Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Sombrero
Pima County Medical
Society Officers
Jerry Hutchinson, DO
Roy Loewenstein, MD
Kevin Moynahan, MD
Snehal Patel, DO
Wayne Peate, MD
Kenneth Sandock, MD
Sarah Sullivan, DO
Salvatore Tirrito, MD
Debra Townsend, MD
Fred Van Hook, MD
Scott Weiss, MD
Leslie Willingham, MD
Jaren Trost, MD (Resident)
Aditya Paliwal, MD (alt. resident)
Jared Brock (student)
President
Timothy C. Fagan, MD
President-Elect
Michael A. Dean, MD
Vice-President
Susan J. Kalota, MD
Secretary-Treasurer
Unfilled / Appointment
Past-President
Melissa D. Levine, MD
Members at Large
Vol. 49 No. 7
Charles Krone, MD
Clifford Martin, MD
Robert M. Aaronson, MD
R. Screven Farmer, MD
Board of Mediation
Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Sheldon Marks, MD
Mark Mecikalski, MD
Delegates to AMA
Timothy C. Fagan, MD (alternate)
Gary R. Figge, MD
Michael F. Hamant, MD (alternate)
Thomas H. Hicks, MD
Arizona Medical
Association Officers
Michael F. Hamant, MD
Vice President
Thomas C. Rothe, MD
Outgoing Past President
Executive Director
Bill Fearneyhough
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: billf 5199@gmail.com
Editor
Bill Fearneyhough
I welcome your feedback and story ideas.
E-mail: billf 5199@gmail.com
Printing
West Press
Phone: (520) 624-4939
E-mail: andyc@westpress.com
Advertising
Dennis Carey
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: dcarey5199@gmail.com
Art Director
Alene Randklev
Phone: (520) 624-4939
Fax:
(520) 624-2715
E-mail: alener@westpress.com
Publisher
Pima County Medical Society
5199 E. Farness Dr., Suite 151
Tucson, AZ 85712
Phone: (520) 795-7985
Fax: (520) 323-9559
Website: pimamedicalsociety.org
NORTH
$465,000
$559,000
Madeline Friedman
Vice President
296-1956 888-296-1956
Inside
5 How to Discourage a Physician: A sneak peak into the
mind of one health care consultant.
7 Letter to the Editor: Not everyone agrees with PSRs
agenda.
8 ArMA News: President Gretchen Alexander, MD,
addresses the issues of health care in the 21st
century.
11 Road Trip: Eastern Arizona provides an opportunity
to cool off and explore pioneer history.
14 In Memoriam: Remembering Dr. David Hardy and
Dr. Alma Hansen.
15 End of Life Care: EOLCC reaches out to Pima County
through workshops and presentations.
18 UA College of Pharmacy: Students launch new search
tool to help patients and physicians find prescriptions.
20 New Technology: Neurosurgeon Joseph Christiano
pioneers procedure to insert new MRI-compatible
spinal cord stimulator.
21 HIPAA: Attorney Bryan Bailey discusses the trend of
texting and staying compliant with HIPAA.
24 News Briefs: TMC Mega Raffle results, UA Fills
leadership positions, Rural Health and diabetes
programs receive funding.
On the Cover
The climb up along the Coronado Trail Scenic Byway, through the
Apache-Sitgreaves National Forest, takes drivers through multiple
topographic zones, including vast grasslands.
Course Director
Roberto Ruiz, MD, FACP
Assistant Clinical Professor of Medicine
University of Arizona College of Medicine
Creighton University School of Medicine
Faculty
Pablo Mora, MD, MSc, FACE, CDE
Endocrinologist, Diabetes America
Clinical Associate Professor of Internal Medicine
University of Texas Southwestern Medical Center
Faculty
W. Timothy Garvey, MD, FACE
Butterworth Professor and Chair
Department of Nutrition Services
University of Alabama at Birmingham
Faculty
To register, visit
www.MandatoryCE.com/AZdiabetes
or call 888-YourCE1 (888-968-7231)
Jointly Provided by St. Josephs Hospital and Medical Center and MandatoryCE, LLC.
Faculty
Debbie Hinnen, APN, BC-ADM, CDE, FAAN, FAADE
Advanced Practice Nurse and CDE
Memorial Hospital Out Patient Diabetes Clinic
University of Colorado Health
Faculty
Linda Delahanty, MS, RD
Assistant Professor of Medicine
Harvard Medical School
Director of Nutrition & Behavioral Research
Massachusetts General Hospital Diabetes Center
This activity is supported by an independent educational grant from
Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA, LLC.
This activity is supported by an educational grant from Sanofi US.
This activity is supported by an educational grant from Novo Nordisk Inc.
ot accustomed to visiting
hospital executive suites, I
took my seat in the waiting
room somewhat warily. Seated
across from me was a
handsome man in a welltailored three-piece suit, whose
thoroughly professional
appearance made me in my
rumpled white coat, sheaves of
dog-eared paper bulging from
both pockets feel out of place.
Within a minute, an
administrative secretary came
out and escorted him into one
of the offices. Shortly thereafter, I noticed that he had left a
document on an adjacent chair. Its title immediately caught my
eye: How to Discourage a Doctor.
No one else was about, so I reached over, picked it up, and began
to leaf through its pages. It became immediately apparent that it
was one of the most remarkable documents I had ever read,
clearly not meant for my eyes. It seemed to be the product of a
healthcare consulting company, presumably the well-dressed
mans employer. Fearing that he would return any moment to
retrieve it, I perused it as quickly as possible. My recollection of
its contents is of course somewhat imperfect, but I can reproduce
the gist of what it said.
The stresses on todays hospital executive are enormous. They
include a rapidly shifting regulatory environment, downward
pressures on reimbursement rates, and seismic shifts in payment
mechanisms. Many leaders naturally feel as though they are
building a hospital in the midst of an earthquake. With prospects
for revenue enhancement highly uncertain, the best strategy for
ensuring a favorable bottom line is to reduce costs. And for the
foreseeable future, the most important driver of costs in virtually
every hospital will be its medical staff.
Though physician compensation accounts for only about 8% of
healthcare spending, decisions that physicians strongly influence
or make directly such as what medication to prescribe, whether
to perform surgery, and when to admit and discharge a patient
from the hospital have been estimated to account for as much
as 80% of the nations healthcare budget. To maintain a favorable
balance sheet, hospital executives need to gain control of their
physicians. Most hospitals have already taken an important step
in this direction by employing a growing proportion of their
medical staff.
Transforming previously independent physicians into employees
has increased hospital influence over their decision making, an
effect that has been successfully augmented in many centers by
tying physician compensation directly to the execution of hospital
strategic initiatives. But physicians have invested many years in
learning their craft, they hold their professional autonomy in high
esteem, and they take seriously the considerable respect and
SOMBRERO August/September 2016
trust with which many patients still regard them. As a result, the
challenge of managing a hospital medical staff continues to
resemble herding cats.
Merely controlling the purse strings is not enough. To truly seize
the reins of medicine, it is necessary to do more, to get into the
heads and hearts of physicians. And the way to do this is to show
physicians that they are not nearly so important as they think they
are. Physicians have long seen the patient-physician relationship
as the very center of the healthcare solar system. As we go
forward, they must be made to feel that this relationship is not the
brilliant sun around which everything else orbits, but rather one of
the dimmer peripheral planets, a Neptune or perhaps Uranus.
How can this goal be achieved? A complete list of proven tactics
and strategies is available to our clients, but some of the more
notable include the following:
Make healthcare incomprehensible to physicians. It is no easy
task to baffle the smartest people in the organization, but it can
be done. For example, make physicians increasingly dependent
on complex systems outside their domain of expertise, such as
information technology and coding and billing software. Ensure
that such systems are very costly, so that solo practitioners and
small groups, who naturally cannot afford them, must turn to the
hospital. And augment their sense of incompetence by making
such systems userunfriendly and
unreliable. Where
possible, change
vendors frequently.
Promote a sense of
insecurity among
the medical staff.
A comfortable
physician is a
confident physician,
and a confident
physician usually
proves difficult to
control. To
undermine
confidence, let it be
known that
physicians jobs are
in jeopardy and their
compensation is
likely to decline. Fire
one or more
physicians, ensuring
that the entire
medical staff knows
about it. Hire
replacements with a
minimum of fanfare.
Place a significant
5
Why choose
Desert Mountain Insurance?
see why our customers did...
Our physicians were so
impressed with how multitalented your team was and
that we were able to get our
malpractice, office, workers
comp, health and disability
policies in what seemed
like an instant. I would not
hesitate to say Desert
Mountain Insurance is the
best insurance source in
the Southwest!
Eric, Administrator
Read more testimonials at
desertmountaininsurance.com
COVERAGE INCLUDES
Professional Liability
General Liability & Property
Employee Benefits
866.467.3627
866.467.3611 fax
info@desertmountaininsurance.com
www.desertmountaininsurance.com
6
Leer to Editor
Barry Kirschner professionally handles claims of persons who have become medically
disabled from employment through personal or group disability insurance policies and are
denied benefits. Barry has successfully litigated on behalf of doctors, lawyers, and other
professionals. Barry has handled ERISA terminations administratively and in court, opposing
every major disability insurance carrier. Barry continues to be selected by his peers for
inclusion in The Best Lawyers in America in the field of Litigation ERISA and continues
to receive the highest AV ranking for quality and ethics from Marindale Hubbell.
ArMA News
Last, but not least, thanks to all of you for the opportunity to
serve you in the coming year. Please feel free to contact me at
gretchen@ipls.com with comments, questions or suggestions.
References
1. Cruess SR, Cruess RL. Professionalism and Medicines Social Contract
with Society. AMA Journal of Ethics, April 2004, Vol 6, No 4.
2. National Health Expenditures 2014 Highlights. https://www.cms.
gov/research-statistics-data-and-systems/statistics-trends-and-reports/
nationalhealthexpenddata/downloads/highlights.pdf
3. Rampell, C. Doctors Salaries and the Cost of Health Care. The New
York Times. November 14, 2008. http://economix.blogs.nytimes.
com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/
None of this can occur without significant effort on the part of all
involved. I would like to thank my supportive husband and our
wonderful children George, Anna and John who have tolerated
many late nights, mediocre dinners and opportunities to babysit
each other as I engaged in ArMA work over the last several years.
I would also like thank our hardworking ArMA staff, the Board of
for Responsive Politics. https://www.opensecrets.org/lobby/indusclient.
php?id=H04&year=2015.
Directors and the House of Delegates for their active participation
and guidance. Thanks are also due to past presidents Orford,
9. Mathur, Aparna. Medical Bills and Bankruptcy Filings. American
Thrift, Rothe, Mueller and Laufer and also my department chair
Enterprise Institute. July 2006. http://web.archive.org/
web/20120723055727/http://www.aei.org/
at MIHS, Dr. Carol Olson, for their invaluable mentorship over the
files/2006/07/19/20060719_MedicalBillsAndBankruptcy.pdf
NG
I
Z
Z
last several years.
U
B
ING
G
N
I
R
BUZZING
TINNITU
RING
BUZZ
TINNITUS
BUZZING
RING
HUMM
RINGING
HUMMINGGING
Your patients
deserve the
best hearing
care possible
RIN
ING
HUMM
S
NITU G
TIN UZZIN
B
G
N
I
G
We offer
comprehensive
tinnitus
consultations.
TINNITUS
RINGING
TINNITUS
BUZZING
HUMMING
TINNITU
RIN
BU GING
HU ZZING
M
MIN
520.742.2845
520.742.2845
520.648.3277
10
11. Altschuler,Margolius,Bodenheimer,
Grumbach. Estimating a Reasonable Patient
Panel Size for Primary Care Physicians With TeamBased Task Delegation. Ann Fam Med:
September/October 2012vol. 10no. 5396-400.
HUMMING
RINGING 12. D. Morra, S. Nicholson, W. Levinson et al., U.S.
G
IN
Learn more about why we are a
R
preferred audiologistplease visit our website: www.arizonahearing.com
We are preferred providers
on most insurance plans.
Road Trip
Mountaintop Meander
What to do in the summer heat? Feast your eyes on big sky
panoramas, explore pioneer history, and take it from there.
By Monica Surfaro Spigelman / Photos by Leigh Spigelman
An old highway route along the fertile Gila Valley offers another
After browsing the Old West Highway towns and Saffords
interesting detour, just outside of Safford. US 70 West passes
Discovery Park, its time to
through cotton and
head north onto US 191,
rancher towns settled by
toward the Apache
Mormons in the 1870s: In
Sitgreaves National Forest.
Thatcher, Eastern Arizona
This is where youll find the
College houses a
Coronado Trail Scenic
significant collection of
Byway, which follows a
ancient cultural artifacts,
portion of the path made
including hundreds of
by Spanish conquistador
restored pottery
Francisco Vzquez de
excavated from
Coronado, who led an
archaeological sites in
expedition from Mexico in
New Mexico and Arizona.
1540, in search of the
In Pima, you can refresh at
Seven Cities of Gold. Its a
Taylor Freeze, an oldstunning, winding road
fashioned drive-in with
passing through over 400
tasty soft-serves, burgers
switchbacks that traverse
and shakes. You also can
high desert, national
browse through the three
forest, and panoramas full
historic buildings in town,
The climb up along the Coronado Trail Scenic Byway, through the Apacheof scenic land and Western
where the Eastern Arizona
Sitgreaves National Forest, takes drivers through multiple topographic
history.
Museum and Historical
zones, include vast grasslands.
SOMBRERO August/September 2016
11
Pioneer Escapades
A stop along US 191 about 12 miles north of Safford is Clifton, the
Greenlee County seat that also is known as Geronimos
birthplace. In the mid 1800s, copper ore brought a boom of
claims and the railroad to Clifton, which is a rough and tumble
small town set in a rocky San Francisco River canyon. Historic
Chase Creek houses Cliftons main street a row of mining-era
territorial architecture that now accommodates several local
shops. To get the full picture on local history, the Greenlee County
museum and historical society building has exhibits documenting
Coronado, Apache, miner and rancher history, and is open on
weekends or by appointment. Other Clifton landmark marvels
include a restored early 1900s railway station and a stone,
Bastille-like jailhouse built in the 1800s. There are many stories
of Wild West bandits incarcerated in this famous old stone jail.
archaeological site called Casa Malpais awaits, with its Great Kiva
and rock art sites.
928-428-6260
Eac.edu/discoverypark/mgio.shtm
***
Sometimes we want to soak up surprises, poking through
territorial towns or motoring along historic roads with extra
pizzazz. Theres no doubt that this memorable trip through
Graham and Greenlee counties conjures up a wild and
picturesque southwest pallet and its mountaintop diversion is
perfect for a summer outing that offers much to love and explore.
TOUR RESOURCES & SPECIAL UPCOMING EVENTS:
Mt. Graham International Observatory Tour
Eastern Arizona Colleges Discovery Park Campus
1651 W. Discovery Park Blvd., Safford
There are exhibits and a simulator at the Discovery Park center.
For reservations up to the Observatory: $40 ticket includes
transportation, lunch & full day tour
13
In Memoriam
nesthesiologist and
long-time Tucson
resident David L. Hardy, MD,
passed away June 23, 2016.
He was 83.
Hardy was born in Ancon in
the Panama Canal Zone on
June 16, 1933. He studied at
the University of Kansas
where he received his BA and
graduated from medical
school in 1959. Hardy finished
his internship at William
Beaumont General Hospital in
El Paso in 1960 and completed
his residency in
anesthesiology in 1963 at Brooke General Hospital, Fort Sam
Houston, Texas. He practiced and taught anesthesiology residents
and nurse anesthetists at Tripler General Hospital in Hawaii for four
years before coming to Tucson.
He started his practice and joined the Pima County Medical
Society in October 1967. He was a member of PCMS until 1998.
He was also a member of the American Society of
Anesthesiologists.
Outside his practice, Hardy was interested in herpetology and
snakes. He did extensive research into the behavior and venom of
rattlesnakes in southern Arizona in partnership with
herpetologists at the University of California.
He was preceded in death by his wife of 58 years, Billie Frances
(Bergen) Hardy. He is survived by his brother Perium Hardy and
sister-in-law Diane Hardy; his daughter Margaret C. Hardy and
son-in-law Danny L. Rowland; his son David L. Hardy and four
grandchildren William, Anna, Katarina and Annika. Donations in
his memory can be made to the Tucson Herpetological Society or
the Arizona Sonoran Desert Museum.
n
Website design
SEO
Disc duplication
UV Coating
14
520.624.4939 | 888.637.0337
www.westpress.com
SOMBRERO August/September 2016
Remote Receptionist
Appointment Scheduling
Order Taking
Se Habla Espaol
2434 N. Pantano
Medical Society
Exchange
790-2121
Established
1971
www.RinconCommunications.com
17
UA College of Pharmacy
She got to the pharmacy only to learn they were out of that
Her pharmacy has the medication and her insurance covers it,
but the prescription still costs more than the patient can afford
to pay.
Three entrepreneurial UA College of Pharmacy students are
creating a transparent network that they hope will put an end to
these frustrating situations. Jason Kwan, Jingxin Yang and
Osamah Eljerdi, students of the PharmD Class of 2017, spent
several months developing this resource, which they named
LinkX at www.linkx.us. It is available on your phone or desktop by
going to the URL in the search bar. Its a website consisting of a
medication database that reports drug availability and cash prices
from local pharmacies. The websites pithy slogan is Search
Smarter. Choose Better.
Using LinkX, patients whose insurance doesnt cover their
prescription or coverage is not sufficient enough can find a local
pharmacy that has the drug they need in stock at a reasonable
price. A user simply:
picks up the drug from the pharmacy with a hard copy of the
prescription
Your partner
Contact us at:
(520) 901-4800
cpcc@communitypartnersinc.org
www.CommunityPartnersInc.org/CPCC
19
New Technology
20
HIPAA
Steven J.
Blatchford,
MD
A. J. Emami,
MD, FACS
James D.
Gordon,
MD
(520) 792-2170
Adam D. Ray,
MD
Green Valley
Sierra Vista
Marana
David T.
Miyama
MD
Now youre
Thinkin Smart
Simplify your communications with
Simply Bits state-of-the-art managed
voice and data services
ROC #278632
23
News Briefs
In response, the UA Center for Rural Health was awarded a threeyear $348,000 grant by the Health Resources and Services
Administration to support the Arizona Small Rural Hospital
Improvement Grant Program.
SOMBRERO August/September 2016
25
Members Classifieds
NURSE PRACTIONER NEEDED Tucson Allergy/
Immunology practice seeking an experienced nurse
practitioner to add to our group. Allergy background
preferable, but not necessary. We are looking for a fulltime or nearly full-time practitioner. Competitive salary
and benefits, profit sharing and 401K with match. Contact
Dr. George Makol at Alvernon Allergy, phone number 3229426, ext 115. May submit resume by fax to 520-322-8462.
USED MEDICAL EQUIPMENT FOR SALE:
One NovaSure Endometrial Ablation RF Controller with
cavity assessment Model 09;
One NovaSure Endometrial Ablation Footswitch;
One NovaSure Endometrial Ablation AC Power Cord.
(Please note that the NovaSure CO2 canisters used in
conjunction with the operation of this machine are not
available for sale. The sterile single-patient use NovaSure
Disposable Device is not for sale either. These must be
purchased from the manufacturer).
HYSTEROSCOPY EQUIPMENT:
One ACMI Micro digital IP4.2 Single-Chip Image
Processing Video Endoscopy Camera System. Includes
camera and adaptor.
Being Mortal
520.544.9890
casahospice.com
26
Benefits Include
Alerts for finalized
patient reports
Customizable notifications
Alert preferences
User friendly interface
Compatible with
iPhone and iPads
(Android app coming soon)
Free download from
the iOS App Store
For more information, contact RadVision Technology Services at (520) 901-6747 or radvision@radltd.com.
A TUCSON TRADITION FOR MORE THAN 80 YEARS
27
28
(602) 956-5276
(800) 352-0402
www.mica-insurance.com