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Round-up October 2016
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October 2016 | Volume 62 | Number 10 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 firstname.lastname@example.org. All solicited and unsolicited written materials and photos submitted to Round-up will be treated as unconditionally and irrevocably assigned to and the property of MCMS and may be used at MCMS’ sole discretion for publication and copyright purposes and use in any publication, website or brochure. MCMS accepts no responsibility for the loss of or damage to material submitted, including photographs or artwork. Submissions will not be returned. The opinions expressed in Round-up are those of the individual authors and not necessarily of MCMS. Round-up reserves the right to refuse certain submissions and advertising and is not liable for the authors’ or advertisers’ claims and/or errors. Round-up considers its sources reliable and verifies as much data as possible, but is not responsible for inaccuracies or content. Readers rely on this information at their own risk and are advised to seek independent legal, financial or other independent advice regarding the content of any submission. 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.
PUBLISHED MONTHLY BY THE MARICOPA COUNTY MEDICAL SOCIETY
October 2016 | Volume 62 | Number 10
4 6 9 11 13
Arizona Physician What’s Inside
An Open Letter On Early Detection By Ian Grant-Whyte, MD
Healthcare Providers Who Are Providing MORE
Hospice of the Valley:
A legacy of community service By Beverly Medlyn
How Four Health Plans are Fighting the Opioid Epidemic By Mari Edlin
Circle the City Founder By Dominique Perkins
The Dream Machine:
Healing a Community: Sister Adele O’Sullivan, CSJ, MD
Arizona’s smokers helpline
23 29 32
Community Relations 2.0 By Gerald C. Kane, Robert G. Fichman, John Gallaugher & John Glaser
MICA Gives Back to the Community through MICA Medical Foundation By Julie Ritzman, MBA
How to Help People With Mental Illness By Miriam Anand, MD
36 42 43
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Out with ROUND-UP, in with ARIZONA PHYSICIAN!
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 exciting 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. 4
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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 read publications online, please simply email us at email@example.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 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.
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What’s Inside H Jay Conyers, PhD
ave you ever read our mission statement and thought about what it means? It’s on our website, out there in the open. It’s something that I show each month when we begin our Board meeting, by putting it up on the screen for all to see before the President strikes the gavel to commence. I’ve been doing this literally every month I’ve been here with the Society (going on three years this month). Personally, I love the beauty and simplicity of it. 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.
So our organization has a commitment to our community, but does this mean that each physician should strive to ‘heal’ our community? In many ways, the answer is yes. Ensuring that their patients know about available resources beyond the exam room is something that nearly every physician I’ve talked to does on a regular basis. Answering questions about how a patient’s treatment may impact their family is a common discussion between physician and patient. Volunteering with a local non-profit that provides care or services to underprivileged individuals is a common weekend or day-off activity that I see many of our physicians commit to doing. And the list goes on. The reality is that many, if not most, of our physician members engage their local communities in ways that most people simply don’t recognize. So why all the fuss to engage local communities? For one, research has shown that the relationship between a hospital and its community has evolved over the years, to the point where patients no longer feel drawn to their ‘local’ hospital but instead seek out what they read/hear/see as their ‘best’ option for care. While mar6
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keting efforts have largely helped push the envelope on this, patient satisfaction metrics really drive the migration from the closest possible hospital and/or clinic to those that have a good (better) reputation amongst the community’s residents. But what’s the reasoning behind this? One example would be media reports of negative events, which put healthcare facilities in the spotlight — albeit an unflattering one — and makes others in the community aware of things like infectious disease outbreaks, poor marks for maternity care, or unreasonable ED wait times. The community puts its trust in these facilities, and when actions dampen that trust, patients seek care elsewhere. Need an example? Look no further than Presbyterian Hospital in Dallas, where they saw huge declines in patient traffic after it admitted — and treated — the first Ebola patient on American soil in 2014. Was it the two nurses who contracted the disease after coming in contact with the patient? Did the community feel the physicians misdiagnosed the patient? Two years later, no one truly knows, but the reality is that patients thought twice about seeking treatment at Presbyterian after the Ebola case. And it showed on the balance sheet, where revenue took a big hit in the months following. In medicine, community engagement almost always equals trust. A community with close-knit relationships between its residents and physicians are those that thrive (from a health standpoint, at least). Many hospitals, clinics, and practices understand this, and make it a part of what they do. Hosting community events, health fairs, free screenings, and engaging patients with informational blogs go a long way towards establishing the community relationship between physicians and the local residents. Does this mean you should have your patients over for dinner? Does it mean you should accompany your patients to church? Or does it mean you should join the PTA in close proximity to your prac-
tice, so that you can speak to potential patients about medical issues? Of course it doesn’t. But what you can do is engage your community. Volunteer. Inform. Educate. Interact. Socialize. Understand. Get out there and find a way to volunteer and interact with the patients in your community. By doing so, you’ll (re)gain their trust. You’ll become more a part of their community. In the end, both doctor and patient win.
So on to this month’s issue….. This month, we profile Sister Adele O’Sullivan, MD, one of our community’s brightest stars. A physician and a member of the Sisters of St. Joseph of Carondelet since 1968, she cares for those in need though Circle the City, a local respite home she founded a few years ago with the assistance of Hospice of the Valley. We’re confident Sister Adele’s story will move you to becoming more actively involved in your own community! In this issue, we bring you a thought-provoking article about how four health plans have gone the extra mile to help communities combat opioid abuse. We also feature an update on the Maricopa County Department of Public Health’s ASHLine (Arizona Smoker’s Helpline) and offer some tips on how the service is working with local provider groups and the University of Arizona’s School of Public Health, as well as a call for earlier breast cancer screening by Dr. Ian Grant-Whyte. Hospice of the Valley summarizes some of the great community programs they’ve rolled out over the years and describes volunteer opportunities that may appeal to some of our readers. We also have a wonderful article from MICA that describes the efforts of their community outreach program, the MICA Medical Foundation. Next month, we focus on what membership means to physician organizations like the Society, and we profile Dr. Gladys McGarey, a pioneering force who always did things her own way. Just shy of her 96th birthday, Dr. McGarey shared with us her thoughts on her career and what being a member of the Society has meant to her. We hope you enjoy reading next month’s Roundup as much as we’re enjoying putting it together!
Got something to Say? Share? Celebrate?
We want to hear from you! Contact us at firstname.lastname@example.org Or mail letters to: Maricopa County Medical Society Attn: Round-up Editor 326 East Coronado Rd, Suite 101 Phoenix, AZ 85004 mcmsonline.com/round-up
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Presidentâ€™s Page T
he topic this month is Community. None of us practices in a vacuum; we are all part of a community. In fact, we are part of several communities. We are most obviously part of the local community in which we live, be it our county, our city, or our local neighborhood. However, there are many more communities to consider. We belong to the community of physicians and to the community of students, residents, fellows, and teachers. We belong to the community of patients. We belong to the community of well-to-do patients who show up for appointments and are compliant with their medications, and to the community of underserved patients whom we may never meet except for an unfortunate emergency room visit. And we belong to the community of presently young and healthy people who have yet to require our services but can by their own lifestyle choices hasten or delay their first medical encounter. We belong to the community of taxpayers who pay for our Medicare fee schedule, and we belong to the community of voters who vote for the officials who write the rules and regulations that govern the way we practice medicine.
And we belong to the community of nations, many of which are poor and underdeveloped, lacking the modern healthcare tools which we take for granted, yet provide us with many of the raw materials necessary for the technology we use and even the clothing we wear. It is incumbent upon us, therefore, to give back to these communities, without which we would not be able to practice medicine. Luckily, because we are a part of so many different communities, there are many options for us to consider. Firstly, we can simply donate money to charitable organizations in our communities, ranging from the universities where we attended medical school, to the free clinics in the center of town, which give care to the uninsured. There are many organizations which give free care through which we can donate our time and expertise, again ranging from once a year local health fairs to international organizations working in war-torn regions. We can give back to our teaching communities by taking on a medical student, or by giving a lecture to a group of residents. We can give back to our civic community by teaching legislators in our district about the nuances of medical practice so that the laws they pass act to safeguard our patients with a minimum of unintended consequences. We can even give back to our community of patients simply by spending a little more time teaching our patients one by one during our routine office and hospital visits. If each of us were to choose just one way to give back to just one of our communities, think of how much richer and healthier our world would be.
Adam Brodsky, MD, MM
MCMS PRESIDENT 2016 email@example.com 602.307.0070
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
President’s Page Locally, we do have a specific governmental organization devoted to the health of our community. Its mission statement is “To protect and promote the health and well-being of Maricopa County residents and visitors.” Of course I am speaking about our own Maricopa County Health Department. Despite being one of the most underfunded on a per capita basis of any county health department in the country, our local health department does amazing things, ranging from engineering responses to local epidemics, to maintaining databases of reportable diseases, to organizing vaccinations and vaccination policy. Whereas we individual physicians are charged with caring for our individual patients, our county health department is charged with maintaining the health of our entire community. This is not simply a semantic distinction. I know there are some who would say that in addition to the county health department caring for the entire population of our county, we as individual physicians must
realign our mission such that we begin seeing ourselves as caring for populations rather than individuals. While I fully endorse the need for any well-educated physician to understand epidemiology and other population-based disciplines, I believe there is a fine line, which should never be crossed. That is, my patient should never have to wonder whether I am sacrificing his or her care for the sake of the population. When I am working on or with a particular patient, in my opinion, my only aim should be the health of that patient. Since our responsibility is to the individual patient, and in my opinion we cannot let societal concerns influence our responsibility to that patient, it becomes even more important that we have a capable health department who is exclusively charged with the welfare of the entire community. There is a healthy tension between communal concerns and individual concerns. However, tilting the balance too far to the communal is not the answer for our individual patient interactions.
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The Dream Machine: An Open Letter On Early Detection BY IAN GRANT-WHYTE, MD
reast cancer is the second most common form of cancer among women. Every year 40,000 women in the United States and 5,000 women in Canada die from this disease in spite of all the research and money collected. Far too many.
If this incredible mammography machine had been previously available, there would have been far fewer untimely deaths. With that potential, the only remaining difficulty is funding and implementing a viable and affordable clinical system.
One reason is that many women have dense breast tissue and the 2D mammography machine is not able to find the cancers. It is a bit like looking for a polar bear in a snowstorm. The white images make it almost impossible to find many of the cancers in the 40% of women who have dense breast tissue.
I recently introduced Kit Vaughan, PhD, to Dr. Kopans in the hope that they will collaborate and be able to combine DBT and ABUS into a single unit. Dr. Vaughan’s company has recently developed a successful clinical system that combines 2D mammography with ABUS (www.caperay.com).
According to Harvard Radiology Professor Daniel Kopans, MD, FACR, a world authority on breast cancer imaging, digital breast tomosynthesis (DBT), now called 3D mammography, is available in the United States.
The development of a successful DBT-ABUS system will be a daunting, time-consuming, and expensive task.
It is a better program and it detects some cancers that are not visible on 2D mammography. However, even with the improved detection the 3D imaging can offer, there are still cases where an ultrasound can detect cancers not evident on DBT alone. The combination of DBT and 3D automated breast ultrasound (ABUS) will find many more cancers at an early, curable stage than in 2D mammography.
Here’s how Dr. Kopans described the challenge: “DBT is done with the patient upright and the breast is compressed side to side and top to bottom. ABUS is presently done with the patient lying supine and the
Dr. Kopans, who invented DBT, believes that a DBTABUS combination machine will enable detection of up to 95 percent of early breast cancers.
breast flattened out on the chest wall. The tissues are oriented completely differently between the two studies, making comparisons very difficult. They are now two separate studies taking twice as much time. If the two studies were done simultaneously in the same position and with the breast in the same orientation, comparing the findings would be immediate because the DBT and ABUS images would be registered with one another. We should be involved in the design and development of a new system that integrates DBT and ABUS in a single platform.â€? It would also enable the detection of more cancers at an earlier, curable stage, particularly in women with dense breast tissue, who are not only at increased risk of developing breast cancer, but whose cancer may have been missed by 2D mammography.
For more information, or to find a way to get involved, I encourage you to contact: Daniel Kopans, MD, FACR Harvard Radiology Professor firstname.lastname@example.org 617 726 3093 Dr. Kit Vaughan email@example.com or + 27 72 795 8099 www.caperay.com
With just one visit there would be far less anxiety while waiting for results, and at less expense to the patient than two consecutive visits. Dr. Vaughan has estimated that it would require $250,000 to build a clinic-ready system combining DBT and ABUS, to be sent to the Massachusetts General Hospital in Boston for Dr. Kopans to evaluate in his breast imaging clinic. One in eight women will face down this too-often deadly disease during their lives, and while we wait to find a cure, early detection invariably means a better prognosis. It would be wonderful if we could band together and raise the necessary finances to get this machine up and running.
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IAN GRANT-WHYTE, MD, CAMBRIDGE Dr. Grant-Whyte is a retired physician on a personal crusade to help further the early detection of breast cancer. He has been a member of MCMS since 1978.
Healthcare Providers Who Are Providing MORE
ith Arizona adult tobacco use rates at their lowest in generations at 14 percent;1 some are feeling it is time to shift focus to other health concerns. But did you know that tobacco use is still the leading preventable cause of disease, disability and death in the United States and Arizona?
According to the Centers for Disease Control and Prevention, an estimated 42.1 million people in the US, about one in five adults, currently smoke, and an estimated 480,000 people die prematurely from diseases caused by smoking or secondhand smoke exposure each year. Tobacco use also accounts for an estimated $300 billion in health costs and lost productivity.2
Who quits and why? Studies show that up to seventy percent of the 42 million Americans that smoke think about quitting each year, and usually try to quit 7-10 times before they are successful. Smokers that don’t participate in a smoking cessation program with counseling or nicotine replacement therapy (NRT), sadly are only successful four to seven percent of the time. 1 Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS) 2015. 2 http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_ data/cig_smoking/
You play a key role in fighting tobacco use Advice from a healthcare professional is cited by tobacco users as the number one motivator to quit. No matter your specialty you know tobacco negatively affects every system in the body. By advising all tobacco using patients to quit at every visit, you make a significant impact on Arizona’s tobacco use rate.
How can ASHLine help my office? The Maricopa County Department of Public Health (MCDPH) offers different tools and resources to help tobacco users quit, including partnering with the Arizona Smokers’ Helpline (ASHLine), who has been helping people quit tobacco since 1995. The ASHLine provides free telephone and web-based services in both English and Spanish to offer support to Arizona residents to quit tobacco. One-on-one trainings on how to approach the subject of quitting tobacco with a tobacco user are provided for healthcare providers, community and faith-based organizations, and worksites. The ASHLine helps healthcare professionals become more comfortable talking to their patients about quitting tobacco use. The outreach professionals are able to assist healthcare providers in developing tobacco screening and intervention policies, getting registered to make patient referrals, help track referrals in the database and provide information on how to bill for intervention sermcmsonline.com/round-up
vices. The resources and technical assistance provided by the ASHLine are free, and funded by state tax on tobacco products. This year nearly 10,000 Arizonans enrolled in the cessation program with a quit rate of nearly 40%.3 WebQuit, a web-based personal quit plan, allows any user to sign up to monitor their own progress when quitting tobacco. Based on scientific methods, WebQuit suggests activities and exercises for clients to complete to keep on task for quitting. WebQuit can be accessed 24/7.
What role does a personal coach play? The quit coaches through the ASHLine are real people located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona. The chances of successfully quitting tobacco use can be doubled with the help of professional counselors, most of whom are former tobacco users themselves. They understand how hard it is to quit and stay quit. Quit coaching is customized to each person individually so any special circumstances that might affect a person’s quit process can be taken into consideration.
Tri-City Cardiology’s success with tobacco intervention in office protocol Tri-City Cardiology knows only too well that smoking is a controllable risk factor to help prevent cardiovascular disease. Since receiving training from MCDPH in 2014, the five 3 ASHLine Annual Report, Fiscal Year 2016
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East Valley Tri-City Cardiology locations have referred over 560 patients to ASHLine for help to quit tobacco usage. They have been honored as the top referring medical practice to the ASHLine for the past few years by the MCDPH. The relationship with Tri-City Cardiology began by working with Angela Szczublewski, Chief Operating Officer, in setting up a referral process in the office protocol to help patients with smoking cessation. This relationship has proved extremely beneficial and has helped numerous patients quit smoking and reduce their risk for cardiovascular disease. Tri-City Cardiology utilized the data from the American College of Cardiology PINNACLE Data Registry on smoking cessation and intervention clinical quality measures to identify an opportunity for improvement in this quality metric. This referral process also improved their quality metric score with the ACC PINNACLE Registry to be above the national benchmark. The Tri-City team is committed to improving clinical outcomes through prevention, diagnosis, and treatment to help prevent cardiovascular diseases and ensure quality care to their patients. They are a leader in preventative medicine and have been selected by the Centers for Medicare and Medicaid Services (CMS) to participate as an Intervention Group for the Million Hearts Model Atherosclerotic Cardiovascular Disease (ASCVD) Risk Reduction Program starting in 2017. This program will allow Tri-City to lead the way in developing effective Cardiovascular Disease Risk Reduction strategies to help patients reduce their risk for heart disease and stroke through risk stratification, identifying high risk patients, engaging patients in shared decision making, and ongoing monitoring by the care team. Szczublewski says, “I feel like we are a step ahead of many other practices in that we already have an established and successful Tobacco Cessation program via ASHLine in place at Tri-City Cardiology to address a major risk factor in heart disease and stroke.” Dr. Bob England, Director of MCDPH says, “The key to Tri-City’s success is support from the top down and bottom up and having a written protocol for referral in place. Everyone is knowledgeable, vested and on board.” Referrals to the ASHLine increases a tobacco user’s likelihood of quitting and staying quit. By advising all tobacco-using patients to quit at every visit you can increase the quality of life for your patients and make a continued downward impact on Arizona’s tobacco use rate. To schedule a personalized office visit from the professional staff at Maricopa County Department of Public Health call Charles Carpenter at 602-372-8416. ASHLine.org. The Office of Healthcare Innovation within Maricopa County Department of Public Health in collaboration with Tri-City Cardiology, contributed to this article. The mission of the Maricopa County Department of Public Health is to protect and promote the health of it’s over 4 million residents. The Maricopa County Department of Public Health partners with organizations like Tri-City Cardiology to promote programs and improve the health and well-being of the residents of Maricopa County.
Hospice of the Valley: A legacy of community service BY BEVERLY MEDLYN
early 40 years ago, a group of citizens shared a vision about a new way of caring for the dying.
Led by the Rev. Q. Gerald Roseberry, the volunteers established Hospice of the Valley in 1977 — the first hospice in Phoenix, Arizona, and one of the first in the nation. They worked in rent-free space at the Maricopa County health department. Their goal was to support patients in their homes — offering medical, social and spiritual comfort — rather than isolating dying patients in hospital wards.
As Maricopa County grew, so did Hospice of the Valley (HOV). And as hospice became more accepted nationwide, it was added as a Medicare benefit in 1982, establishing its place in the health care system with a secure financial foundation.
The community hospice Today HOV retains its community orientation and commitment to serve all, regardless of whether the patient has Medicare, insurance, or financial means. mcmsonline.com/round-up
Last year the total value of community services provided by HOV was $10.3 million, including nearly $8 million in charity care.
Value of community services provided by HOV: $10.3 million
Charity care Uncovered cost of services to AHCCCS patients Community health services Contributions and in-kind donations
The integration of end-of-life care into the healthcare Where our money goes system spawned a new medical specialty. In 2006, hos1% 13%
Program services Management & general Fundraising
11.5 million in donations HOSPICE OF THE VALLEY 6
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pice and palliative medicine was recognized by the American Board of Medical Specialties, which certifies physicians. Professional associations for nurses and nurses’ aides also offer certification for expertise in hospice and palliative care. The spectrum of palliative care has broadened to include serious illnesses prior to hospice eligibility. Community volunteers remain very much a part of hospice care. At Hospice of the Valley, some 2,500 volunteers provided 195,000 hours of service in 2015. Their contributions include home and inpatient visits with patients; reading or singing to patients; providing respite for caregivers; brightening the day with pet visits or engaging in religious or spiritual practices with patients if requested. Volunteers also provide administrative office support; sew and stitch items; work in the agency’s thrift stores and make greeting cards. “Compassionate community members give valuable support to our patients and families in so many ways,” said Debbie Shumway, executive director of HOV. “In return it is our privilege to serve those who need care but face financial or other barriers.”
Charity care for those in need Donations, grants and gifts make it possible for Hospice of the Valley to care for people without insurance and to pay for extra services that aren’t covered by Medicare or insurance.
house calls. Medications related to the cancer diagnosis were provided at no charge. That included liquid morphine — more expensive than pills — because it was the only type of painkiller Jesse could swallow. For a week in July, Jesse stayed at a Hospice of the Valley palliative care unit in Gilbert at no cost to the family. “It is so hard to express in words what hospice has done for us,” Julie said. “I will never forget it, and my kids won’t either. If I hit the lottery today I would donate it all to hospice. They have been so good to us.”
Take the case of Jesse Gutierrez, who worked 33 years in construction. When he was diagnosed with throat cancer in April 2015, he had health insurance through his employer. But after he was off work for three months, he was fired. Since he was only 58, Jesse didn’t qualify for Medicare. “After that we had to go on Cobra,” said his wife, Julie. The Casa Grande couple paid $1,261 per month for health insurance, but hospice care was limited to three months. After that HOV stepped in to cover the cost of Jesse’s care. A doctor, nurse and social worker made
Donations and grants also cover HOV’s Pet Connections program, with 130 pet teams that visit patients and families throughout the Valley. The four-legged visitors bring smiles and evoke memories patients have of pets they used to have. Dogs, cats and even miniature horses make the rounds. Another service supported by donations and grants is Hospice of the Valley’s perinatal program for parentsto-be who have been told their babies most likely won’t survive birth. For those who do survive but aren’t expected to live long, Ryan House is available to families. “We felt so much love and care there,” said Seth Darnell, who stayed at Ryan House with his wife, Jennifer, and their infant daughter, Nora. Nora died peacefully in her parents’ arms two weeks after birth. Their extended family was there, as were a nurse and social worker from Hospice of the Valley. “We are grateful for the care,” he said.
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Volunteer: Eckstein Center, Hospice of the Valley
Why I do it Dr. Albert Eckstein, my father, was Hospice of the Valley’s first medical director. (In fact, he wrote articles for this magazine about hospice care in the 1980s.) My wife Diane and I are honored to volunteer at the palliative care unit in Scottsdale that bears his name. He was my main mentor, as a person and as a physician. Volunteerism, philanthropy, and service have always been important to our family.
What I do At the Eckstein Center I do not volunteer as a physician. Diane and I go once a week in the late afternoon and early evening, doing what any volunteer does. First I go into the kitchen and make chocolate chip cookies. I make great chocolate chip cookies! (Not from scratch — the dough is already made, but I know the secrets for baking cookies just right!) The families, patients, and staff all enjoy the cookies. We determine if any patient rooms need cleaning and restocking. We also clean and maintain the common areas. If a patient or family member requests a meal, we prepare it. Mostly we enjoy talking with patients and their families.
Best part of the “job” Talking and listening to patients and their families. If they comment about the facility, I tell them it is named after my father. We also provide the history of HOV. If they ask what I do, I tell them I’m a physician, which may lead to questions and discussion. I keep my comments general, and never offer specific opinions about their particular problem or question any medical treatment or care. Mainly I listen. Since many families come from out of town, we may talk about their communities. There is no set agenda. We also enjoy talking with and observing the caring staff. Never in all my years of medical practice have I heard a negative or critical word about the care provided by Hospice of the Valley. The staff is exceptional. Bricks and mortar make a comfortable physical facility. The HOV staff creates the far more important caring and emotional experiences at the end of each patient’s life for both the patients and their families. Diane and I are so honored to contribute our small part. My father would be pleased.
Round-up October 2016
Volunteers contribute to patient care Behind every hospice volunteer is a heart-warming back story. Most of them step forward as a way of expressing appreciation for care given to their loved one. Many have nurturing personalities. Some have medical backgrounds or scientific interests, including some students, even teenagers. Three of Lee Benson’s four grandparents had dementia and hospice care. He got involved volunteering at HOV’s Gardiner Home as a university graduate student majoring in biomedical informatics because it “seemed like a good way to give back.” Gardiner Home specializes in caring for dementia patients in an inpatient setting. Ann Kooi also volunteers at Gardiner Home. Her careers — intensive care/emergency room nurse, followed by paralegal work — plus her personal experience helping her sister care for their mother with Alzheimer’s disease — perfectly prepared her for the job. “I retired and was looking for something to do with the skills I had to apply,” she said. “My ex-husband had died at a Hospice of the Valley palliative care unit and I was impressed with the care given there. I wanted to give back.” Patsy Pearce is among Hospice of the Valley’s longtime volunteers, with 20 years of service. Last year she was presented the Hon Kachina Volunteer award, a statewide honor. She has served as a home care and palliative care unit volunteer, provides spiritual care to dementia patients and respite for family caregivers in the East Valley, gives community talks and educates prospective volunteers. As a young girl, Pearce cared for her grandmother at the family farm in Oklahoma. Anyone with a kind heart and listening ear can volunteer. HOV volunteers go through 24 hours of training over the course of a month to make them comfortable with caregiving. Those who wish to work in areas not involving patient care do not have to complete the group classes, but go through individual training related to their roles. For more information on volunteering, call 602636-6336 or view hov.org.
BEVERLY MEDLYN Beverly Medlyn is communications director for Hospice of the Valley. Email her at email@example.com.
How Four Health Plans are Fighting the Opioid Epidemic BY MARI EDLIN
ealth insurers are not sitting back and letting the opioid epidemic put a dent in their efforts to increase care quality and cut healthcare costs. Instead, they have designed holistic approaches to treating members who are abusing or overusing these sometimes-dangerous painkillers. A July 2015 study in Mayo Clinic Proceedings found one in four people who were prescribed a narcotic painkiller for the first time progressed to long-term prescriptions, putting them at risk for dependence and dangerous side effects. There is some good news, however: IMS Health reports that U.S. opioid use has declined for the first time in 20 years, 12% fewer prescriptions nationally since a peak in 2012. One of the primary causes of opioid abuse is patients who are prescribed the drugs for short-term pain relief but receive many more doses than needed, says
Mary Jo Carden, vice president, government and pharmacy affairs, Academy of Managed Care Pharmacy. She puts her money on prescription drug monitoring programs (PDMPs), state-based electronic databases that track the dispensing of controlled substances in a state. They are designed to monitor this information for suspected abuse or diversion and to give providers critical information regarding their patientsâ€™ controlled prescription drug history. This year, the CDC developed the â€œGuideline for Prescribing Opioids for Chronic Pain,â€? which emphasizes using non-opioid therapies for chronic pain, initiating the lowest effective dose for the shortest time period and screening for abuse. Here are four plans that are going above and beyond new recommended guidelines and requirements to combat opioid abuse and misuse.
Neighborhood Health Plan Neighborhood Health Plan (NHP) in Boston developed an algorithm to track the number of opioid prescriptions filled and pharmacies and physicians visited by members. When the results exceed a certain level, the plan reaches out to members and enrolls them in a pain management program. NHP also notifies prescribers if their patients are getting multiple prescriptions filled. Paul Mendis, MD, chief medical officer, says that in extreme cases, members are locked into a single pharmacy. He says that NHP placed limits on quantities of controlled drugs dispensed for years before it was mandated, but that the new legislation has further restricted the amount. The health plan also has covered medication-assisted treatment (MAT), a combination of pharmacological drugs and behavioral therapies, since 1999, for Medicaid members. As of the summer of 2015, private insurers in Massachusetts must cover methadone treatment for people recovering from drug addiction. NHP joined forces with Beacon Health Options, its behavioral health partner, in providing recovery coaches to members who have been substance abusers and admitted to Boston hospitals for drug overdose. The coaches counsel them in the hospital and following discharge. The program, piloted by Massachusetts General Hospital, aims to reduce recidivism among people with substance use disorders who might be hard to reach and treat through a peer-to-peer relationship. Mendis says that if the program proves effective, NHP will encourage hospitals outside its network to adopt the program. Steve Bentsen, MD, regional chief medical officer for Beacon Health Options, says the program increases access to MAT providers in locations where drug abuse might be prevalent, while increasing longevity of stay-in substance abuse programs. NHP also has developed a number of other programs to combat opioid abuse. The Neighborhood Care Circle Program is a community-based program for members with diagnoses of mental illness or substance use disorders (one or more behavioral health diagnoses) that spend more than $17,000 a month on
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Round-up October 2016
healthcare. Mendis says that 0.5% of NHP’s membership drives 20% of medical spending. The program relies on a multidisciplinary team to provide care management wherever members with substance use problems might be. The team develops a care plan for each member focusing on medical and behavioral issues and social determinants, such as housing, transportation and food. Mendis calls the program “feet on the street” and says its goals are reductions in total medical expenses, emergency room and hospital care.
CeltiCare Health Like NHP, Waltham, Massachusetts-based CeltiCare Health is also tackling the opioid abuse and misuse problem with community-based initiatives. Opioid abuse is the number one health issue for the insurer whose population is primarily Medicaid managed care — newly insured by expansion, low-income, childless adults often unemployed and homeless with mental health issues. Jay Gonzalez, president/CEO of CeltiCare says 23% of hospital admissions by its members are related to substance abuse with the next highest percentage for any other reason is only 7%. Substance abuse is also the number one driver of drug costs and of behavioral health problems. CeltiCare recently contracted with Advocates, a behavioral health provider, to identify, locate and support members who are most at risk of substance abuse. Once CeltiCare identifies members, Advocates’ staff members locate and assess them by going directly to their homes or shelters and collaborating with CeltiCare’s integrated care management team of physicians, nurses, behavioral health professionals and social workers to ensure that members have the care they need. “Given the magnitude of the opioid epidemic, CeltiCare Health sees this as an effective way to extend care management into communities where members need assistance, but who may be reluctant to accept it,” Gonzalez says. “Our goal is to achieve a much greater level of engagement and participation by our members, providing a greater likelihood that we can assist them in moving down a path to a safer, healthier lifestyle.”
Blue Shield of California Blue Shield of California launched an initiative in 2015 to find alternative ways to help members control pain. It set quite a challenging goal for itself: reducing use by 50% in 2018. Blue Shield currently is working toward reducing the number of high doses from 120 mg morphine equivalent dose (MED)/day to 90 mg; preventing chronic use to less than 90 days; and preventing the progression of first–time users to chronic use. Salina Wong, director, clinical pharmacy programs for Blue Shield of California, says the insurer has met or
American Society of Addiction Medicine (ASAM) to provide the organization two years of de-identified, real-world customer claims to test and validate three performance measures related to substance abuse treatment:
topped all three goals — 15%, 11% and 25%, respectively. Its overall reduction in use has been 5% since March 2016. The plan’s approach incorporates a combination of more effective opioid prescribing from the onset; providing access to addiction and support services; identifying and managing fraud, waste and abuse; managing formulary coverage policy; using pharmacist and nurse case managers; and working with all of its accountable care organization (ACO) providers and the California Department of Justice to encourage use of the Controlled Substance Utilization Review and Evaluation System (CURES), California’s PDMP.
1. Use of pharmacotherapy for individuals with alcohol use disorders. 2. Pharmacotherapy for individuals with opioid use disorders. 3. Follow-up after detoxification services. Doug Nemecek, MD, chief medical officer, behavioral health at Cigna, says the insurer expects to develop standardized metrics, report baseline measures and set targets for opioid use through sharing data. He also anticipates identifying how many members have been diagnosed with substance use disorders and how many services they have accessed.
Registering to access CURES became a state mandate for all prescribers and licensed pharmacists on July 1, 2016. Implementing state PDMPs is associated with a 30% reduction in the rate of prescribing Schedule II opioids, according to data from the National Ambulatory Medical Care Survey.
To achieve its three-year goal, Cigna is combining prevention, wellness, behavioral health and chronic disease management programs; encouraging rapid adoption of new CDC guidelines on opioid use; urging prescribers to consult CURES; decreasing the length of use of opioids in treating chronic pain; and using MAT.
In addition, Blue Shield is designing a member-directed program to educate, activate and empower members to self-manage their chronic pain, using healthcare services more effectively and finding ways to improve daily function.
“Our actions will impact those who don’t need opioids long term and not impact those who could really use them,” Nemecek says. “Our overall goal is to help decrease the number of deaths from opioid overuse.”
It also plans to develop a training program to help providers taper patient use of opioids by sharing reports on high users visiting many providers and tracking the number of pills, fills and cumulative dose limits. “It is important that we partner with providers in our ACOs and listen to their challenges,” Wong says. “Our ongoing priority is physician engagement.”
MARI EDLIN Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.
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Round-up October 2016
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Healing a Community: Circle the City Founder
Sister Adele O’Sullivan, CSJ, MD
BY DOMINIQUE PERKINS
his month in Round-up we are focusing on our communities, and our roles in them. Also, of course, what we can do to contribute to our own, wherever we are. Physicians contribute to the well-being of their communities in so many ways, from simply caring for their patients, to giving of their time, talents and resources to found organizations and support causes that help so many of our population who have nowhere else to turn. Whatever level of “giving back” you subscribe to, I think we can all find inspiration in the dedication, caring, and incredible life of service led by Sister and physician Adele O’Sullivan, CSJ, MD.
A pioneer Born in Los Angles, California, Adele O’Sullivan entered the Sisters of St. Joseph of Carondelet in 1968, whose motto (according to their website) is “moving always toward profound love of God Article photos by Denny Collins Photography. www.dennycollins.com • (602) 448-2437
and of neighbor without distinction.” After making her vows, O’Sullivan sought a new way to fulfill this mission, and the community sent her to study pharmacy at the University of Arizona in Tucson. “As a community, we were looking at our call toward ‘options for the poor,’” she said. “And [we] knew that our particular call would lead us into positions of presence and companionship with our dear neighbors who lived in poverty.” So, after studying pharmacy, O’Sullivan asked the community if she could go to medical school. It was nearly 1980, and they had never educated a Sister to become a doctor before. However, O’Sullivan’s request was approved, and she began coursework at the University of Arizona, and completed her residency in Family and Community Medicine. “The time must have been right,” she said. Over the next 10 years, O’Sullivan practiced in various areas in Arizona, including practice at the Arizona State Hospital. In 1996 she was practicing in a Family Health Center in El Mirage, Arizona, when she got a call about the need for a physician at the walk-in program servicing the homeless in downtown Phoenix. “I went, and my life has never been the same,” she said. 24
Round-up October 2016
Seeing a great need Serving in the walk-in program downtown, O’Sullivan naturally noticed the many needs of those who came in. The first needs were obvious — and simple: food, clothing, shoes. Other needs weren’t quite so easily met, such as specialty medical needs, glasses and hearing aids; rent, jobs, and utilities. O’Sullivan asked for donations to help meet these needs as she saw them, and kept the community’s small sums in a shoe box. “That really is how Circle the City came to be,” she said. “I feel that part of my role is advocacy for a population who have little opportunity for voice.” As patients came in, O’Sullivan would dip into the shoebox to meet the myriad of needs she saw. And no matter the circumstance, there always seemed to be enough in the little shoebox to cover the expense. “Like the ‘loaves and fishes’ miracle, it never ran dry,” she said. In fact, the outpouring of community support grew so great, that with an overflowing shoebox, O’Sullivan decided to tackle one of the biggest needs she had
seen — the need for a clean, safe place where her patients experiencing homelessness could go to recover and pull their feet back under them. Many of the sickest of her patients at the walk-in clinic had nowhere to go after their initial visit and diagnosis. Many were headed back to the streets, to boxes, abandoned buildings and the very situations that had caused (or exacerbated) their conditions in the first place. These situations were hardly conducive to a solid course of treatment and a healthy recovery. O’Sullivan took her faith and her shoebox, and Circle the City opened a beautiful 50-bed facility in October of 2012 — Arizona’s first Medical Respite Center for the homeless.
The circle that keeps growing, and giving
collaborations. Circle the City is truly a community driven success.” While much of her time is taken up by meetings with Circle the City’s many community partners, collaborators, and funders, O’Sullivan still takes as much time as possible to interact with the patients on a day-to-day basis. Indeed, she says this, more than anything, is still what drives her. Talking with the many who come to Circle the City, O’Sullivan is able to catch a glimpse of their lives and experience, and see the way this organization changes so many lives each day. As crucial to the organization’s mission as medical care is the chance to help patients recover a measure of their humanity and dignity, something lives of poverty has so often robbed them of.
O’Sullivan is the Founder and Chief Medical Officer of Circle the City, which is now a thriving 501 (c)(3) nonprofit community organization that includes a Medical Respite Center, The Parsons Family Health Center, and a Mobile Medical Clinic. The organization continues to grow rapidly, and is dedicating to providing high-quality, holistic healthcare to men, women and children facing homelessness in Maricopa County.
“They share with me how they used to feel invisible when people passed them on the streets, avoiding eye contact and refraining from any engagement with them,” she said.
O’Sullivan credits the company’s growth to her fellow staff, supporters, and volunteers who she says are full of talent and compassion, and serve patients with both enthusiasm and joy.
It takes a community
“From our volunteers to our part-time and full-time staff and clinicians, every person involved in Circle the City elevates the organization in their own unique way,” O’Sullivan said. Participants in the organization come from all walks of life and include widely differing careers and life experiences. However, they ultimately have much in common — big hearts, wisdom, and a deep sense of gratitude. Through their acquired and precious life experience, each has gained the ability to understand the human condition, to accept others where they are — something O’Sullivan says is a critical quality for interacting with Circle the City’s patients — and the ability to provide comfort to those who are sick and recovering at deeply vulnerable moments in their lives. “We create an environment in which everyone knows they are valued and appreciated, and as a result, we attract some of the best clinicians and staff members, who care deeply for our patients,” O’Sullivan said. “Their passion and success with helping patients recover their lives is attracting new funding sources, new community partners and new
“They tell me how different they feel at Circle the City from the minute they walk through our doors. They feel important, and valued, and respected.”
Before Circle the City, there was no medical respite center that provided for the most ill and injured adults experiencing homelessness in the entire state. Since the opening in 2012, nearly 1,000 men and women have come there for a time of healing. More amazing still, nearly 80% of these have moved on to stable living situations after completing their treatment — instead of returning to the street or an emergency shelter. “We are so proud when our patients come back to tell us how they are doing, and even ask to volunteer in one of our programs,” O’Sullivan said. This is hardly surprising since O’Sullivan does not just serve a collection of individuals, she serves an entire community. The Respite Center was just the beginning. Circle the City has since evolved into a continuum of healthcare for the homeless that is one-of-a-kind in Arizona, and one of the only models of its kind in the nation “We continue to find ways to create and deliver innovative healthcare solutions for men, women and children facing homelessness,” O’Sullivan said. In addition to the Respite Center, The Parsons Family Health Center at Circle the City opened in 2015 — an outpatient integrated family health clinic that offers primary care as mcmsonline.com/round-up
well as behavioral health services, case management, and substance abuse intervention. There is also a tworoom mobile clinic that travels throughout Maricopa County and administers primary healthcare services to patients experiencing homelessness by visiting parks, supportive housing complexes, and other agencies. “One of our core values is meeting people where they are, and treating them with dignity and respect,” O’Sullivan said. “I believe that is lived and actually palpable in our programs.” While Circle the City continues to look for new ways to expand its reach, O’Sullivan knows that it takes a community to serve a community. “Our role at Circle the City is to care for the homeless and underserved community, and that involves collaborating with other organizations to ensure all of our patients’ needs are being met while they’re under our care, and beyond,” she said. The path to full recovery requires a community that responds to and supports these individuals on every level — be it finding a place to live, an education to pursue a career, employers to provide jobs, and the list goes on.
Finding new ways O’Sullivan said a great deal of good work is going on in our communities to address the issue of homelessness, and to assist those who are experiencing it. She’s grateful for the chance she has to find a place in this mission. “The practice of medicine has been a rich and challenging one,” she said. “I have met and gotten to know beautiful people who let me into their lives and let me journey with them. Their resilience and courage inspires me, and makes the practice of medicine, in a clinic, a soup line or on the street, a joy and a privilege.” However, she also said there is always more work to be done! There are so many who need the services that even with the resources they currently have, space is limited and there is only so much to go around. “Part of the challenge is complexity of the medical issues and the lack of resources with which to meet them,” she said. “The other invigorating part of this practice is figuring out how to design care systems that deliver high quality, state-of-the-art medical care in the most unusual of circumstances.” O’Sullivan said she and those who work with her are currently looking for ways to extend the availability of the Respite Center’s services throughout the community. They are also constantly assessing the needs with new eyes, looking to develop new models to help those experiencing homelessness overcome the barriers that currently exist in their efforts to find health services. One such barrier O’Sullivan says is often overlooked is a lack of transportation. No matter how many re26
Round-up October 2016
sources are in place for assistance, if those who need it cannot get there, it will do little good. Cars, buses, and freeways can make everything seem so close together, but without access to reliable transportation a distance greater than a few miles can seem insurmountable. O’Sullivan says Circle the City is currently trying to address this issue of transportation in a few different ways. First, of course, they have their mobile medical clinic, which she said they feel very fortunate to have received a grant for. The unit travels throughout Maricopa County, trying to reach the population directly. In addition to the van, O’Sullivan said that Circle the City uses a 12-passenger bus to make the rounds throughout the Valley and bring those who need it to the respite center, and they even have providers who go out on foot. “It’s always about finding out how we can best provide services and meet people where they are,” she said. “With the thousands of individuals facing homelessness in Maricopa County each year, there is always more we can do.” O’Sullivan said there is always a need for physicians to get involved and volunteer their time and services. We asked if she had any advice for those physicians looking for ways to become more involved in their communities. First of all, she said that volunteer work to serve those in such great need is incredibly rewarding — in fact, it changes lives — and not just the lives of the patients. And, of course, if you are looking for a place to get involved, you can always call them up over at Circle the City, and find your own way to contribute to the little shoe box that gave birth to this incredible organization. O’Sullivan said there is a particular need for specialists who would be interested in seeing a patient for them once in a while — in their own offices, pro bono. “The physicians who volunteer at Circle the City tell me it’s been the highlight of their career,” she said.
DOMINIQUE PERKINS Dominique joined 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. Dominique also enjoys helping with Society events. Be sure to look for her the next time you attend! Dominique can be reached at email@example.com.
Sister Adele O’Sullivan, CSJ, MD | On the Personal Side What is your favorite food, and favorite restaurant in the Valley?
I like just about any food, but especially good barbecue. Try out the new “Pork on a Fork” — it’s great!
What career would you be doing if you weren’t a physician (other than your role with the church)?
Best movie you’ve seen in the last ten years?
I don’t know about best movie. But someone asked me recently who I thought would play me in the movie of my life. I said I thought Katherine Hepburn, just like “On Golden Pond.”
Favorite Arizona sports team (college or pro)?
Probably something outdoors. Maybe I have some farming genes from way back. Even at home in Los Angeles we had a garden every year, and I’ve always enjoyed growing my own vegetables.
I’m a Diamondbacks fan, and of course a Cardinals fan. And I can’t wait for College basketball season to start so I can root for my Wildcats.
What’s a hidden talent that you have that most wouldn’t know about you (play the guitar, sing, etc.)?
Love to walk with my little dog Lilly.
I’m a pretty good cook.
Favorite activity outside of medicine? (hiking, painting, fishing, etc.) And also love to read. After all the worthwhile reading I have to do is done, I love a really good, well-written mystery. mcmsonline.com/round-up
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Round-up October 2016
Community Relations 2.0 BY GERALD C. KANE, ROBERT G. FICHMAN, JOHN GALLAUGHER & JOHN GLASER
usinesses and other institutions have long practiced “community outreach” to nurture cooperative relationships between themselves and the public. Before the Internet, firms had far more time to methodically monitor and respond to community activity. With the rise of social media, that luxury has vanished, leaving a community-management vacuum in dire need of fresh skills, adaptive tactics and a coherent strategy. In fact, in today’s hyperconnected world, a company’s community has few geographical barriers; it comprises all customers and interested parties, not just local neighbors. Based on our research examining social media engagement at more than two dozen firms, we describe the changes wrought by social media platforms and show how your company can make the most of this brave new world.
What’s different about new communities? Information technology-enabled collaborative tools such as social networks, wikis and blogs greatly increase a community’s speed of formation and magnify its impact and reach. New communities come together and disperse quickly and are often led by different peo-
ple at different moments. And mobile interfaces keep groups on the alert, ready to drum up information or break into action. And with social media, we’ve moved beyond the era of stand-alone, static Web pages. Today’s communities actively post and vet information. Users increasingly treat these venues as their first stop in gathering data and forming an opinion. A recent Pew study found that nearly 40 percent of Americans say they have doubted a medical professional’s opinion or diagnosis because it conflicted with information they’d found online. If users put that much faith in what they learn on the Internet, what will they be willing to believe if members of a social media forum start trashing your organization? And are you prepared to handle it when it happens?
The community opportunity To many businesses, online communities look like antagonists, not would-be partners with intersecting interests. But in the health care field, communities like Sermo and PatientsLikeMe may be the seeds of a future in which it’s common practice for diverse constituents to attack shared problems together. Consider the challenges of speed and scale. Medmcmsonline.com/round-up
Social media capabilities
Social media platforms enhance the power of online communities in four ways:
1 Promoting deep relationships Community members using social media tools and features establish multifaceted relationships that are far richer than those in earlier-generation online communities, such as discussion boards. These connections engender deep trust, as shown by the kind of information sharing that occurs among the amyotrophic lateral sclerosis, Parkinson’s and other member com-
munities on PatientsLikeMe, an advanced online social network for patients with particular chronic diseases. Patients volunteer details about their diseases and the treatments they’ve pursued – including those not prescribed by their doctors. Charts and progress curves on the Web site help people to visualize their own complex treatment histories, allow comparisons among peer groups and prompt members to provide feedback and advice on one another’s progress.
2 Allowing rapid organization Social media tools enable calls to action around com-
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Round-up October 2016
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mon interests or upcoming events and promote the easy formation of electronic communities. Hundreds of thousands of people can be mobilized in just a few hours. Online communities are also leveraged in quickstrike lobbying efforts. Sermo (a social network exclusively for doctors) has enabled physicians to rapidly mobilize on a broad set of issues. For instance, they used it to call attention to insurers’ proposed reimbursement cuts and successfully organize resistance to them.
3 Improving knowledge creation and synthesis Modern online communities can aggregate the knowledge generated by members into persistent documents and other artifacts that are much more useful than the disjointed discussion threads and
ical knowledge tends to progress slowly through studies of clinical outcomes and other forms of research. As communities assemble large populations of patients, they can compile data showing the effects on patients not only of various medical treatments but also of age, genetics, nutrition, mental outlook, socioeconomic status, physical fitness and the presence of other medical conditions. The ultimate opportunity is to customize treatment protocols to match ever more granular sets of patient and disease characteristics. Thus a physician would be able to assess treatment options for an individual patient against a body of experiential evidence drawn from tens of thousands of detailed cases of a particular disease – such as diabetes, HIV/AIDS or rheumatoid arthritis. Such novel cooperative alliances in health care should inspire similar experimentation in other industries. Like many managers, you may be dealing with outside communities mainly by trying to minimize their negative potential, but there are sure to be communities whose goals complement your own. For that reason, as you modernize your company’s approach to community relations, you’ll need to recognize the key distinction between two fundamental activities: Preventing damage to your reputation and brand, and identifying new opportunities. The former calls for marketing and public relations skills, whereas the latter calls for business development skills. You should assemble a social media team with strengths in both areas.
Engaging the next generation of online communities A company’s social media team must develop policies and strategies for managing online communities, both to mitigate negative consequences and to foster positive engagement. Its responsibilities should include monitoring online communities that exist outside and
bulletin boards of yore. For example, a recent study that Lara Devgan and colleagues from Johns Hopkins presented at the American College of Surgeons showed that a sample of Wikipedia medical articles did not contain a single egregious factual error. In fact, the vast majority were considered by the researchers to be appropriate references for patients.
4 Enhancing information filtering Harnessing the knowledge of a worldwide community of (mostly) amateurs would be worth little if there were no way for people to separate wheat from chaff. Fortunately, ever-improving categorization, search and filtering tools make it possible to identify the most popular or helpful contributions.
inside the company, engaging those communities when necessary and serving as first responders in the event of a social media crisis. In all cases, direct communication between community managers and senior executives is vital. Otherwise, intermediary agents could distort critical messages — for instance, by minimizing criticism of efforts they had a hand in creating. The social media team does not need to retain sole responsibility for engaging the social media space, however. Virtually every organization has a cadre of employees who are already active in online communities. These workers constitute a rich pool of experience, expertise and energy that the social media team can draw from. They should be deputized to assist with the team’s core mission. It’s time to take social media seriously. You can take steps now not only to avoid costly errors, but also to harness the power of online communities.
GERALD C. KANE is an assistant professor of
ROBERT G. FICHMAN is an associate professor of
JOHN GALLAUGHER is an associate professor of information systems, all at Boston College’s Carroll School of Management. JOHN GLASER is the CIO of Partners HealthCare in Boston. From Harvard Business Review. © 2009 Harvard Business School Publishing. Distributed by The New York Times Syndicate.
MICA Gives Back to the Community through MICA Medical Foundation BY JULIE RITZMAN, MBA
ccording to an aphorism attributed to Benjamin Franklin, to do good you must do well. This is true for physicians and others in healthcare who strive to provide excellence in patient care. As MICA approached its 40th year anniversary, this concept also rang true for the member-owned company. MICA has always sought to “do good” and to reflect the foundational elements of Hippocrates and the precepts of physicians like Sir William Osler in its delivery of medical professional liability programs. As a natural extension of its mission, in 2014 MICA created a 501(c)(3) charitable organization, MICA Medical Foundation (MMF). The MMF pursues its goal principally through financial support of (a) the training and education of physicians and health care professionals and (b) research to improve the safe, effective and compassionate delivery of medical care for the benefit of the community as a whole. As a physician-founded, physician-directed and physician-managed company, MICA, throughout its history has made conscious, deliberate and explicit decisions to comport itself according to the idealized values that characterize its physician-members. Through that same set of values, MMF has made one of the core pillars of its mission to offer assistance for the training and education of students pursuing careers in the medical profession.
Projected physician shortage in Arizona The Association of American Medical Colleges reported in February 2014 that by the year 2020 the United States will likely face a shortage of 45,000 primary care physicians and 46,100 surgeons and medical specialists. These estimates take into account an aging physician workforce, as well as the 15 million patients 32
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who are to become eligible for Medicare and the 32 million younger patients projected to become newly insured through the Affordable Care Act. Between 2000 and 2010, Arizona was the second fastest growing state in number of medical students, expanding by 117 percent. Unfortunately, simply increasing medical school enrollment was insufficient according to the March 2012 report, “Graduate Medical Education in Arizona: Growing the Physician Pipeline,” co-authored by the St. Luke’s Health Initiatives (now Vitalyst Health Foundation), the Greater Valley Area Health Education Center and the Arizona Chamber Foundation. According to the report, as of 2012 there were 3,583 practicing Arizona medical school graduates. Of these, 1,571 were currently practicing in the state, of which 916 had also performed their residency in Arizona. Only 28% of those physicians who graduated from an Arizona medical school returned to the state to practice, if they did their residency training outside of Arizona. More recently, in August 2016 the Pew Charitable
Trust published the article “A Shortage in the Nation’s Maternal Health Care,” citing that the American Congress of Obstetricians and Gynecologists (ACOG) estimates that the United States will have between 6,000 and 8,800 fewer OBGYNs than needed by the year 2020 and a potential shortage of 22,000 by the year 2050.
MICA Medical Foundation grants The projected physician shortage, along with its founding mission, provided the momentum for MMF to begin researching how it could develop a core grant program to expand the established physician residency programs in Arizona. Through the aid of a third party, MMF anonymously reached out to the various residency programs within Arizona. Ultimately, the recipient chosen for this initial grant commitment was Dignity Health St. Joseph’s Hospital and Medical Center with the funding of an additional OBGYN residency slot. “The MICA Medical Foundation sought a partner to support physician training and to help fill the need of additional physicians in the community. St. Joseph’s met our mission and goals. We look forward to working with St. Joseph’s Hospital and Medical Center on this partnership to continue to grow graduate medical education in the Phoenix area,” said Dr. Amy Silverthorn, MMF’s Board Chair. Dignity Health St. Joseph’s Hospital and Medical Center went on to select Meisje Burton, M.D. to fill that position. Dr. Burton is a graduate of the University of Arizona College of Medicine–Phoenix. Prior to medical school, she received a Bachelor of Science degree in Biology with an emphasis in Pre-Medicine and a minor in Chemistry and a Masters of Business Administration from Barry University, Florida. Dr. Burton’s goal in pursuing a residency in Obstetrics and Gynecology is to become an exceptional physician, and a future leader and advocate in the field. As someone once said, ‘it isn’t about being able to write the check, it’s about being able to touch someone’s life’. With this gift, not only is MMF able to affect the life of a future physician, but also the many mothers, infants and families who will be cared for by Dr. Burton in our community. The MICA Medical Foundation has also awarded certain other grants during its short tenure, one of which is a partnership between the MICA Medical Foundation and the Maricopa County Medical Society as an essay contest for each of the medical schools within Arizona. The winner of each essay receives an award of $2,500. To date, the winners that have been selected include: Aishan Shi from the University of Arizona-Phoenix, Thomas Esposito from A.T. Still University, Himaja Gaddipati from Midwestern University, and Michael Hafertepe from Creighton University. MMF has also partnered with the Arizona Medical Association to help fund the Annual Physician Leadership Academies held at Mayo Clinic Hospital each year. Attendees include practicing physicians from all areas of employment, specialty and regions of the state. The MICA Medical Foundation has similarly sponsored the Academ-
ic Excellence Day held at the University of Arizona College of Medicine Phoenix campus. This annual event focuses on the magnitude and variety of clinical and bench research being done by residents, fellows, medical students and graduate students across the greater Phoenix area. Although the MICA Medical Foundation began in 2014, MMF’s grant making endeavors have been received with great appreciation. The MMF Board has been thoughtful and deliberate in establishing a mission that will serve as a community partner to improving patient outcomes. It is MMF’s intent that its grants will aid the community through the pursuit of safe, effective and compassionate delivery of healthcare for many years to come.
JULIE RITZMAN, MBA Julie Ritzman is MICA’s Vice President of Risk Management Services as well as the Vice President of the MICA Medical Foundation. Julie earned her Master of Business Administration from the University of South Dakota. Prior to joining MICA, Julie was the Director of Risk Management at St. Joseph’s Hospital and Medical Center. Prior to moving to Arizona, Julie was the Director of Risk Management for the Physician Division of Sanford Health System with its corporate headquarters in South Dakota.
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How to Help People With Mental Illness BY MIRIAM ANAND, MD
What can I do if I suspect a loved one or someone I know has mental illness?
What is mental illness, and what are the warning signs?
It is estimated that approximately one in five Americans suffer from mental illness in a given year, so you may know someone who either has a mental illness or has a family member, friend, or coworker with mental illness. Living with someone who is emotionally unstable can be stressful and it can be difficult to know how to get your friend or loved one help. Some may be afraid to get help because of the worry that they will be negatively judged if others find out that they or someone they love has mental illness. Additionally, there may be the fear that the mentally ill loved one may become angry and lash out at those trying to help him or her. It may be especially hard to know what to do it you are concerned about a friend of coworker with mental illness.
Mental illness can vary from mild to severe and there are different types of conditions. Sometimes the symptoms may be a reaction to something that happens in a personâ€™s life, such as a deep depression from the loss of a loved one. Other times the symptoms may be more severe, as in someone who hears voices that are telling her/him to believe things that are not true. Much like other medical conditions, there can be genetic and biological causes for mental illness, so the person usually cannot control the symptoms without help. While we hear a lot in the news about people with mental illness attempting to hurt others, most often those with mental illness are more likely to try to hurt themselves.
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Mental illness can interfere with a personâ€™s ability to deal with lifeâ€™s ordinary demands and routines. Some
who are mentally ill may resort to substance abuse as a way to try to cope or self-medicate. This can make things worse, as it can cause the person’s behavior to be even more unpredictable. Some warning signs of mental illness include social withdrawal and isolation, change in eating or sleeping habits, or change in personal hygiene habits. There may also be extreme changes in mood, such as deep depression or exaggerated happiness, angry outbursts, or feelings of fear and anxiety that seem out of the ordinary given the circumstances.
Warning signs may vary for different age groups. For more information on the warning signs for each age group, visit the following website: http://www.mentalhealthamerica.net/recognizing-warning-signs.
How to get help There are different levels of help available, depending on the nature of the problem. These include support groups, one-on-one counseling, group counseling or inpatient treatment. The appropriate type of treatment depends on the situation. There are a number of different resources available to learn more about mental illness, many of which are listed in this article. Unfortunately, it may be difficult to get help for a legal adult unless he is a threat to himself or others. Adults must often be willing to seek help or treatment. Parents or legal guardians can have more control in getting their child into treatment, although the child or adolescent may still be resistant to following through with recommended therapy.
“Put your own mask on first” – Why it’s important to take care of yourself as well as your loved one. Visit the following websites to find out more about local support groups: http://www.mentalhealthamerica.net/find-support-groups http://www.nami.org/Find-Support You cannot control how willing your friend or loved one will be to accept treatment or how he or she will respond to it. Having a loved one or friend with mental illness can be very stressful and can cause you to burn out or suffer health consequences. You can still be supportive in a way that protects your own mental health and well-being. You need to take care of yourself first in order to be available to help your loved one or friend. You should try to seek support from family, friends, or religious organizations. If this is not available or not adequate, join a support group. Therapy and counseling can also be very helpful for you to learn to set the appropriate boundaries and manage stress. Be sure to take time out for activities that you enjoy. The following website is intended to help those with mental illness live well, but provides good advice for everyone facing stress: http://www. mentalhealthamerica.net/live-your-life-well Other importance resources: Mental Health America – www.mentalhealthamerica.net
The Arizona Department of Health Services has a Behavioral Health Division (www.azdhs.gov) and useful information to determine where and how to get help can be found there.
Mental Health America in Arizona – www.mhaarizona.org – 480-928-5305
Flowchart to help determine referral to treatment based on insurance status, country, or tribal affiliation: https://azahcccs.gov/AHCCCS/Downloads/Veterans/accessing-bh-system.pdf
American Academy of Child and Adolescent Psychiatry – www.aacap.org
Substance abuse and mental health services administration – www.samhsa.gov – 800-789-2647 National Alliance for the Mentally Ill – www.nami.org – local chapter: 602-244-8166 American Psychiatric Association – www.psychiatry.org
What can I do if I suspect that my loved one may try to hurt himself or others? If there is reason to believe that there is immediate danger, call 911. If you believe that there is no immediate danger, but that the person is in need of mental health assistance right away, call the 24/7 national hotline at 1-800-273-suicide or 1-800-273-talk. For Maricopa County, you can also call 1-800-631-1314.
National Institute of Mental Health – www.nimh.nih.gov
MIRIAM ANAND, MD Dr. Miriam Anand, MD, is an allergy specialist practicing in Tempe. She was the Society’s 120th president, and has been a MCMS member since 1998.
Health Policy FORUM
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Thank you to everyone who attended our Health Policy Forum! Held Thursday, September 22, in the Society courtyard, the evening was made possible by our sponsor and long-time partner, MICA. We can’t thank them enough for all they have done for our community, and for the Society. We’re so grateful to have them as partners! The morning of the forum got off to a rocky start, with quite a bit of rain! Capricious as the Arizona weather can be, the rain continued throughout the day and had us all a little concerned! However the weather cleared up perfectly just in time for the event, and it was a warm, beautiful night. The MCMS courtyard looked wonderful, and everyone who attended certainly enjoyed the evening. Guests mingled with friends – and made some new ones - while enjoying drinks and amazing appetizers provided by Amuse Bouche Gourmet Bistro. We then took our seats and settled into an informative, question-answer style discussion on
current topics in Health Policy. We are so grateful to our panelists, who gave of their time to come and answer these questions for us. Get to know these amazing women a little better:
Representative Heather Carter
is the LD-15 representative from North Phoenix, Cave Creek, and North Scottsdale. Currently, she is the Chairperson of the House Health Committee, and a member of the Committee on Elections and Committee on Energy, Environment and Natural Resources. First elected in 2010, she has a track record of sponsoring legislation that solves many of the complex problems facing Arizona, making her one of the most effective legislators at the Capitol, where she has won a number of prestigious awards from education groups, veteran organizations, healthcare and patient advocacy groups, including many other â€œLegislator of the Yearâ€? honors. In her professional life, she is a well-respected educational leader in her community, working as a clinical associate professor at Arizona State University, preparing teachers and leaders for Arizona Schools. She also works with local school districts on educational reform issues. She has devoted her professional life to making Arizona a quality place to live, learn, work and prosper.
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Senator Katie Hobbs
is a State Senator of the LD-24 Phoenix District, and is in her second term in Arizona serving as the Senate Minority Leader. Prior to being elected to the Senate, she served one term in the AZ House of Representatives. Katie is from Phoenix, Arizona, and has a Bachelor of Social Work from Northern Arizona University and a Master of Social Work from Arizona State University. She has been a professional social worker since 1992. She is currently the Executive Director of Emerge Arizona, the premiere political training program for Democratic women. She is also involved with her professional organization, the Arizona Chapter of the National Association of Social Workers, and is adjunct faculty in the Social and Behavioral Sciences department at Paradise Valley Community College.
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Ms. Christina Corieri
serves as Governor Ducey’s health and human services policy advisor. In this position, she advises the governor on policy affecting healthcare at the state and national level as well as on welfare, insurance, juvenile corrections, child safety, and health related licensing boards. Prior to joining Governor Ducey’s staff, she held positions including healthcare policy analyst at the Goldwater Institute, Chief of Staff for Councilman Sal DiCiccio, and Vice President of Government and Board Relations for a national nonprofit. She holds a JD from ASU as well as a B.S. in political science and a B.A. in history.
Pele Fischer, JD
is Vice President of Policy and Political Affairs at the Arizona Medical Association, and did a wonderful job moderating the discussion, and we are grateful to her for giving of her time, expertise, and experience to lead the night’s conversation. Panelists answers questions on topics such as health board reform, graduate medical education, public health funding, and scope of practice, and also answered a few questions direct from our guests. One sentiment certainly echoed throughout the evening — get involved! Indeed, Representative Carter issued a “homework” assignment for all our physicians: Find out who your representatives are, and send them an email introducing yourself. It was a great night, and we are grateful for all of the hard work that went into making it possible. Denny Collins was on site to document the event, and the full array of pictures can be seen on the Society Facebook page! www.facebook.com/medicalsociety. Follow us on Facebook, Twitter, and Instagram to stay on top of Society events and happenings! We hope to see you all at our next event! We have a few great ones planned. If you would like to make sure you receive future invitations, please email our event coordinator, Dominique Perkins, at dperkins@ mcmsonline.com
In Memoriam Dr. Lindsay Jack Kirkham MD 1923 — 2016 Kirkham, Dr. Lindsay Jack, 92, formerly of Sun City West, passed away on August 19, 2016. Kirkham lived with his wife, Mary Anne, in Sun City West from 1988 until the late 1990s, when they moved to the greater Seattle area. Kirkham, was born Sept. 11, 1923 to Lindsay Jack Kirkham Sr. and Abigail Lillis Kirkham, and spent his childhood in the Kansas City, Mo., area. He graduated from the University of Kansas, and was awarded a medical degree from the Washington University School of Medicine in St. Louis in 1946, only six years after graduating from high school. After serving as a Navy medical officer aboard
the USS George Clymer in the Pacific in the late 1940s, Kirkham married Mary Ann Reynolds of Silver Spring, Md., in 1952 and began a practice as an internist in Mason City, Iowa, where he and Mary Ann raised seven children. He retired from private practice in 1976, and from 1977 through 1980, he worked as an examining physician for the U.S. Department of Health, Education and Welfare. After earning a master’s degree in public health from the University of Hawaii, Kirkham worked for the State of Hawaii as chief of Hospital and Medical Facilities and chief of the Research and Statistics Division. He is survived by his wife, Mary Ann of Bellevue, Wash.; children, Clifford of Seattle, Wash.; William of Elizabeth, N.J.; Richard of Bellevue, Wash.; Maura Taggart of Madison, Wis.; Jeffrey of Seattle, Wash.; Christine (Tina) of Helena, Mt.; and Douglas of Bothell, Wash.; son in-law Timothy Taggart; daughter in-law Eileen Garry Kirkham; and five grandchildren and four great-grandchildren.
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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MICA CLAIMS SERVICES YOUR BEST DEFENSE Our philosophy is to carefully evaluate claims to eliminate those without merit, promptly pay those that warrant settlement, and vigorously defend those where a perceived or actual bad outcome is not the result of malpractice. We support our physiciansâ€™ right to have their day in court to protect their reputation. MICA retains experienced defense counsel who focus on medical professional liability matters and the MICA policy provides that defense costs are paid outside the policy limits. For 40 years MICA has provided peace of mind for our policyholders. Contact us today for a quote and to discuss how we can help protect you and your practice.
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