC

Gregory J Fenzl, DO

Radiology Medical School: University of New England, College of UNE/COM, Biddeford, ME Residency: Cleveland Clinic, Cleveland, OH

Lawrence Finkel, DO

Diagnostic Radiology Medical School: Michigan State Univ College of Human Medicine, East Lansing, MI Residency: Detroit, MI

Kenneth G Flanagan, MD

Pathology Medical School: UCLA - David Geffen School of Medicine, Los Angeles, CA Residency: Harbor UCLA Medical Center, Torrance, CA

James Flynn, MD

Radiation Oncology Medical School: St. Louis University Health Sciences Center School

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of Medicine, St. Louis, MO Residency: New York Hospital/Cornell Medical Center, NY, NY

Fellowship: Medical College of Wisconsin, Milwaukee, WI

Jean Hage, MD

Radiology Medical School: Boston University School of Medicine, Boston, MA Residency: Boston University Medical Center, Boston, MA

Infectious Disease Medical School: University Di Firenze, Firenze, Italy Residency: Winthrop University Hospital, Mineola, NY Fellowship: Winthrop University Hospital, Mineola, NY

Christian J Ingui, MD

We know that you need to spend your time Wissam Jaber, MD Pulmonary with patients, The Society is here to help you Medicine/Critical Care William Harvey, DO Medical School: American University of Beirut Anesthesiology Residency: Emory University School of Medicine, Atlanta, GA in areas you don’t have time for.

Medical School: Lake Erie College of Osteopathic Medicine, Erie, PA Residency: Rush University Medical Center, Chicago, IL

Fellowship: Cleveland Clinic Foundation, Cleveland, OH

• More than Eric A Hegybeli, DO 1,000 patient referrals per month

Cardiology/Internal Medicine Medical School: Philadelphia College of Osteopathic Medicine, Philadelphia, PA Residency: Frankford Hospital, Philadelphia, PA Fellowship: Frankford Hospital, Philadelphia, PA

Psychiatry • Networking / Social /University/Larkin Educational events Medical School: Nova Sountheastern Community Hospital Business resources physician Residency:• University of Texas Health for Science Center practices

William Jaffe, DO

• Preferred Partner Program for local discounts Jordana Jaffee, MD Noah S Horowitz, MD Psychiatry & incentives Medical School: University of Western Ontario, London, Ontario, Canada Residency: Medical College of Wisconsin, Milwaukee, WI

CREDENTIALS VERIFICATION ORGANIZATION

Internal Medicine Medical School: not on AZ medical board

call 602-252-2015

visitMD us at www.mcmsonlilne.com Waheed Jalalzai, Radiology Medical School: SUNY Downstate Medical Center Residency: The Cleveland Clinic Foundation, Cleveland, OH Fellowship: The Cleveland Clinic Foundation, Cleveland, OH

Ask a Debt Collector….

Kirsten Janosek-Albright, MD

WHAT CAN OUR CREDENTIALING TEAM DO FOR YOU? • Primary source verification • Medical record compliance reviews • Facility site audits

Urology “At what age should our office Medical School: University of OK College Of Medicine sendHenry accounts collections?”

Residency: Ford to Health System, Detroit, MI Residency: Henry Ford Health System, Detroit, MI

Q.

A. A good rule of thumb

Michael Kayser, DOthat is to assign accounts

Genetics have had no response from Medical School: Oklahoma State University College of Osteopathic the patient Medicine, Tulsa,after OK 90 days Residency: of Oklahoma College of Medicine, Tulsa, OK of billing.University Industry statistics Fellowship: show the National value of Institutes accounts of Health/National Human Genome Research Institute, Washington, DC

receivable declines sharply

Imran after Kazem, 90 days toMD around 15

Radiology -20% School: of their Indiana original University value. School of Medicine, IndianapoMedical considering the costs lis, When IN Residency: Oakwood Hospital of resources necessary to and Medical Center, Dearborn, MI Fellowship: Baylor College of Medicine Hospitals, Houston, TX

continue billing and subsequent

Kevin MDon unpaid followKearney, up expended

Radiology accounts, your practice may get Medical School: Tufts University Medical School, Boston, MA better return putting those resources into current billing.

Residency: Henry Ford Hospital, Detroit, MI AssigningOregon delinquent accounts to an agency prioritizes Fellowship: Health and Science University, Portland, OR

your unpaid billsMD for earlier resolution.

Douglas Kelly,

Radiation Oncology an agency for your practice, choose When considering Medical School: McGill University, Montreal, Quebec, Canada the one the General experience you need to protect Residency:with Ottawa Hospital, Ottawa, Ontarioyour

602-256-0705

visit us at www.azcvo.com

Serving Arizona Physicians since 1987!

good name. Since 1951, Bureau of Medical Economics

Amer Khan,healthcare MD has served providers exclusively with careful Internal Medicine/Nephrology patientSchool: account management.

Medical Memorial University of Newfoundland Residency: LAC/USC Medical Center, Los Angeles, CA Fellowship: LAS/USC Medical Center, Los Angeles, CA

Call Today for a Free Accounts Receivable Analysis

Alexander Kim, MD

602-252-3469

Anesthesiology Medical School: University of Arizona College of Medicine, Tucson, AZ Residency: University Medical Center, Tucson, AZ Residency: University of Arizona Health Sciences Center, Tucson, AZ

Suzi Kochar, MD Endocrinology

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Medical School: Mandalay University, Mandalay, Myanmar Residency: Lutheran Medical Center, Brooklyn, NY Fellowship: Finch University of Health Sciences/Chicago Medical, Chicago, IL

Medical School: Baylor College of Medicine, Houston, TX Residency: Mayo School of Graduate Education, Rochester, MN Fellowship: LDS Hospital, Salt Lake City, UT Residency: Mayo School of Graduate Education, Rochester MN

Vineel Kurli, MD

Madhu Murthy, MD

Radiology Medical School: Chennai Medical College, Chennai, India Residency: Yale University School of Medicine, New Haven, CT Fellowship: New York University School of Medicine, NY, NY Fellowship: Beth Israel Medical Center, NY, NY

Shafeeq Ladha, MD

Neurology Medical School: University of Arizona College of Medicine Residency: St. Joseph’s Hospital & Medical Center, Phoenix, AZ Fellowship: Mayo Clinic, Rochester MN Fellowship: Mayo Clinic, Scottsdale, AZ

Stephen Larsen, MD

Urology Medical School: Rush Medical College of Rush University Residency: Rush University Medical Center, Chicago, IL

Irene Lin, DO

Radiology Medical School: Kirksville College of Osteopathic Medicine, Kirksville, MO Residency: Stroger Hospital of Cook County, Chicago, IL Fellowship: Keck School of Medicine of the USC, Los Angeles, CA

Cynthia Lynch, MD

Infectious Disease Medical School: J S S Medical College, Mysore, Karnataka, India Residency: University of South Dakota School of Medicine, Vermillion, SD Fellowship: Creighton University School of Medicine, Omaha, NE

Daniel Nader, DO

Pulmonary Disease Medical School: University of Health Sciences, Kansas City, MO Residency: NRMC (CA)

Prashant Narain, MD

General Surgery Medical School: Rajendra Medical College, Ranchi Univ, Ranchi, Bihar Residency: Medical College of Virginia Hospitals, Richmond, VA

Kashif Nasim, MD

Hospitalist/Internal Medicine Medical School: Nishtar Med Coll, Multan, Pakistan Residency: Maricopa Medical Center, Phoenix, AZ

A. Nuri Ozkan, MD

Anesthesiology Medical School: Tulane University School of Medicine, New Orleans, LA Residency: Maricopa Medical Center, Phoenix, AZ

Hematology/Oncology Medical School: Drexel University College of Medicine, Philadelphia, PA Fellowship: Brody School of Medicine at East Carolina University, Greenville, NC

Prabhakar Pandey, MD

Kevin McCabe, DO

Gaurav Patel, MD

Pathology Medical School: College of Osteopathic Medicine, Pamona, CA Residency: Wilford Hall USAF MC (TX)

Ammar Mian, MD

Internal Medicine Medical School: King Edward Medical College, Univ of Punjab, Lahore, Pakistan Residency: Harlem Hospital Center, New York, NY

Nizamid-Din Missaghi, MD

Anesthesiology Medical School: Virginia Commonwealth Univ, School of Medicine, Richmond, VA Residency: University of Virginia Health System, Charlottesville, VA

Michelle Mix, MD

Cardiovascular Disease Medical School: University of Illinois College of Medicine Residency: Keck School of Medicine of the USC, Los Angeles, CA Fellowship: Loma Linda University School of Medicine, Loma Linda, CA Fellowship: Banner Good Samaritan Medical Center, Phoenix, AZ

Colin Mooney, MD

Anesthesiology Medical School: Creighton University School of Medicine Residency: University of Kansas Medical Center, Kansas City, KS

Benjamin Munroe, DO

Anesthesiology Medical School: Kirksville College of Osteopathic Medicine, Kirksville, MO Residency: St. Louis Univesity Hospital, St. Louis, MO

Michael Murray, MD Anesthesiology

Urology Medical School: Patna Medical College, Patna Univ, Patna, Bihar Residency: Metropolitan Group Hospitals, Chicago, IL Residency: University of Mississippi Medical Center, Jackson, MS Radiology Medical School: University of Virginia Health System Residency: Brigham & Women’s Hospital - Harvard Medical School, Boston, MA Residency: University of Rochester Medical Center, Rochester, NY

Kalpesh Patel, MD

Radiology Medical School: M S Ramaiah Medical College, Bangalore University Residency: University of Rochester Medical Center, Rochester NY Fellowship: University of Rochester Medical Center, Rochester, NY

Rakesh Patel, MD

Radiology Medical School: Saba University School of Medicine, Saba, Netherlands Residency: University of Illinois, Chicago, IL Fellowship: Proscan Imaging, Cincinnati, OH

Sundeep Patel, MD

Thoracic Surgery Medical School: University of Texas Medical Branch, Galveston, TX Internship: University of Texas Medical Branch at Galveston Affiliated Hospitals, Galveston TX Fellowship: New York University and Affiliated Hospitals, New York, NY

Russell Reisner, MD

General Surgery/Surgical Oncology Medical School: New York University School of Medicine, New York, NY Residency: Long Island Jewish Hospital, New Hyde Park, Long Island, NY Fellowship: Roswell Park Cancer Institute, Buffalo, NY

Hector Rodriguez-Luna, MD

Gastroenterology Medical School: Ponce School of Medicine, Ponce, Puerto Rico Residency: Ochsner Foundation Hospital, New Orleans, LA Fellowship: Mayo Clinic Scottsdale

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Fellowship: Good Samaritan Medical Center/V.A. Medical Center, Phoenix, AZ

William Romano, MD

Radiology Medical School: University of Western Ontario, London, Ontario Residency: Western Pennsylvania Hospital, Pittsburgh, PA

Anjali Roy, MD

Radiology Medical School: Patna Medical College, Bihar, India Residency: University of Texas Health Science Center, Houston, TX Fellowship: University of Texas/M.D. Anderson Cancer Center, Houston, TX

Veronica Y Ruvo, DO

Radiology Medical School: Chicago College of Osteopathic Medicine Residency: Overlook Hospital, NJ

Barry J Sadegi, MD

Radiology Medical School: American University of the Caribbean School of Medicine, St. Maarten Residency: University of Illinois at Chicago Fellowship: University of Illinois at Chicago

Farshid Sadeghi, MD

Urology Medical School: University of Southern California School of Medicine Residency: Baylor College of Medicine, Houston, TX Fellowship: Baylor College of Medicine, Houston, TX

Paul Sawrey, MD

Cardiology Medical School: Queens University Faculty of Medicine, Kingston, Ontario Residency: Good Samaritan Regional Medical Center, Phoenix, AZ

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Matthew J Seidel, MD

Orthopedic Oncology Medical School: Ohio State University College of Medicine Residency: Maricopa Medical Center, Phoenix, AZ

Saman Selahi, MD

Hospitalist/Internal Medicine Medical School: St. George’s University School of Medicine, Grenada Residency: Coney Island Hospital, Brooklyn, NY

Abhijit Shah, MD

Radiology Medical School: UMDNJ - Rutgers Medical School Residency: Cleveland Clinic Foundation, Cleveland, OH Fellowship: Johns Hopkins Medical Institutions, Baltimore, MD

Akhilesh K Sharma, MD

Infectious Disease Medical School: University College of Medical Sciences, New Delhi, Delhi India Residency: Oakwood Hospital, Dearborn, MI Fellowship: Creighton University Medical Center, Omaha, NE

Doris Stair, MD

Radiology Medical School: Univ of Rochester Sch of Med & Dent Residency: Long Island College Hospital, Long Island, NY Fellowship: Massachusetts General Hospital, Boston, MA

Steven Standiford, MD

General Surgery/Surgical Oncology Medical School: Rutgers New Jersey Medical School, Newark, NJ Residency: Temple University Hospital, Philadelphia, PA Fellowship: University of Medicine & Dentristy of New Jersey, Newark, NJ Pathology Medical School: Cebu Institute of Medicine Residency: University of Illinois College of Medicine, Chicago, IL

Gregory Titus, MD

Radiology Medical School: Indiana University School of Medicine Residency: University of Arizona Health Sciences Center, Tucson, AZ

Chafeek Tomeh, MD

Otolaryngology Medical School: Medical College of Wisconsin Residency: University of Tennessee, Memphis, TN

William Weiss, MD

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Bradford Tan, MD

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Gary Scherr, MD

Round-up November 2016

Nephrology Medical School: Rosalind Franklin University of Medicine and Sciences Residency: George Washington University Medical Center, Washington, DC Fellowship: Case Western Reserve University School of Medicine, Cleveland, OH

David Weitz, MD

Radiology Medical School: Wayne State University School of Medicine, Detroit, MI Residency: Cedars Sinai Medical Center, Los Angeles, CA

Richard M Willey, DO

Radiology Medical School: Des Moines University/OMC Residency: Naval Medical Center, San Diego, CA

Aaron F Wittenberg, MD

Radiology Medical School: Medical College of Ohio, Toledo, OH Residency: Metrohealth Medical Center, Cleveland, OH Fellowship: Metrohealth Medical Center, Cleveland, OH

Farid Zehtab, DO

General Surgery Medical School: College of Osteopathic Medicine of the Pacific, Pamona, CA Residency: Grandview Hospital

Gilman Wolsey, MD

Radiology Medical School: Medical College of Wisconsin, Milwaukee, WI Residency: Medical College of Wisconsin Affilliated Hospitals, Milwaukee, WI Residency: University of Texas Health Science Center, San Antonio, TX

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In Memoriam John A. Jones, MD Dr. Jon “Jack” Jones, 92, beloved husband of Elaine, peacefully passed away on Oct. 13, 2016, at the Villas in Green Valley. He was the first-born son of the late Warner and Mabel (Straw) Jones.

Born Dec. 7, 1923 in Wheatland, Wyo., he was a graduate of Wheatland high school and the University of Wyoming.

friends. It was during this time that he served as president of the Arizona Society of Anesthesiologists and received a special recognition award in appreciation for distinguished service.

A member of the Phoenix Country Club and the Rotary Club, Jack liked people and had a wonderful smile. He was a gifted fly fisherman and could tie masterful dry and wet flies. He had a love for aviation and received his private pilot’s license and instrument rating. Also, he was an avid reader, history being his favorite. He loved golf and one time played with the great Jack Nicholas.

He enlisted in the Navy after Pearl Harbor and honorably served nearly 3 years as a medical corpsman in the Pacific Theater. While in service, he met his first wife, the now-deceased Francis Haley.

Jack had a deep passion for music. His ability to whistle would astonish the likes of Arthur Fiedler and Andrew Lloyd Webber. Now the angels in Heaven are elated that he is whistling harmony with their glorious chorus.

Jack received his M.D. degree from the University of Colorado. Upon finishing his medical internship at Good Samaritan Hospital in Phoenix, he began Family Practice with a friend, Dr. James Anderson. The two young docs often made house calls to their patients.

After 15 years of Family Practice, Jack returned to school at the University of Southern California and became a board-certified anesthesiologist.

Jack and Elaine enjoyed 15 years of retirement in Green Valley. During this time he lovingly cherished his companion dog Abby. He and Elaine delighted going to the Pops Tucson Symphony, attending movies and entertaining friends and family.

He returned to Phoenix and completed his career, after practicing many years, with a group of anesthesiologist

He is survived by his brother Bill (Jeanne); 4 loving daughters, Rosemary Duvall, Jan Jordan, Deborah Slavic (Tony), and Bobbye Fisher; 9 grandchildren and 6 great-grandchildren. A sister, Marion Jean Blinn, predeceased him.

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MCMS Membership.................................................... 22 Bureau of Medical Edonomics.................................. 26 Perlmutter Medical Law............................................. 28 Greater Arizona Central Credentialing Program..... 38 MCMS Preferred Partner........................................... 40 ProAssurance...............................................................41 Arizona Dermatology....................... Inside back cover MICA.............................................................. Back cover

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Round-up November 2016

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